25

Training Professionals in Mindfulness: The H.eafi of Teaching

SusanLcsley'Woods
"T'Ire in ,rtostprc,ctlcttltlting ue can acLtieue an1 kind of tuork is insisbt 'fhe nore fartiliar u'e ittside of us as tueda it. itrto url.ratis l.rappenirrg ilre uith our lnner terrain, the tilore sureforttedour teacLting- ctnd lit,ing - becoutes." PitrkerPdmer There is cttrrently sttbstlntial interest in the use of mindftilnessbased approachesin clinical prnctice. This raisesa number of interesting questions regarding the training of health professionals.There are a number of treatltent modalities utilizing mindfulness but not as yet collective agreement as to the components and characteristics of mindfrtlness as they relate to the clinical setling. Fttrthermore, some rnindfulnes*based clinical programs employ mindfulness practice as the key to their approach, while others use mindftrlness as a sct of skills. The hean <lf mindfulness, however, is more than lr clinical method or skill set, and becattseof this presents some atypical challenges for prot'essionaltraining. This chapter will outline the ways in wl-rich some mindfttlnessbasecl trainings are distinctive trom other profer sional training Progrnms. Health care professionalsare used to being instructed in particttlar theories and techniques and then gaining direct experience from the application of those techniques in clinical practice. And, indeed, some aspectsof mindtulness can be taught through otr ttsttalways of communicating knowledge via the transmission of concepts and through intellect. But there is a large part of mindfulness that can only be truly discoverecl and commtlnicated when the clinician/instructor embodies this approach wholeheartedly. I3y this, we mean going beyond method to connect to heart, "meaning heart in its ancient sense,as the place where intellect ancl emotion and spirit will converge in the human self" (Palmer & Parker, 1998). This places a different emphasis on clinical learning becattse it means delivering mindfttlness from a position that resonateswith an authenticity about what the practice lrrings to the life of the clinician. Unlbrttrnately,it is beyond the scope of this chapter to comment on every clinical program that incorporates aspectsof mindfirlnessbasedpractices. So, the focus will be on jttst two, mindfttlness based stress reduction (MBSI{) (.Kabat-Zinn, l99O) and mindtidness-based 2OO2>.Ilecause these cognitive therapy (MBCT) (Segal,Williams, & Teasdale, rwo programs emphasizethe practice of formal and informal mindftdness,it allows us to discusselements of mindfulness as they are taught in the NIBSR

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and Mllcr prollrarns and horv these are emboclied by the teacher.'fhror.rgh emboclir.nent, the teacher rnodels a way of conmunicating a sense of trnity ancl integration about the experience of mindfulness and her/his relationships in the world; one that of'fersan genuine presence. From this position, we can adclress key questions about training. Mllslt is the f<rtrndationalprogram upon which many other clinical approaches have been bascd. MBSII and Mllcr are fiurdamentally the same but are clill'erentin the clinical groups they are intended fbr ancl the rvay in rvhich le:rrning is targetd. These two programs, clelivered in a group fornlat, provicle a rigorotts training in formal daily mindfulness meclitation :rncl how to integrate its practice into daily living. NIBSR works with patients who present rvith a broad range of medical, psych<llogicalancl stressrelateclcliagnoses.NIBCT targetsa specilic clinical popr.rlation,those who are vulnerable to a relapseof depression and adds an additional component, elements of a traditional psychological treatment, cognitive behavior therapy.

The Heart of the Matter

Mindfulness originates liom the Buctdhist contenplarive traclition. It has been described as an, "awarenessthat emerlaesthrough paying attention ()l1 purpose, in the present moment, and nonjuclgmentally to the unfolcling of experience moment by moment." (Kabat-Zinn, 'ZOO3; Baer, 2003). Dimidjian and Linehan have positecl that key components of min<lfirlness can be categorized into "(l) observing, noticing, bringing awareness;(2) describing, labeling, noring; ancl (3) participating." 'I'hey also identi-ff three characteristicsembedded in the way one engageswith these activities, ,,(l) nonjudgmentally, with acceptance, allowing; (2) in the present momenr, with beginner's mind; and (3) etTectively"(Dimicljian & Linehan, 2oo3). This constructive description of what constituent components and characteristics might be ernbedded in rninclftrlnessis helpfirl in bringing some clarity to the fhctors we are practicing with and engaging in when teaching minclfulness. The practice of mindlirlness oflbrs a means to directly observe the natlrre of thoughts, emotions, and physical sensationsar:clthe ways in which they either contribute to happiness, or to sr-rll'ering. Attention is directed to thc examination of all expericnce as it arises in tl-represent nroment. It is rlot a passive process but rather a kindhearted and intentional engagement of wakefirlness. w.ith sustained practice, it is possible to see the many ways we gct hijacked by wishing things to be clillbrent from what is actually present. r\s a result of continuing cfTcrrt, enefgy and patience, this "awareness" presents the possibility of less rcliance on self'-absorbed thinking, cm(). tions and behaviorsand wider cht-rices especiallywhen presented with stressful sitr.rations difhculties. or I.Intil recently, in the west, little emphasishas been placed on the stuclyof the human mincl in trnderstancling role of positive mental statesanclemothe tions. Instead psychology has paid attention to ncgative moocl ancl thought clisorders and to the development of a range of psychological interventions that are designed to work with unhelpful modes of mind. l)irecting

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'Iraining Professionals in Mindfulness

46S

..lttentiontgwards investig:ttingthose mental statesthat etrgendcr happiuess' compitssion,ioy, gencfosity,alld eqtlanimity has been largcly loving-kinclness, sttch leglectecl. Also ignored, tllltil fecently, have becn methoclsof teaching and cotllpassion in the establishment and tnind states as kindness 1r.r.riti.,r. to clevelopmentof the therapeutic relationship. Iustcad the fbctrs has tended neutralify infbrmed by t plrticular theoreticxl rety on a senseof constructive technique or a blencl of variotts nlethods as a rvay to wofk through rnaterial presented in therapy (Freedberg, 2OO7). In both western psychology xnd llLlddhist contemplative traditiotr, emopeople tions and mental constrtlcts ltfe seen as strong inlltlences in how teach that some qualitics of think an<Ibehave. Severalschools of Budclhism end mind are more helpful than others tbr creating long lasting happiness hatred, holding onto a sense of transformation (G<ileman,2003). Craving, ,,I,,,,,me,"or ,'mine" Are SeenaSh:rrmful statesof mind, whereaSexpending mindef'fort on strengthening ancl cleveloping attenti<ln,concentration, and blsed on an understanding of contnlness leld to equanimify ancl rvisclom Ricard' & <litions leading to happiness ancl unhappiness (Ekman, Davidson, Lama was asked what might contribute to wallace, 2OOr. When the f)alai like healthy statesof mincl, he respondecl,"ctlltivating positive mental states'lnd leads to better psychological health kinclnessand compassion detinitety happiness." (Dalai Lama & Cutler, 1998)' iitt o.tgtt compassion is a central theme in psychotherapy it is not clea4y of clelined or unclerstood and yet it is considered to be a core compouent (Glaser, 2oo5). Compassion is most genmoving toward health ancl healing or erally understood as a sense of sympathy and concern tbr the suffering with an ability to resonate with that sorfow' [t prisfortune of another along with is not to be confuseclwith f'eeling sorry for someone, which carries Instead, a pre-cltrsor tbr the establishment of comit a senseof superiority. passion is empathy, the appreci:ltion for the feeling experience of another difficulancl the understancling that as human beings we will all encounter Kinclness ancl compassion when extended toward ties from time to time. judgments 6neself ancl clirected otttwards toward others, tend to relax the ancl of others ancl is characterizerJ by a deep state of we have of ortrselves caring. It Caring ancl compassion play imPortant roles in ottr work as clinicians' that takin| care of oncself, as well as caring for clicnts, is sted has bei:n sugge particularly relevant in carrying otrt effective therapy (Gilbert, 2006). Evithat when health care professionals are dissatislied with .1..r.. sug,gests ue experienci-ogpsychological clistress,patient care stffers their jobs and (shanafelt, Ilraclley,wipf, & Illack, 2oo2). working as a health prof'essional consis" brings its own unique stfessors,particulady lor those whose work them working with clinical poplllations with high levels of tently involves program for suff'ering.when shapiro et al., facilitated an eight week NIBSR the results inclicated a recluction in perceived stress' therapists in training, positive In aclilition, participants in this stuclydemonstrated higher levels of (shapiro, Brown, & Biegel, 2o(\7). These prclimiaffect ancl sclt:compassion a nary results appe r to offer health prof'essionals way to develop a healthier effects of stressorsin their own lives and when working with responseto the clients.

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Elements of teaching in MBSR/MBCT

A. Emtrodied Awareness Eurly on in the MIISR and MIXIT programs an exploration of body scnsatiolls is highlightecl. This is not usual territory in psychological treatment. The body as a cotttaiuer and resource of information and wisdom is ofien ncglected. In the MllsR and llllcr programs, the intuitive intelligence of the body is re-discovered,emphasized and supportecl not only through what is lleing encottntered in meditation practice but ulso through the mindfirl movernellt aspectsof thc progmms. Too often the body is only noticed when physical pain or discomfbrt is present. simple mindfirl movements can remind us that we cAn movc for the joy of being in motion tbr its own sakeand can help grottnd tts in ottr boclies.Incorpontting specilic attention and awarenessto movement as a vehicle of knowleclge provides a reservoir of inftrrmation. 'rhis can alert trs to somatic connections before we are made aware of them cognitively which in turn can idcntiff proactive ways of taking care of ourselves. Those who wish to teach the NIBSIT VIBCTprograms will neeclto and have a personal systernof minclful fllovement like yoga, tai chi, qigong. Vhen the teachcr of llBSIt and MIICT conrmtrnicates a stance of openhearted awareness towards all that is bcing encountered in the moment throtrgh the practice of mindftilness, including body sensations,a different relationship to pirin ancl suf'fering emerges. In reinforcing the relevance of e;tch ntoment rxther tl'ran seeking to change or clispute what is arising ()r trying to make sense of the past or predict the firture, a diffbrent tianre of ref'erenceis highlighted. In traditional psychokrgical approaches, interventions typically assume that something is amiss which neeclsto be tixed <lr adiusted. il{indftrlness posits tl-re opposite that by being curious about all inner sensorialexperiences, (body, emotions, cognitions) an uncovering of intrinsic health occurs, and in this insight lies the recognition of being a part of a greater whole (Kabat-Zinn, 1996). This has important implications lbr those mental health illnessesthat present with excessiveattachment to egocentric thinking.

Awareness in Dialogue Mindfulness staysfirmly in the present moment. Its fbcus is on what is here right now; what is present. 'fhis stance has a clifl'erent center from many psych<llogicalmethods, where exarninatiorl of past history as it relates to cttrrent clifficulties is a critical fbcus. A central and important theme in the MBSRand MITCTprograms is albwing awareness and attention to be directed towarcl the inner explnration of the unfblcling nattrre of physical, emotional ancl cognitive sensationsin the prescnt, and rlso the outward articulation of that process.This requires a slrecial kind of responsiveness the part of the on teacher. -fhe wc-rrd"inquiry," often used to describe this process, calt sometimcs convey a sense of looking fbr something in partictrlar, and has its derivatiolt in the Lxtin, "quaerere" and "in<1uirere" seek (Concise Oxfbrd Dicto tionary, 2004. Eleventh Edition). This suggestionthat there is sontething tcl

Chapter ?5 Tr aining Profbssionals in Mindfu lness fincl can create a fllorc narrowly fbcusecl tialnework ftlr what is unfolcling, in tl-reNIIISRancl NTBCT !4r0ups.tjsing the word "dialogtle" to describe the allows fbr a more spaciousframe glfblcling mcaning of the process of inqr"riry discovery and "exploration of a sttlr' of reference rvhich supports a sense<>f ject" (concise oxforcl Dictionary, 20o4. Eleventh Edition.) rather than lookir-rgfbr answers. To some extent the instrLtction and delivery of the mindftllness pmctices in ilIBSRalld MBCT can be learncd tl-rroughmocleling and rcpetition tlntil the basic langttageof instruction is committecl to rnemory. Bttt the teacher who operates solely from a position of rote learning and intellect will find it clifficult to facilitate the discussion and explorition of mindftrlnesspfactice' The teachef who relies which comprises a signilicant portiotl of the classes. primarily on technique will be challengeclto learn tq sit with lnd be with the comments, qtlestions and experiencesarising from minclfulnesspractice. To responcl fiom a mind solely orientated toward the concepts of patient' the 4iagnosis,illness,or diseaseis to leaveottt what mindfulnesslTas potential to ofl'er. Insteacl the MBSR/MBCT teacher encotlfrlges the group pafticipants to lvhere meaning is uncovered moment encounter a place of "not-knowilg." ttle ssenceof what is being by moment without moving to "lix" or sl-rape experienced. The teacher ofTersand invites open-ended convefsations that can reveal the unfolding natllre of what is present in the ro1;m rather than a quest for answers, closttre, of even requiring anything to be found. The conversltions open ttp into the possibility of rediscovering and betriending empirical connections to meaning. This reqtrires from the teacher a gentle an ancl compassionateattentivenessand steircliness, tlnderstanding born Of herlhis own encotlntering of what comes tlp in personal practice. Otherwise there is a tendency to rationalize this observed learning. This is where the instnrctor's personal practice becomes central to working with the material presented by the participants. It is where Segalet al. noticed, when observ(Appndix B) "the ing the MBSRinstructors at the center fbr Nlinclftrlness remarkable way they were able to embody a different relationship to the most intense clistressand emotion in their patients. And we had seen the MBSR instructors going further in their work with negative atl'ect than we hacl been able to do in the group context, by staying within otlr therapist roles."(Segalet ^1.,'2OO2).

167

Experiential

Engagement

Iloth MBSRanclMBCT emphasizethat the instrllctor teach fron1 an experienwith mindfirlness rather than through a cognitive process' tial engag;ement reasons fbr this are clescfibed by the developers of IIBCT when they The articulate their Own learning pfocess in Segalet al. (2002). Their initial view was that mindtllnesybase<Jinterventiol1scould be taLlghtin vrry mtlch the same way as any other therapy, tlrrough leaming about the rationale for the techniqqes and then applving them. Howevel as they continued to obserye the MBSITteaclters at tl-IeCenter fbr Mindfirlness, they came to appreciate tlre qualitative difference it made to the teaching when the instrtrctof spoke

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Woods

tiom a place of personal experiencwith the practice of mindtulness.As they noted, 'A vit:rl part <;fwhat the MIISRinstructor conveyed was l-ris her own or embodiment of mindtulness in interactions with the class.. .Participants in the MIISR program learn about nrindfulness in two ways: throulah their own practicc, and when the instructor him- or herself is able to embody it in the rvay isstresare dealt rvith in thc class."(Segalet il.,2OO2). TI-retransformationalpntential of mindfulness practice can only be available to participants and teachers alike if one is living with the practice by actively ernploying the attitudinal f<runclations within the fibric of one 's own lif'e. It is this quality that is rcferred to in the ref'erencemanual of the Center for Mindfirlness. "In order fbr a clrss or for the program as a whole to have any meaning or vitaliry the person who is delivering it must make every efTortto embody the practice in his or her own life and teach out of personal experience and his or her own wisdom, not iust in a cookbook fashion out of theory and out of the thinking mind. ()therwise, the instruction becomes a mechanical didactic exercise at best and the tnre virtues of the mindfirlness approach will be lost. W'e never ask anything of our patients that we are not asking of ourselvesto a g,reater degree, moment to moment and day by day." (Kabat-Zinn & Santorelli, 1996). In teaching NIIISR and MIICT the teacher is embracing a specific wtty of being with and engaging in experience, by paying deliberate attention to it with an:rttitude of kindly interest. There is nothingi fbreign about awafeness and paying attention for it is an innate human ability, but mindtulness illuminates and reinforces this factrlty in a clearly delined 'rntl organized manner. This is because there are specific aspectswithin the attending - that of non-striving, compassionatelistening, deepening self'-inquiry and self-acceptance - which require an ongoing ancl sustainecl focus. The intention is that nothing is pushed away,chased after or tuned out. Eventually,more diflicult mind statessuch as anger,hatred, hopelessnessand helplessness can be seen for what they are - the proliferation of uttconstnrctive qualities of mind created by contact with an unpleasant moment. Often it is our reactionsto difficult and stresslirlsituations,or from wanting to hold ollto and lind ways to replicate pleasurableexperiences,'which lead to much "thinking," problem solving and "doing." Sometimesthis method of processing the emotional, cognitive and feeling material born out of experience works well. But at tinres it can lead to an impasse.Then it is as though thinking takes over and we become engaged in creating a potent narrative about what we ire going to do, what we cotrld have done and what we should have been able to do. The tuIIISR/MBCT teacher will encounter this type of thinking many times from the group participants as they struggle to make senseof their relationship to difficulties, disappointments and pain. It is here, at this intersection that minclfrdness (ancl the teacher's manner of embodying this) offers the possibility to step out of all this .cloing" mode, and into "being" mode, by moving toward all sensationsiust as they are in this moment. It is an insightfirl process of attending to and allowing for what is here. In acknowledging what is present, observation of the sensationscan include a narrow focus of attention or a broacler frame of awareness. This is not easy and reguires con' centration and effort that kindly notices when the xttention has moved arvay fiom tlre present molnent. It involves a gentle mindftrl intention to rettlrn

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'trclningProfessionals in iltindftllness

t+69

back to a conmitment to be present f'or cach moment along with patience lrnd a quality of triendliness and openncss. This requires pfactice ovef time $ecause it needs remembering and reinfofcement. It is diflicttlt to see how this process can be revealecland acknowledgcd by the teacher in auy other fbrm than fiom a deep sense of having encountered these moments many timcs in One'sown Pr.lctice. It is when meeting strlTeringin its entirety and in the present moment directed toward the unwanted, that a quality of awarenessand setf-kindness, is emboclieclby the teacher through the discovery in personal meclitation practice of being able to be rvith herlhis orvn unconstructive and difhcult modes of mind. Over time and with practice, aversivestates(1 neeclto cfeate clistance from negative afTect and to femove and reject difficulty and suffer' ing) are lessened.This is not a passive stance but rather one of receptivity' acknowleclgment and compassionate action. A "willingness to embrac in awareness and nonjtrdgmentally those aspects of oneself that one is most highly {efencled against, are essential qualities for the successthl prlrsuit of this work' (Kabat-Zinn & Santorelli, 1996).lt is only through the instfllctor's own experience with mindftllness practice, that she,/he improves the possibilities of repfesenting these qllalities of acceptance,nonitldgment, kindness, continuing investigation, self-inquiry and compassion in their fullness.

Relevance of Personal Practice

Directing awareness through pefsonal mindillness practice towafd strengtheling such positive mind states as loving-kindness and compassion requires attention, receptivity, plttience, and tftlst, all attributes of a practical engagement with mindftrlness. This takes practice and time. Ily working regularly and clirectly with what afises from her/his expefience of mindfrtlness practice, and cultivating such attitudinal modes of mind as nonjtldgment, patience, beginner's mind, trllst, non-striving, acceptxnce and letting go, th reacher conveys the possibility to MBSRand MBCT participants of developing a clifTerentrelationship to difliculties and stress(Kabat-Zinn, l99O). These part of what the attitudinal lements of mindftllness become vefy nLlch "L teachef embodies in instmction and can also be seen as important featttres of psychotheraPY, Highlighting the efficacy of continuolts personal wofk in this particular way is a somewhat unusual approach in the delivery of clinical training progfams, although there is a similar association in of trndergoing personal therapy when training as a psychodynamic therapist' f'he difl'erence here is that embedded in the practice of mindftllness is the assumption that continuing to practice in this way provides an authentic way of being that adds a richnessfor living in the wodd. tsy sustaining efTort, patience and friendliness to the contents of oLlr own mind/body, particularly those aspects of thinking and f'eeling that we have the most clilhculty with, understanding grows about hearing, receiving and being with all the reactions and responses presented by the MBSRand MBCT group participants. Cr.rriosity and compassion are conveyed by the clinician's abiliry to authentically present the process of rettuning to the present moment. This is the platform the instrttctor can offer to the participants,

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originatin{aas it (loes frorn havitrg met olleself again and again in personal and conrpassion. practice with a senseof nonjndgnent, self-acceptance

Professional Training Progfams in MBSR and MBCT

Combining an emphasis on the clinician's personal mindfitlness practice elongsiclehcrlhis development of knowledge and theory reclttires cirrefttl consideration when designing professional training for MIISR and llllCT teachers. At a basic lcvel, prof'essionaltraining in MBSR and MIICT will devel<lpand advance teaching skills for the pr.rctice of minclfulness.It will tbster tl-re enhancementof group process as it relatesto mindfultress,encotlrage and support interpersonal skills, snch as warmth, acceptance, compassion and respect alongside appropriate professional and personal botlndluries.In the case of ltBCt it will also include the understanding,placement and ir.nplernentation the cognitive behavioral segments embeclded in the of program. Additionally, there is a responsibility to convey intention and meaning to the unfolding natlrre of mindftrlnesspractice and the variotts ways that this can be communicated by the clinician. Training progr.lms will also need to carefully identify the undedying princiltles of mindfulncss practices and their implications for either the general medical population, or for a targeted clinical cliagnosis.We can renrember that the practice of mindfulness is more than a skill set; more than a behavioral intervention anct more than a clinical methocl developed as a way to work with health care issues. Insight into the application of and implications fbr mindfulness grows with the experience of practicing ancl teaching it. So, Iinding ways within each training program to sttpport and reintbrce the instructor's ongoing personal committnent to practice will be as important as the presentation of the intellectual material. This is why at a later stage,after gaining some experience in tacilitating MBSRand MBCT llroups, additional training and supervision can ofl'er incrernental opporttu'rities for gaining deeper perspectives. ln the Uucldhisttradition, the engagernentwith mindftilness is practiced thror.rghlong-term personal practice and under the sttpervision of teachers. silent retreats There are a number of centers worldwide that offer teacher-lecl frrr those wishing to deepen their pmctice by engaging in sustainedpractice fbr specilic lengths of time. MIISII and MBCT teachers need to lind ways of sustainingtheir pers<lnalpractice as well as obt:rining supervision of their teachers.Iloth these processes teaching with experienced minclfulness-based cun take place within supervision, or by having sttpervision separate tiom personal mindlirlness practice being experienced through recognized mindtillness teaching centers or with an experienced mindftthrcss practitioner. .\s mindfirlnesybasedapproaches in clinical settings grows, more seasoned practitioners with both a personal rnindfulnesspractice and the experience of facilitating mindfulness-based interventions will develop. This will provide a useful irnd practical support system ftlr training purposes. This is wlrere l-ravinga method of identifying/certi$ing, those clinician/instnrctors who have undergone a recognized process of training and who can then provicle supcrvision and mentorship rvill be an important contribution to the field.

Chapter

'25

Ttaining

Professionals

in Mindfulness

41'L

Representative Training Routes

Mindfulness-Based Stress Reduction Trainings 'fhere are a number of u'cll est:rblishedtraining programs in the LISA and Europe that stressthe importance of personal mindftdnesspractice in order to tcach MBSR.In fact the relevance of a contintdng mindfirlnesspractice is enrphasizedfiom the fbundatiorr programs to full certification as an instrttctor in MIISR.One of thc best known of thcse centre is the training programs ofTercd by the Center For llinclfirlness (CFM) in Worcester, N'lA (Appendix Ii). In the CFM trainings, the establishment of a daily mindttlness meditation practice and attendanceat silent, teacheded retreatsis a prerequiste for entry to teacher trainings alter the \nitixl 7'd^y residential training retreat. An additional requirement is to have trained in a prof'essionallield itt the level that encompxssesan intellectual knowledge of the scientific !4raduate fbr Personalpsychological development and medical r.urderpinnings NIBSR. is cncortraged,as well as the experience of body ccntered movement sttch as minclful yoga, tai chi, qigottg. 'Ihe CFM offers a 7-day residential training retreat. This program is an intense education in the teaching of MIISR.The retreat provides an opportuniry to explore the practice of mindfulness, the strttcture of the program, how to teach ancl guicle others, as well as examine research supporting the which etficacy of the program. The CFM also ol'fers a practicttm in NIBSR, tl-re CFM where all provides the opportunity to attencl an MIJSRclass at the sessions c-rfthe eight-week progfiml are tatlg,ht by senior instructors. The practicum ofTersa rich experiential learning through being a participant in the group and in observing the instrtlctor teaching. After the group has ended, practicttm participants meet with the teacl'rerfor discussionand instrllction. A fitrther layer of teachr training provided by the CFM is the Teacher Development Intensive, an advanced eight-dayteacher training retreat. This program is a highly interactive and collaborative learning where MBSRteaching skills are clarilied and refined and the strttctural underpinnings of the MIISR program ate examined. There is an in-depth exploration of the intersection between personal rnindfirlnesspractice and the teaching of mindfirl nessitself, along with time devoted to expkrring those moments of challenge rvhen feaching.An important component in this training is recognizing how our modes of mind efl'ect orlr actions and how they inform ouf teaching. supervision and consultation is also provided by the CFM. Ongt-ring Mindfulness-Based Cognitive Therapy Trainings

There are also a diverse and growing ntunber of MBCT training prolarams clrrrently available in the USA irncl Europe but ref'erencingthem all wottld be impracticable. Instead a tbctrs on some generic methods of delivery will Ire reviewed by examining MIICT training in North America and the UK. h-rNorth America, MBCT prof'essionaltraining programs are currently delivcred in one or two-day introduction seminars,a live-daytraining retreat program (Lcvel 1) and an eight-day advanced teaching and study retreat program (Level 2) (Appenclix B). An additional layer of tmining is also provided by supervision and consultation from experienced teachrs.From the onset,

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teaching revolvesrround the intcrsection of didactic material and the experi entiill. In the one and trvo-dayseminars,exposure to some of the mindtirlness ruedit:rtionprxctices that patients wilt be taken through is as much a part of the teaching as discussionof the structure and rationalesfor N{I}CT. Thc live-dayprofessionaltraining program in MBCT (Level l) is an intense cotlrse that introdttces the clinician/instnrctor to the stnrcture and themes of MIICT and also provides periods of time clevotedto personal rrindftlt practice alongsiclethe teaching of didactic instruction material. It offers an opportunity to rvork with the application of mindftrlnessand the placement of the cognitive behavioral elements through a course of instnrctive, experiential, large and small group tcachings. A deliberate tbcus is placed on the intersection of the intellectual grasp of the materials and the experience of the practice of mindfulness.This emphasishighlights the ways in which as clinicians we tend to be more comtbrtable and used to being taught a method. By returning to silence and the practice of mindftrlnessat the end of the day during the first few days of the program, the clinician/instmctor discoverswhat it is to be with thoughts,/emotions,/body sensationsthat arise from what is being taught and experienced. It is not that the power of the intellect is being discouruged,r:lther 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 thxt is taking place on the inside. This is similar to the experience that will be encountered by MBSR and IIBCT group participants. The domain is one of going back and tbrth between experiential awarenessand intellectual thought. As a way to reinforce the efhcacy of ongoing learning there are dif'ferent entry requirements for attendance in the Level I and l"evel 2 trainings. The eight-daylevel 2 training, is intended for those professionalswho have an established personal nrinclftrlnesspractice, are aware of the necessity of personal practice as a platlbrm from which to teach and have attended teacher-led silent meditation retreats. It is for those clinicians who have alreadytaught MBCT groups. Much is learneclfrom the experience of facilitating ilIBCT groups, not only fi<lm the perspective of the practicalities involvecl but also fiom what is being elicited in the instnrctor dr.rringthe teaching. Lcarning to return to the l:rndscapeof mindfulness, rather than be drarvn into the territory of psych<-rlogically based inten'entions is whcre rnuch of the instructional nature of this training is placed. Opening days of silence support the process of mindfulness practice, a reminder to re-enter mindfirl awareness as place to be, and from which to teach. Frorn this place of remembering a focus is held on the intention and intellrity of mindftrlness.based experiential learning alongside the trnclerstanding of the intention and sequencing of the cognitive behavioral elements. Lcarning is lbstered by the use of large and small gror.rps, dyads and teacher supervision as well as the return to silent mindfulness practice at the end of the day throtrgh breakfastthe fbllowing day. In the UK, there are now a number of avenuesfbr training in MBCT at the introductory level as well as the more advanced ancl these are baseclin scveral ccnters around the country. The trainings at The center for Minclfulness I{escarch and Practice at l}angor lJniversity, in wales, are wicle-ranging and similar in ideology to the programs outlined for North America. However, in

Chapter 25 Training Professionals in Mindfulness eddition llangor offers a master's clegreein mindfirlnessbased approaches, which provides two directions for learnitrg; an NIScor an MA. The NIScis lvailable to those who are interested in scientilic research and the LIA ftlllows a more experiential methodology (Appendix B). The llniversity of Oxford in Oxlbrd ofTers a master's of stuclies degrce in llllcT (Appendix l]). It is a part-time program open to mental health pro' fessionalswith psychotherapy experience and is taught over two years. It is structured around ten three-dayteaching blocks and two residential retreats, five days in the Iirst yer and seven days in the second. It includes instrttction in il,lBCT,an understanding of germane clinical and cognitive psychology as well as aspects of Buddhist psychology and philosophy. Placing resiclential mindfulness retreats within an academic curriculum highlights the importance of the clinician's own experiential practice alongsideintellectual learning. Another avenlte of training inch.rclesa one-year certificate or twcyear diploma program. The University of Exeter offers sttch a program (Appendix B). These training progrnms provide trainees with both the abilify to participate in an NIBCT group as well as facilitate a grotlp ttnder sttpervision' Trainees have the opporttmity to learn the theory and research reinforcing NIBCT and be instructed in Buddhist psychology. Once cnrolled in these programs, attenclance a teacher-ledsilent retreatsis cxpected. at

473

Conclusion

and Future Directions

Training in mindfulness-basedapproaches for clinicians is evolving with increzrsedunclerstanding and knowledge of wl'ret mindfirlness actually otfers in a clinical setting. This chapter has tbcused on iust two of the clinical progrin"rs that utilize mindfttlness, MBSR and MIJCT,becattse at their core, they provide a sustained and systematic instruction in mindlirlness nrcditation practice rvhich has important and novel implications for training health is professionals.Ntinclfitlness not a quick lix or a time limited intervention for It the amelioration of pain and sufTering. is an approach that concentrateson the sttrdy of clirect experience and consciotlsnessand is a commitment over tin1eto. rlurture the mind toward the possibility of insight and wisdom. 'Ihere are many questions in the tuture about the role of mindfulness in W'e health care setting,s. are at the beginning of otrr understanding aboltt the mindfulness as a clinical treatment. We are only jttst starting to etlicacy c-rf learn about tvhat aspects of mindfttlness make a difference in clinical settings. W'e do not really know what are the elements of competency for its iltstrLlction. Bringing a scientific lens to understanding th variotls components in mindfulness and how best to convey and instruct those elcments in clinical settings rvill be the strbject of further studies (Ilaer, 2OO3;Baer, '2006). There is empirical evidence Smith, Hopkins, Krietemeyer, & T<rney, that mindfulness practiced over time and regulady,contribtltes to happiness and alleviatessuffering. There is dso preliminary scientilic cvidence that the Iltrddhist practice of meclitation can shape the way the brain processescertain aspects of emotion and thought (Davidson & Harrington, 2OO2;David' Rosenkrxnz,etal., 2OO3). son, Kabat-Zinn, Schrtmacher,

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Strs:rn Lesley Woocls

MIISII and lvlli(lT empkry mindfirlness practice as tlte core ro their prog,rlrnlsintervention. ()ther clinical prol4ralnsfocus on teaching specific components clf mindfirlness as a skill set, a tvily to ucldresssufl'ering alongsiclethe use of rffestern therapies. Further clinical studies are needeclto better sttrdy these rwo ways of applying mincltulness-based interventions. MB(IT constnrcts a platform fbr the delivery of what colanitive behavior therapy tundcrstands be the thought and nrood patterns contributing tr: relapse in to clepressionancl what the rigorous practice of mindfirlness otTersin developing a clifl-erent relationship to those experiences. IIIISR off'ersthe systematic exploration of tl-reelfects of stress as a potent componcnt in our relationship to healing anclhealth and works with generic medical and psychological problems. Both off'er an opportunity for the group participants to enhance expcriential understanding xbout a more universal arena of health and wellbcing, one that is heart centered in its tirllest ser-rse c()nnecting to a deep by core of wisdc.rm; profbtrnd f'ee a ling of being at home regardless of where we rrreirnd wlr:tt is heplrcning. Mindfulness is a way to remember how to rediscover the experience of the moment. Its practice takes trs deeply into tl'reway the mincl/body works. It is only by meeting our minds over and over again in practice that we can hope to convey a senseof insight bathed in compassion and embark on the journey of embcldying what is being asked in teaching. For this reason professionalteaching programs need to encompassboth intellcctual and cxperiential learning in mindfirlness,otherwise whirt the practice has to offer will l<.rse heart centered approach to working with suflbring. its References llacr, R. (2003). llinclfulncsstraining as a clinicll intervention: conceptr.ral A ancl enrpiricafreview.C)linical Ps_ycLtology: Science ancl Practice,10, 125-143. BaeqR., Smith,G. T., Hopkins, Krietemeyer, & Toney,L. (2006). tJsingselfJ., J., report asscssnrent metho(lsto explore facetsof mindfrrlness. ;lssesynent,l.J(l), )ltrcl't. 27-45. Concise OxforclDictionlry (2OO1). Eleventh Edition Dalai Lanra& Ctrtler,H. C. (1998). Tlre art (t hctppiness. New York: Riverherd Books,41. Davicfson, J. & Harringron, (Ecls.) (2002). Visiorls compassion. R. A. of New york. ( )xfcrrdLlniversityPress. l)xvidson.R. J., Kabat-Zinn, Schumacher, Ilosenkrlnz,M., er al. (2003).AlterJ., J., :ttions brainand immuncfunctionprocltrcerl minclfulness in by meditxtion. Psychosotttct c trleclici 6 5. i61- 570. ti ne, Dimicliian, & Linchan, (2003).Definingan agcncla firtureresearch ttle clinS., M. for on ical rpplication of nrintlfirlness plilctice. C'l/rrical Psycl.toktgy: Science and Prdctice, t ()(2).166. [kman, P, Dlviclson, J., Ilicard,M., & Walluce, A. (2005).flurldhisr It. I]. unclpsychologicalperspectives emotions on rurcl wcll-bcing. Currcnt Dir?ctiotts Ps_y,chologin it'ctlScience, 1.1(2). 59-63. I;reetlbcrg, (2007). Ile-exlminingempxthy:A rclational-fenrinist S. point of view SoclctlWo t 2( 3), 2t | - 259. rk, (;ilbcrt, P (20O6). Corrtpctssiort: Corrccptutilizati()ns, researcb cuttl rtse psycl.)otberin ap.1'. Ncw Yolk:Routledge. Glaseq ( 2OO7). call to crtnpasslrtn.York lleach,,V!: Nichol:;-Hayes, A. A Inc. (iolcnran, (2003).l)cstructit'e D. ertotions.New York:I]rlntam

Chapter 2J Training Professionals in Mindfulness (1990). [:ull catttstropl.lelit'itlg. New )'ork: Blntam DotrbledayDell' Klbrrt-Zirrrr.J. Iuterventions in context: Pnst, prescnt in(l Kabat-Zinn,J (2001) I{inclfulncss-bitsccl (tttcl Practice, I0(2), lli' Scicnce fntwe . Olirticat Ps-1'ct.rolog,y: 'llindfulrtcss-ltased Kabrrt-Zirrn, & Santorelli, S. (1996). A teacltittg tnanclakt' J.. (leuter ntctnttctl' Massachttsetts: prrtfesSional lrctittittg resoLt'fce stressredttctirttz for Minclfttlncssin )tcclicine, Helltl'r Clre' :tnd Socicty' 'l'he cotr.ruge to teacLr. San Frlncisco: John wiley & prrlnrer.& lhrker J. (l99ti). (r, I I Sons, cogttitiue tl)erapJt for segtl,2., willilnrs, J., &'fclschle. J. (2002). ,lllnr{uhrcss'b4sed Press' tl t\eu dppfoAch to prerenting relapse. New York: Gttilclford dcpfessior.t: '1. (2002). lJttrnottt ancl selfShanafelt, D., tlracllev,K. A., Wipi J. E., & tllack, A. t. xn intefnxl meclicine residency pfogfam. Annals of Inter' rcpofted pttient clre in icine, /.i6. i58-.i6-' t ttr!,llctl 'l'elching self-clre to caregivers: s. L., tlrown, K. \(, & Iliegel, G. .\,I.(2007). Shapiro, 'fhe rapists StressReclrtctionon the )lental Health of Ei'fectsof .\linrlfrrlness-llased '[raining in Pro.fessiottctlPs-ychoktgv, l(2)' lo5-l15 ancl Etlttccr.tion in rfxining.

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