Competency Measurement in Mindfulness
Mindfulness has grown in popularity as both a practice and an intervention. Research assessing the impact of mindfulness practice has also surged in more recent years, with benefits ranging from reduced rumination (Chambers, et al., 2008) to stress reduction (Hoffman et al., 2010) to less emotional reactivity (Ortner, et al., 2007) and more cognitive flexibility (Cahn & Polich, 2006; Davidson et al., 2003; Siegel, 2007). It has also been shown to support therapists by improving empathy (Aiken, 2006), compassion (Kingsbury, 2009), and counseling skill (Newsome, et al., 2006; Schure, et al., 2008). Scores of other benefits are found in the research literature (for a review, see Goldberg, et al, 2018 for a review).
Despite this growth, little research has been conducted on competencies for those who implement or use mindfulness as a therapeutic approach. However, underlying philosophy and stages of competence have been defined (see Dreyfus and Dreyfus 1986), and a call to competency in delivering this practice has been made: “In this rapidly developing context, there is a growing demand for teachers and trainers of teachers. Understandably, concerns are being expressed from within the field that practitioners may be tempted to respond to this demand without engaging in personal preparation and developing the competencies required for these endeavors (e.g., Crane et al., 2012).” One study evaluating 16 mindfulness competencies has also been conducted (Stauffer & Pehrsson, 2012), and competencies in teaching mindfulness-based courses have been explored (Crane, et al., 2011). Recent efforts to provide competency guidelines for clinical social workers have underscored the importance of focusing on the competent delivery of mindfulness training and practice (Paulson, 2018).
It is important to recognize that several of the CBS-oriented therapies use mindfulness practices as a part of their interventions and has been included in information concerning intervention-specific competencies. For instance, acceptance and commitment therapy acknowledges mindfulness practices in two of its core process competencies: 1) Present Moment: The therapist uses exercises to expand the client’s sense of experience as an ongoing process (e.g., mindfulness exercises), and 2) Self-as-context: The therapist helps the client make a distinction between self as context and content by employing mindfulness exercises (e.g., leaves on a stream, soldiers on parade, observer exercise) metaphors (e.g., chessboard) and behavioral tasks (e.g., take your mind for a walk). Consideration in mindfulness competencies is relevant to the CBS-oriented therapies using this practice.
Products/Assessments/Work Products
Adaptation of Dreyfus and Dreyfus stages of competence (see Dreyfus and Dreyfus 1986 or Crane et al., 2011) for mindfulness-based teaching competence:
Summary of Competence and the Underlying Philosophy of Mindfulness-Based Approaches
List of Competencies to train clients in mindfulness methods
1. Regular daily practice
2. Educational resources on mindfulness
3. Therapeutic alliance
4. Meta-cognitive awareness
5. Empathy
6. Facing rather than avoiding difficult experiences
7. Attention regulation
8. Acceptance and non-judgement
Stage Competence descriptors:
1. Incompetent Teaching:
Is inappropriate, likely to compromise the safety of participants, and to lead to negative therapeutic consequences. The trainee has not grasped the fundamentals of mindfulness-based teaching practice and does not recognize basic principles and rules. There is nonadherence to the program form.
2. Beginner Trainees:
Operate in a state of rule learning and rule governedness. Preparation for teaching is likely to be dominated by memorizing scripted responses to participants and bringing to mind a list of ‘teaching points’ to bring to class dialogues. Although aspects of competence are demonstrated at this stage, there are numerous substantive problems and an overall lack of consistency. Experience is needed to progress through this stage—underlining the importance of training programs offering considerable time to practice skills with fellow trainees and receive feedback.
3. Advanced beginner:
Having had opportunities to practice newly acquired skills in mindfulness-based teaching, trainees are able to more easily recall the ‘rules’ that need applying (i.e. the different steps within the sitting practice guidance, ways of opening up class dialogue following a practice) and are increasingly able to apply these in a more sophisticated way. The teaching process is still deliberative, and significant inconsistencies require further development, but competencies are clearly demonstrated. Participants’ emotional and physical safety is adequately taken care of, and at a very basic level, the teacher is ‘fit for practice’—at this stage, the participants would not be harmed and are likely to have opportunities for learning.
4. Competent:
Focusing on context-free rules in the previous stages drains attentional resources and, through increasing familiarity with the teaching process becomes far less necessary. Trainees at this stage move away from a predominant focus on applied problem solving and the application of learned rules towards an embodied engagement in the moment and a greater degree of fluid responsiveness. Although there are some inconsistencies and problems, the teaching is at a workable level of competence and is clearly ‘fit for practice’.
5. Proficiency:
At this stage, the teacher can intuitively use learned patterns without decomposing them into component features and has increased moment-by-moment responsiveness and flexibility. The teacher operates from direct contact with the arising of experience in self, in individual participants, and in the group.
6. Advanced:
At this stage, the skill that the teacher has in teaching mindfulness is part of him/her as a person. While teaching, they are immersed in the process and no longer use rules, guidelines, or maxims. She/he has a deep tacit understanding of the teaching and is an original, flexible, and fluid teacher. The breadth and depth of knowledge of the teacher at this developmental stage is an inspiration to others. At this stage, the teacher’s skills are consistent despite strong difficulties such as participant hostility or strong emotion. The process is intuitive, and the teacher is unlikely to be able to articulate how he/she is teaching if asked easily.
https://link.springer.com/article/10.1007/s12671-011-0073-2/tables/1
Methodologies for assessing mindfulness teaching skills associated with competence: Teaching portfolios
1. Reflective assignments
2. Academic assignments
3. Self-assessment
4. Peer assessment
5. Review of teaching by an expert panel
6. Use of rating scales: two scales: The MBCT Adherence scale
7. Mindfulness-based Relapse Prevention Adherence and Competence Scale
https://link.springer.com/article/10.1007/s12671-011-0073-2/tables/2
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| Table 1: General Guidelines of Developing Competency with Mindfulness-Based Interventions |
|---|
| 1. Baseline general clinical competency |
| 2. Functional understanding of mindfulness |
| 3. Training in the delivery of mindfulness skills |
| 4. On-going supervision and education related to mindfulness |
| 5. Sensitivity to diversity issues and client preference |
| 6. The clinician maintaining their own personal mindfulness practice |
Paulson, J. (2018). Developing competence with mindfulness-based interventions: Guidelines for clinical social workers. Journal of Sociology and Social Work, 6(1), 1-6:
References
Aiken, G. A. (2006). The potential effect of mindfulness meditation on the cultivation of empathy in psychotherapy: A qualitative inquiry (Doctoral dissertation, Saybrook University).
Britton, W. B. (2016). Scientific literacy as a foundational competency for teachers of mindfulness-based interventions. Resources for teaching mindfulness: An international handbook, 93-119.
Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging studies. Psychol Bull. 2006;132:180–211
Chambers, R., Lo, B. C. Y., & Allen, N. B. (2008). The impact of intensive mindfulness training on attentional control, cognitive style, and affect. Cognitive therapy and research, 32, 303-322.
Crane, R. S., Kuyken, W., Williams, J. M. G., Hastings, R. P., Cooper, L., & Fennell, M. J. (2012). Competence in teaching mindfulness-based courses: concepts, development and assessment. Mindfulness, 3, 76-84.
Crane, R. S., Soulsby, J. G., Kuyken, W., Williams, J. M. G., & Eames, C. (2011). The Bangor, Exeter &Oxford mindfulness-based interventions: teaching assessment criteria. Unpublished manuscript.
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., ... & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine, 65(4), 564-570.
Dreyfus HL, Dreyfus SE. Mind over machine: the power of human intuition and experience in the age of computers. New York: Free Press; 1986.
Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical psychology review, 59, 52-60.
Kingsbury, E. (2009). The relationship between empathy and mindfulness: Understanding the role of self-compassion. ProQuest Information & Learning.
Masuda, A. (Ed.). (2014). Mindfulness and acceptance in multicultural competency: A contextual approach to sociocultural diversity in theory and practice. New Harbinger Publications.
Newsome, S., Christopher, J. C., Dahlen, P., & Christopher, S. (2006). Teaching counselors self-care through mindfulness practices. Teachers College Record, 108(9), 1881-1900.
Ortner, C. N., Kilner, S. J., & Zelazo, P. D. (2007). Mindfulness meditation and reduced emotional interference on a cognitive task. Motivation and emotion, 31, 271-283.
Paulson, J. (2018). Developing competence with mindfulness-based interventions: Guidelines for clinical social workers. Journal of Sociology and Social Work, 6(1), 1-6.
Schure, M. B., Christopher, J., & Christopher, S. (2008). Mind–body medicine and the art of selfâcare: teaching mindfulness to counseling students through yoga, meditation, and qigong. Journal of Counseling & Development, 86(1), 47-56.
Siegel, D. J. (2007). Mindfulness training and neural integration: Differentiation of distinct streams of awareness and the cultivation of well-being. Social cognitive and affective neuroscience, 2(4), 259-263.
Stauffer, M., & Pehrsson, D. E. (2012). Mindfulness competencies for counselors and psychotherapists. Journal of Mental Health Counseling, 34(3), 227-239.