Seguimiento de la implementación de las recomendaciones formuladas en la Segunda Ronda

The mindfulness intervention used in this study was primarily a hybrid of the MBSR and MBCT programmes, as per my training by the Centre for Mindfulness Research and Practice at Bangor University (2009), with some additional elements of Insight Dialogue (Kramer,-2007), and contextualized for trainee psychological therapists.

The programme was run twice in the same way, though there were two alternative delivery formats to maximize participant take-up: i) 8-weekly evening sessions of 2.5 hours and a one day silent retreat between sessions 6 and 7; ii) 4 bi-weekly afternoon sessions of 4.5 hours and a one day silent retreat between sessions 3 and 4.

Each session was typically comprised of experiential exercises, meditation practices, practice inquiry, group discussions, didactic sessions, poetry and stories and homework reviews. A Course Overview and examples of Session Agendas is included in Appendix 6. Participants were also given course a course manual and set of practice meditation CD’s (further details in Appendix 6).

Reflection on choosing the training intervention

One of the key choice points I needed to reflect carefully on in this research was which mindfulness intervention to use for the training. I considered a continuum of possibilities from adhering to the hybrid MBSR / MBCT programme I learned to teach at Bangor’s centre for Mindfulness Research and Practice to developing or using a mindfulness training programme specifically targeted at therapists. The advantage of sticking with the existing MBSR/MBCT programme was that it is considered the ‘gold- standard’ mindfulness training course and I had been trained as a teacher in this.

The other possibility of developing a mindfulness training specifically for therapists did not fit given my belief that even a therapist needs to ‘get’ mindfulness at a personal level before extending this to a professional context.

Mindfulness teachers (e.g. my teachers at the Centre for Mindfulness and Research and Practice at Bangor University and my mindfulness training supervisor) who train therapists and others who work in a one to one context generally advocate the necessity of participants ‘getting’ mindfulness for themselves on a personal level before explicitly extending to their clients. ‘Getting’ it is about participants embodying mindfulness at a felt-sense level rather than at a cognitive level. Embodying mindfulness requires participants to engage in regular mindfulness practice, formal and informal, ideally with a daily practice. As Jon Kabat-Zinn reminds us mindfulness “is not simply a method that one encounters for a brief time at a professional seminar and then passes on for others to use…It is a way of being that takes ongoing effort to develop and refine” (2003). Participants in the pilot study I undertook confirmed this need to embody mindfulness at a personal level before using with clients. The literature (e.g. Germer, 2005) also emphasizes this, particularly in respect to the concept of modeling (Bandura, 1977), where it is assumed that much of what the mindful therapist brings to the therapeutic relationship arises at the implicit level, where the therapist models skills and attitudes such as ‘being with’ vs. ‘doing to’ or acceptance (cf Germer’s first level of a mindfulness presence, 2005 p.18). Once this individual embodied level of mindfulness is established, the literature suggests that the therapist may start to use mindfulness at a more explicit level e.g. Germer’s second and third levels: as a ‘mindfulness informed therapist or in ‘mindfulness based psychotherapy’ (2005, p.19).

Embarking on the research process I was unable to find any therapist specific adaptations of mindfulness training; the Aggs & Bambling (2010) ‘Mindful Therapy’ Training programme was published following my own training interventions. Thus I chose to stick with the MBSR/MBCT programme. The next level of reflection was then to consider whether or not to adapt this at all for therapists. To support my thinking around this I undertook a pilot training (detailed in Appendix 9) which suggested that the training needed no adaptation. Rather than adapt the course what emerged was the possibility of ‘contextualising’ it for psychological therapists.

There were three levels to this ‘contextualisation’: firstly there was more subtle level around holding a certain intention and awareness around the training for myself and the participants. In the first session we would discuss lightly holding an awareness

and intention of the mindfulness for our clinical work but really to focus on this at the personal level to start with. Secondly, I would at times in the inquiry process make links to therapeutic practice and allow this to emerge in discussion, like a thread running through sometimes inquiring how something might impact our clinical experience, e.g. after the ‘Raisin Practice’ (where we spend 10 minutes being aware of our experience of a single raisin) I asked “What would it be like to be this present to your clients?” Thirdly, I explicitly wanted to introduce relational mindfulness into the training as mindfulness is sometimes criticised as being over introspective and not sufficiently relational. My own experience of relational mindfulness was that this provided another layer to my mindfulness experience which was directly relevant to being in relationship in the therapeutic encounter. I chose to slowly introduce some relational mindfulness exercises in the second half of the training, including some specific ‘Insight Dialogue’ practices (Kramer, 2007).

Though I have reviewed why I chose to contextualize the training it is also important to recognise the implications of not adapting this (as for example Aggs & Bambling, 2010): it may be that a training specifically customised for therapists (though based on first attaining a strong individual mindfulness foundation) may benefit some participants more. Such an approach might make more explicit, and earlier-on, the parallels between the individual and professional use of mindfulness, perhaps being more useful to some participants who might prefer a more direct approach. As three of the four drop-outs left after session one perhaps an explanation might be that they were unable to see how this initial focus on the personal might bridge their personal aspirations for this training.

Throughout this decision-making process I was supported though both research and clinical mindfulness supervision.