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Abstract

Mindfulness has been described as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” (Kabat-Zinn, 1994, p. 4). It is a technique where one focuses on the present, gradually letting go of thoughts about the past or the future. Mindfulness is becoming more popular as a technique to help people manage stress. Research suggests, for example, that individuals who have higher levels of mindfulness have increased performance in attention and cognitive flexibility (Moore & Malinowski, 2009); report higher levels of relationship satisfaction (Kozlowski, 2013), and lower levels of perceived stress (Roeser et al., 2013). As a therapeutic technique mindfulness has been shown to be effective through, for example, Mindfulness Based Cognitive Therapy and Mindfulness-Based Stress Reduction (Nevanper, 2012). Aims of Research The argument offered here is that mindfulness is likely to act in the same way as other types of coping i.e. that it is not a ‘silver bullet’ and that it is likely to be a referred strategy used by some and not others. The aim of this research therefore is to compare the impact of mindfulness compared to other types of coping on well-being - operationalised as happiness, selfcompassion and stress.
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Irish Association for Counselling and Psychotherapy
Dear Colleagues,
Welcome to the summer
edition of Eisteach.
At a time of year when our
thoughts turn to holidays, time-
out and relaxation it seems
appropriate to take a look at
some of the supports and coping
strategies that therapists use to
deal with the challenges in their
work.
The connecting frame here is
promoting care for the carers;
developing resilience, awareness
and restorative practices that will
support us in working with all the
complexity of human distress.
In a world that encourages and
supports 24-hour availability
through technology the discipline
and need to switch off is ever
more urgent. How do we model
this with clients? When a culture
of busyness is endemic it can feel
like constantly moving against the
tide.
The practice of mindfulness has
mushroomed over the past couple
of years with a proliferation of
workshops, classes and training
courses now available. What is
the appeal? Dr. Antony Sharkey
offers us a brief history of this
phenomenon which places its
popularity in historical context
and gives us an insight into how
mindfulness has moved from the
margins into the mainstream. Our
second piece on mindfulness is
research-based and attempts to
address the question of efcacy;
does it work?
There is now a considerable
weight of evidence which
suggests that individuals who
have higher levels of mindfulness,
have increased performance in
attention and cognitive ability and
lower levels of perceived stress.
The sample size in the submission
of Hazel Morgan and Chris
Gibbons, was relatively large, at
521, recruited through Facebook
but they caution that sampling
was voluntary and likely to attract
a higher percentage of people
who were already pre-disposed
to mindfulness. They are not
measuring whether respondents
have a formal mindfulness
practice per se but the extent
to which the individual shows
receptive awareness and attention
to the present’. The results are
interesting.
Eoin O’Shea takes a broader
examination of how counsellors
and psychotherapists manage
anxieties and set boundaries
to be effective in the work. All
respondents in this research
were recruited through the IACP
database and the results are
presented here as a thematic
analysis which indicates the
range and depth of strategies
used by members including; the
formal, such as group supervision,
personal therapy and CPD and the
less formal such as; peer support,
walking the dog, yoga, skiing and
dance. The researcher indicates
that further studies employing a
similar methodology but focusing
in on specic self-care strategies
may be useful.
Finally, Ann McDonald takes
us into the arena of group
supervision as an environment
ideal for promoting cultural
competency in the work. Ireland
has moved from being essentially
a monocultural nation to one
that is increasingly diverse in a
relatively short space of time and
this brings a challenge to our own
cultural bias and need for self-
reection.
May you be happy.
May you be wise.
May the summer bring you all you
need and deserve.
Aine Egan MIACP
From the Editor:
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Facilitating Cultural
Competency through
Group Supervision
by Ann McDonald
educative/formative (Proctor,2000)
component of group supervision.
What is Culture?
Culture as a social construct
is complex and multifaceted.
It includes but is not limited to
tenets such as ethnicity, race,
gender, religion, social class and
sexuality (Hardy & Laszloffy, 1995).
Falicov usefully talks about culture
as “those sets of world views
and adaptive behaviours derived
from simultaneous membership
in a variety of contexts…religious
background, nationality and
ethnicity, social class, gender-
related experiences, minority
status, occupation…”(1988, p.
337).
The acronym of the social
GRRAACCEESS: gender, race,
religion, age, ability/disability,
class, culture, ethnicity, education,
sexuality and spirituality (Roper-
Hall, 1993) is an accessible way
to generate reection on different
aspects of culture which ‘become
foreground or background at
different times’ (Burnham & Harris,
2002). Use of the frame of the
social GRRAACCEESS (Burnham
et al, 2008) forms a central tenet
of my own training in facilitating
cultural competency as an ongoing
process (and not just a training
event), that can be plugged into
the formative layers and levels of
group supervision.
Facilitating cultural competency
is more about process than
content (Burnham & Harris,
2002). It requires the fostering
of supervisees’ reexivity i.e. a
folding inward to feel their feelings,
question their questions, think
about their thinking, incorporating
reection, critical thinking, self-
awareness and monitoring for the
purpose of recalibrating their work,
particularly in the therapist-client
system (Burnham, 1993, 2005;
Hoffman, 1992) in relation to
cultural sensitivity and competency
(Hardy & Laszloffy, 1995; Divac
& Heaphy, 2005; McGoldrick et
al, 1986). Such reexive inquiry
and consciousness (Oliver, 2005)
opens the space for supervisees
to connect into and affectively
understand their own ‘ecological
niche’ (Falicov, 1988; 1995)
and cultural identity. Here the
supervisor aims to:
Create through the group
supervisory relationship the
necessary receptivity and
openness for the development
of the supervisees’ cultural
competency in relation to
Introduction
Group supervision is profoundly
more affecting and emotional
than might be expected. On
paper, it can have a atness that
belies its necessity to unsettle.
With its centrality of relationship,
multiple tasks and functions,
and its unremitting insistence on
making the implicit explicit, group
supervision unavoidably perturbs.
In the agreed joint service of the
client, and the unique development
and ourishing of each supervisee,
it makes demands on the
supervisor and supervisees for
reexivity, reection and critical
thinking as vital to the group’s
ongoing learning and change. In
this article, I focus on facilitating
cultural competency as part of the
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themselves, each other and their
clients, building, for example,
what McGoldrick et al (1996) call
a ‘road map’ for understanding
their clients’ ethnicity.
Facilitate supervisees’ reexive
capacities and understanding
of the complexities of their own
cultural self and identities over
time. This includes becoming
aware of themselves culturally
as: located in different aspects
of culture, changing in relation
to aspects of culture over time,
participating simultaneously
in different cultural contexts,
foregrounding different contexts
(e.g. gender, age, race) at
different times (Burnham &
Harris, 2002; Divac & Heaphy,
2005.
Give space to critically explore
the values underpinning their
own cultural scripts which
they bring into the therapy
encounter. This is integral
to a reexive stance and a
systemic orientation which
holds that change in one person
in an emotional system can
bring about change in others
(Watzlawick et al, 1974).
Recognise that all members of
the same ethnic group are not
the same (particularly pertinent
in group supervision).
Increase awareness of social
difference and of practices
of power, oppression,
marginalisation, racism and
injustice ( Divac & Heaphy,
2005; Waldergrave, 1990) in a
way that heightens supervisees’
consciousness of their own
power as therapists (Burnham
et al, 2008). To do this with
congruence, the supervisor
must be upfront about the power
and authority invested in his/
her supervisory role (Bernard
& Goodyear, 1992). For Jones,
pretending otherwise is an
abuse of power (1993).
Help supervisees to keep in
mind that emotions, thoughts,
behaviours, and events can have
different meanings in different
cultures, at different times,
and between different people
in similar cultures (Burnham
& Harris, 2002). Examples
of these differences include:
showing and ‘doing’ emotion,
constructs of gender, family,
the self, ageing, addiction and
rituals of death, dying and
bereavement (Murray-Parkes,
1997).
How does the Supervisor achieve
these aims?
To reexively facilitate contexts in
which social difference might be
considered, the supervisor must
be able to use the group and him/
herself in ways that hold both
rigour and imagination (Bateson,
1972), safety and risk (Mason,
1993). There is an ethical
responsibility on the supervisor to
build up his/her own capacities
and expertise so that s/he can
generate therapists’ reexive
consciousness and understanding
of their cultural identity (Hardy &
Laszloffy, 1995; Inman, 2006).
Down (2000) believes that the
supervisor must go through his/
her own experiential and reexive
trajectory prior to facilitating a
similar process for supervisees.
Without such a commitment to
his/her own continuing process of
cultural reexivity, the supervisor
is blind to the effect of his/her
own cultural values and beliefs on
the supervision process.
The relationship of supervisor
and supervisee/s is core – at
the very heart of supervision
(Holloway, 1995). The supervisor
must take responsibility for his/
her part in creating a strong
working alliance (Page & Wosket,
1994, Crockett, 2002), and a safe
enough place to belong (Wilson,
1993). If the emancipatory
discourse and reexive inquiry
is to emerge, the supervisory
relationship must be able to
mirror, guide and contain it, itself
freeing, developing and capable of
being the object of its own enquiry
(Oliver, 2005).
Processes which facilitate Cultural
Competency
Along with an integrated use of the
lens of the social GRRAACCEESS
(Roper-Hall, 1993), ways that the
supervisor can promote cultural
competence as part of group
supervision include:
The group itself - its stages
and dynamics, conscious and
unconscious processes (Bion,
1961; Tuckman, 1965, Schultz,
1967; Proctor, 2000) - is central
to enhancing cultural literacy in
group supervision (Burnham &
Harris, 2002). Using the here-
and –now immediacy of the group
to explore gender, for example,
can expose the mechanics of
power and privilege, projection
and internalised oppression at a
felt level.
Mason’s (1993, 2002, 2005)
ideas of safe uncertainty,
authoritative doubt and relational
risk taking, and his questions:
‘what are we moving away from?
How can we begin to talk about
that?’ can open the necessary
space for the unsaid and the
unsayable. Hawkins & Shohet
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(2002) suggested statements:
‘What I think we avoid talking
about here is; What I hold back
on saying here is…’ are similarly
useful. In this context, use of
the the metaphor of the fth
province provides an imaginative,
containing and liberating
dialogical space (Kearney et al,
1988; McCarthy & Byrne, 1995;
Young, 2000).
Another useful lens here
is isomorphism as parallel
process i.e. mirroring and
the tendency of patterns to
repeat across systems (Du
Laing 1991). The supervisory
relationship can reect or mirror
relationship dynamics (Searles
1955; Doehrman, 1976;
Mattinson,1981; Morrissey
& Tribe, 2001) and patterns
(Carr,2012):
within the client system
between the client and
therapist
within the organisation
at a social, political, cultural
level
The cultural genogram (Hardy
& Laszloffy, 1995). This allows
supervisees to map and
affectively engage with their
own cultural stories and their
meaning over time. Exploring
themes of belonging, inclusion,
marginalisation, pride and
shame can begin a process of
understanding the history of their
own cultural identity which is key
to cultural competency.
The reecting formats and
reexive practices of systemic
supervision as gateways to
the expansion of reexive
capabilities in the process
of supervisees’ ongoing
development as culturally
competent practitioners
(McDonald, 2010). The use of
diverse, multi-layered activities
such as internalized other
interviewing, reecting teams,
role-play and sculpting allows
space for:
movement, meta-positioning,
multiple descriptions,
punctuations, meanings and
perspectives (Andersen, 1991;
Gorrell-Barnes et al, 2000)
rehearsing, inviting
‘clumsiness’ (Burnham et al,
2008), talking about talking,
experimenting and practicing
to stretch ‘the performance of
practice’ (Wilson, 2007)
the unfolding of internal and
external dialogue, along with
the emergence of the ‘not yet
heard and not yet thought of ’
(Andersen, 1993, p.303)
the expansion and
deconstruction of chronological
time, bridging and extending
present learning into reexive
practices outside of the current
episode of supervision (Burck
& Campbell, 2002)
Stories and story-telling as
a reexive site in the process
of learning to learn cultural
competency can:
cut across the boundaries of
time (Roberts, 1994, 2002).
open up future reexive
learning, not least space for
supervisees to reect on
the stories they carry with
them into the therapy and
supervision contexts (Burnham
et al, 2008). In this way, there
can be a loosening of binding
stories (Kearney, 2002) and a
creating of preferred stories
(White, 2000)
provide more personally linked,
and memorable learning
(Wacker & Silverman, 2003),
connecting the supervisee to
themselves and each other
help supervisees to focus on
lived experiences, particularly,
in relation to developing an
emotional understanding of
their own ecological niche
(Falicov, 1988) and cultural
values (Hardy & Laszloffy,
1995 ; Laszloffy & Hardy,
2000; Divac & Heaphy, 2005)
be put into the centre of Kolb’s
(1984) cycle of experiential
learning with supervisees
using the process to best suit
the way that they learn, and
experiment with new ways of
learning (Burnham et al, 2008)
bridge all learning styles (Kolb,
1984;Agget,2004). It allows
supervisees, for example, to
pick up information visually by
creating images; through their
hearing, and also viscerally,
emotionally, cognitively,
reectively, spiritually (Wacker
& Silverman, 2003)
invite reection in and on
(Schon, 1983,1987) their
own and each other’s stories,
connecting the teller to
themselves and to others
Conclusion
For me, group supervision is
an intentionally collaborative
(Hawes, 1993; Anderson & Swim,
1993) relationship where the
supervisor and supervisees,
in the context of the group
process, co-create a reexive
site of learning, imagination,
possibility and fth province like
spaciousness(McCarthy & Byrne,
1995) to jointly facilitate the
responsible care (FTAI, 2005) and
well-being of the client and the
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unique ongoing development of
each supervisee.
Facilitating cultural competency
so that supervisees can reect
on their own cultural stories is
integral to a reexive, questioning
stance in which the supervisor
and supervisees enagage in
transformative learning and
remain open to change as the
only constant (Hoffman, 1992;
Burnham, 2005). Exploring issues
of power and aspects of the
cultural self including gender, race,
religion, age, education, class,
sexuality calls on supervisees to
ask of themselves and each other:
What does my practice stand for?
With regard to race, Kiberd
(1995) wonders if Ireland came to
function as England’s unconscious,
with the suppressed, unbearable
parts of themselves attributed to
the Irish. As supervisors, we need
to face our own cultural projections
and prejudices in relation to all
aspects of culture, and in so
doing increase our capacity to
facilitate cultural competency.
In a progressively multi-cultural
Irish society, this is an ethical
imperative (Swim et al, 2001).
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Ann McDonald
Ann McDonald is an IACP, FTAI, ICP
registered Supervisor, with a PG Dip.
Clinical Supervision (Psych/TCD) &
MA in Systemic Supervision & Training
(KCC/Bedfordshire University). She
works with the HSE and in private
practice. Contact: anmcd59@gmail.com
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The Mindfulness
Phenomenon:
A Brief History
Introduction
In 1996 when I rst started to
run mindfulness courses for
people who were suffering from
medical problems it was a relatively
unknown psychotherapeutic or
medical intervention. How things
have changed. Today there is a
keen openness to know more
and an eagerness to learn how to
integrate mindfulness practice into
daily lives to support resilience,
awareness and all the qualities we
would consider essential to the
‘good life’. This article attempts a
brief outline of the history of the
phenomenon of mindfulness and
offers a context for its appeal to
the helping professions and the
general public.
This is a story of the vision of
some extraordinary people as well
as a story of the extraordinary
times that we have lived through
over the last twenty years. I offer
this short history from my personal
perspective as a medical doctor
and someone who has had a daily
meditation practice of one - two
hours a day for the last 30 years
and as an active mindfulness
teacher with a keen interest in
the ongoing unfoldment of human
evolution.
Why has mindfulness emerged
from relative obscurity in such a
short time period?
New ideas do not usually get
accepted into mainstream culture
and especially into professional
communities that quickly. Why
has mindfulness become such
a popular social trend when
there are many other useful and
proven approaches to health and
well-being? Today, mainstream
psychiatric and psychology journals
report evidence-based research
from conventional medicine,
healthcare, cognitive science
and affective neuroscience
demonstrating the benets of
mindfulness.
Mindfulness courses are now
offered specically for doctors
in the Irish College of General
Physicians. Mindfulness as
an effective ingredient in the
prevention of relapse in chronic
depression is now fully endorsed
by the National Health Service
in the UK. In January 2014,
‘Time’ magazine featured ‘The
Mindfulness Revolution’ on its front
cover.
Where did mindfulness begin?
The story begins with some cultural
cross-pollination between East and
West in the mid to late-nineteenth
century. Philosophies such as
those contained in ancient Hindu
Vedic texts like the Upanishads
and Bhagavad Gita, and Buddhist
texts came to the attention of
many writers and philosophers in
the West including Ralph Waldo
Emerson and William James in
America, W.B. Yeats and friends
(the Golden Dawn movement) in
by Dr. Antony Sharkey
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Ireland and the Transcendentalists
in the UK and Europe.
These philosophies also came
to the attention of the eminent
psychologist Carl Jung who brought
a more spiritualised perspective
to the work of Freud. In the
sciences, the great physicists of
the early and mid-twentieth century
including Einstein, Schopenhauer,
Schrodinger and Pauli were
as interested in the Eastern
philosophical texts and principles
as they were in physics. They
highlighted the importance of the
inuence of human observation to
scientic endeavour and their ideas
set the theoretical ground work
for evidence-based approaches to
research
What exactly is mindfulness?
With the growing pervasiveness of
the phenomenon, there are many
different interpretations as to what
mindfulness means and what it is
means to practice same. In order
to avoid any confusion, I want to
spell out exactly what mindfulness
is, from my perspective so that at
least we know that we are talking
about the same thing.
Mindfulness is the same as
Meditation. They are two sides of
the same coin.
Meditation is a set of skills you
formally practice and learn on a
meditation seat.
Mindfulness is practicing these
same skills when you are off the
seat and getting on with daily life.
I think of the relationship in terms
of tennis. Professional tennis
players spend hours practicing
with a tennis ball machine. With
the machine the player can focus
on one thing - hitting the ball.
Other potentially distracting factors
have been removed as much as
possible. Practicing meditation is
the same in principle. There is one
thing to focus on - usually attention
is given to some sensation in
the body e.g. the breath. All
potentially distracting factors
have been removed. Similarly
with mindfulness, there is still the
same focus of bringing attention
to a sensation in the body but now
there is ‘daily life’ to contend with.
How to explain the mindfulness
phenomenon?
To more fully understand the
mindfulness phenomenon I’m
going to use sociologist Malcolm
Gladwell’s concept of “The Tipping
Point” (‘The Tipping Point: How Little
Things Can Make a Big Difference’
(2000)) as a background organising
model.
Gladwell denes a “Tipping Point”
as “the moment of critical mass,
the threshold, the boiling point”.
He uses the overarching metaphor
of an “epidemic” as a visualisation
of how social trends spread. He
suggests that ideas and products
and messages and behaviours
spread like viruses do. Gladwell
puts the spread of epidemics down
to the “Three rules of epidemics”
as an explanation for why tipping
points happen.
Rule One: The Law of the Few
“The Law of the Few”, or, as
Gladwell states, “The success
of any kind of social epidemic
is heavily dependent on the
involvement of people with a
particular and rare set of social
gifts.”.
These “Few” create and
perpetuate trends. When an idea
comes to the attention of one or
more of these special classes of
people, the likelihood of the idea
tipping into an epidemic increases.
These people are described in the
following ways:
Connectors
These are the people in a
community who know large
numbers of people and who are in
the habit of making introductions. A
connector is essentially the social
equivalent of a computer network
hub. They usually know people
across an array of social, cultural,
professional, and economic circles.
They are “a handful of people
with a truly extraordinary knack of
making friends and acquaintances”
according to Gladwell.
Mavens
A maven is a trusted expert in a
particular eld who seeks to pass
knowledge on to others. The word
maven is Hebrew, meaning “one
who understands”. These are
“people we rely upon to connect
us with new information”. Mavens
start “word-of-mouth epidemics”
due to their knowledge, social
skills, and ability to communicate.
Salesmen
These are “persuaders”,
charismatic people with powerful
negotiation skills. They tend to
have an indenable trait that goes
beyond what they say, which makes
others want to agree with them.
All of the individuals involved in
the mindfulness phenomenon fall
into one of these three classes of
people.
Rule Two: The Stickiness Factor
The Stickiness Factor is a law
about the actual informational
content and packaging of a
message. The “Few” can certainly
help a message spread, but if the
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opposite of the stress response
and coined his famous term ‘The
Relaxation Response’ in a book
that sold widely and spawned an
interest in the subject. However,
the actual practice that Benson
suggested was not meditation per
se. The ‘Relaxation Response’
happened if you systematically
went through your body and briey
contracted the main muscle
groups. In contrast, in meditation
you do not do attempt to do
anything with your body except to
keep it as non-moving as possible.
Although the technique worked, it
tended to be cumbersome to do
and was unappealing to many.
So despite promising early
clinical ndings, ‘meditation’ in the
form of the Relaxation Response
didn’t stick with the medical or
psychotherapeutic professions at
that time. It wasn’t until the 1980’s
when a number of factors coincided
that it really began to spread.
“The Cultural Creatives”
In the late 1980’s there was a shift
in the cultural climate and a new
group of people became identied
called the ‘Cultural Creatives’.
The term was coined by Paul H.
Ray, a sociologist and Sherry Ruth
Anderson, a psychologist in the
1988 publication ‘The Cultural
Creatives: How 50 Million People
Are Changing the World’.
This social phenomenon
comprised ordinary people from a
variety of cultural backgrounds who
identied themselves as ‘spiritual’
but didn’t align themselves with
any traditional Western religion
and was estimated to include up
to one-fth of the population of
the US at the time. They looked
for answers to their physical and
mental health concerns which
didn’t necessarily include standard
Western medication and surgical
intervention.
In parallel, several meditation
retreat centres were being
established in the States. The
founders were either traditional
Eastern monks or Americans who
had spent some time practicing
in the East and were inspired to
return home and practice. These
Americans were talented teachers,
business people and incisive
writers and they had “sticky”
ideas. Two such writers were Jack
Korneld and Joseph Goldstein.
In 1976 they opened the Insight
Meditation Retreat Centre in
Barre, Massachusetts and it was
here that Jon Kabbat-Zinn was
introduced to meditation.
The Emergence of New Clinical
Approaches
In the 1970’s - 1980’s there
emerged new psychotherapeutic
approaches which promised to
treat psychological suffering
more quickly than traditional
psychoanalysis, especially
the suffering associated with
depression. One such approach
was Cognitive Behaviour Therapy,
pioneered by Aaron T. Beck,
psychiatrist at the University
of Pennsylvania. Beck was one
of the Few. He is described as
one of the “ve most inuential
psychotherapists of all time” by
The American Psychologist in July
1989.
Becks main ‘sticky’ idea about
depression
1. Negative thinking processes are at
the root of depressive illness
Prior to Beck most clinicians
assumed that the negative
thinking associated with
message is not worth spreading,
then it is doomed to failure.
The stickiness factor says that
messages must have certain
characteristics which causes them
to remain active in the recipients’
minds. An idea is “sticky” if it is:
Clear and easy to understand
Concrete and practically
orientated
Credible and evidence-based
Emotionally appealing and
based on a story or narrative
All of the ideas embodied in the
mindfulness phenomenon share at
least one of these characteristics.
Rule Three: Cultural and
environmental context
The population must be prone
to these ideas. This is fairly self-
explanatory yet the elements that
make up a culture and environment
are a little bit more difcult to pin
down. I suggest these three rules
go some way to explaining where
we are today and I will draw on
Gladwell’s theory to contextualise
the growth of the mindfulness
phenomenon.
The Relaxation Response
In 1956, Dr. Hans Selye published
‘The Stress of Life’ and is credited
with coining the term ‘Stress
Response’. He believed that;
‘Stress in health and disease
is medically, sociologically
and philosophically the most
meaningful subject for humanity
that I can think of’ (Szabo,
Tache, Somoygi, 2012)
In the 1970’s, the rst scientic
research on the ‘new’ ancient
meditation phenomenon was
performed by Dr. Herbert Benson at
Harvard University. Benson realised
that meditation produced the
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depression stemmed from
unresolved inter-psychic conict
or unbalanced brain chemistry.
In practice this meant that
clinicians treated the underlying
cause (psychotherapeutically or
pharmacologically) with the hope
that the associated negative
thinking would get better. But
for Beck, negative thinking
was the primary problem to be
addressed. He encouraged his
patients to practice awareness
outside of the therapy sessions,
to “catch” their “automatic
thoughts” and bring them in for
investigation.
Beck initiated the idea
of standardisation or
‘measurement’ (Beck Depression
Inventory, Beck Hopelessness
Scale, Beck Scale for Suicidal
Ideation and the Beck Anxiety
Inventory) of depression so
that the CBT processes and
outcomes could be compared
against the standard existing
treatment of antidepressant
medication. This explicitly
evidence-based approach was
‘sticky’ to the logic and reason of
many psychotherapists and other
clinicians.
Evidence-based work of Jon
Kabbat-Zinn
In 1979 a course called the
‘Stress Reduction and Relaxation
Program’ began in the Department
of Medicine in the University of
Massachusetts run by Jon Kabbat-
Zinn. This course eventually
became known as mindfulness-
Based Stress Reduction or MBSR.
This was an eight week structured
program teaching mindfulness
practice to patients suffering from
the stress of chronic physical
illness.
He ran randomised controlled
trials and reported his results
in various standard medical
journals. He also wrote the book
‘Full Catastrophe Living : Using the
Wisdom of Your Body and Mind
to Face Stress, Pain, and Illness’
(1990) which was a summary
of his course material and the
background philosophy. He
conclusively demonstrated that
mindfulness practice worked to
reduce pain and suffering when
nothing else available was working.
I suggest that the primary reason
Jon Kabbat- Zinn’s course was
sticky’ was that he taught patients
a new approach to deal with their
pain: ‘Being with’ rather than the
suppression or expression cycle.
‘Being with’
Kabbat-Zinn taught the traditional
Buddhist approach to pain
which is called the ‘Being With’
relationship. It is the heart and
core of mindfulness practice. Pain,
or any uncomfortable experience
is allowed to ‘be there’. All that
is required is that its presence
is registered in awareness. No
attempt is made to control or
change anything. Paradoxically,
what happens next when “Being
With” is practiced is that the
pain often changes character and
sometimes disappears.
The ‘Being with’ approach to
pain is a nuanced counterintuitive
approach to pain and can be
easily misunderstood as a passive
resignation. To be effective it
required focused tuition and
required conscious commitment
and a deliberate deployment of
energy. It needed regular and
consistent practice to work.
Kabbat-Zinn was masterful at
communicating the nuances and
the course was intensely practice
oriented. Most of the course was
done at home using supportive
audios and participants were
required to meditate for one
hour every day. This meant that
through their own personal practice
they could nd out directly for
themselves what could happen with
this new approach. It would work
for them or not, and it did indeed
work for many of them. What he
was offering did gain ground among
some in the medical profession,
myself included but I don’t think
that his course was a tipping point.
The epidemic was brewing but it
was still localised.
The Tipping Point
In 1992 one of the most popular
TV networks in the US, PBS
broadcast a documentary series
called ‘Healing and the Mind’ with
Bill Moyers, a high prole and
respected journalist. He was one
of the ‘Few’. The documentary
was an in-depth look at workable
alternatives to traditional medical
treatments which included the
MBSR course. This could have lain
forgotten in the archives but with
the emergence of Google (1998)
and YouTube, the lm was uploaded
and has been viewed over 40
million times since then.
Following this, the tipping point
for the mindfulness phenomenon,
I would suggest, came about
in 2001 when ‘Mindfulness-
Based Cognitive Therapy for
Depression’ 2001, Segal, Williams,
Teasdale was published. The
books appearance unleashed
an avalanche of interest, clinical
practice, and research throughout
the world. The authors were
credible PhD professional
researchers and CBT clinicians.
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In 1992, Segal was funded
to investigate alternatives to
medicating solutions for clinical
depression. He and his colleagues
participated in the MBSR course.
The CBT model was eventually
expanded to integrate the MBSR
approach, which they called
Mindfulness Based Cognitive
Therapy. They conclusively
demonstrated that MBCT was more
effective than CBT alone (Segal,
2001).
Two reasons why the book is
‘Sticky’
1. Their evidence-based research
methodology had a transparency
to it.
This is my own very personal
sense and may not be shared
by everybody. I usually read
‘evidence-based’ material
cautiously. I am aware that
there is often a hidden agenda,
usually to convince me that the
product or approach works and
therefore to buy it. ‘Does MBCT
work?’ is the chapter of the book
outlining research methodology
and ndings. It is conversational
in style and non - obscure. There
seems to be no hidden agenda.
I could wholeheartedly accept,
agree and embrace the evidence
that that they presented. To me
and to other clinicians it was
“sticky”.
2. The ‘Way of Being’ of the
mindfulness teacher is vital
The authors repeatedly observe
that the mindfulness teacher’s
way of being with the course
participants is central to
success. The teachers have to
become a living embodiment
of the practice and share from
this place. This is not a new
observation. Similar qualities are
highlighted by Duncan & Millar
(2004) in ‘The Heroic Client’
and others. However, this book
is an eloquent exposition of the
practice.
Teachers are called
“instructors” and teach by
using enquiry, they do not “x
problems”. They communicate
“Loving Kindness” and
“Compassion” non - verbally.
Participants are known as
guests to be treated with warm
hospitality. In essence, the
course material only “sticks” with
participants if the teachers have
a meditation practice of their own
so that they can authentically
‘Be With’ the participants in the
same way that the participants
have to ‘Be With’ their own pain.
Conclusion
The mindfulness story continues
to unfold and we professionals
nd ourselves in the middle of it,
as people search for solutions
to problems that are as old as
time itself. While mindfulness is
considered a modern phenomenon,
its roots lie in philosophies and
practices that are thousands
of years old. I suggest these
teachings survived this long
because they inspired the human
heart and spirit to take effective
action to move beyond apparent
limitation.
More recently these same
philosophies and practices have
been rigorously researched and
have convincingly proven their
worth in alleviating the pain and
suffering associated with some
of our most intractable of human
problems. To become an active
participant in the unfolding story
is simple; all that is required is
to graciously accept mindfulness
as gift and to diligently practice
so that one can be even better at
“Being With” one’s own and one’s
clients suffering.
References
Duncan, Barry L., Millar, Scott D.
(2004) The Heroic Client: Client-Directed,
Outcome-Informed Therapy, John Wiley
& Sons
Gladwell M. (2000) ‘The Tipping Point:
How Little Things Can Make a Big
Difference’, Little Brown & Company
Kabbat-Zinn, Jon (1990) ‘Full
Catastrophe Living: Using the Wisdom
of Your Body and Mind to Face Stress,
Pain, and Illness’, University of
Massachusetts
Moyers, Bill (1993) ‘Healing and The
Mind’, PBS Broadcasting, www.youtube.
com
Ray, Paul H., Anderson, Sherry Ruth
(1988) ‘The Cultural Creatives: How 50
million People Are Changing the World,
Crown Books
Segal Zindel V., Williams Mark G., &
Teasdale John D. (2001) ‘Mindfulness-
Based Cognitive Therapy for Depression:
A New Approach to Preventing Relapse’,
Guilford Press
Szabo, S., Tache Y., Somygi A., (2012)
The legacy of Hans Selye and the origins
of stress research; a retrospective 75
years after his landmark brief letter to
the editor of Nature, Stress Sept. 2012:
15 (5) 472-478
Dr. Antony Sharkey
Anthony Sharkey is a medical
practitioner in general practice in Naas
Co. Kildare. He has taught over 4,500
to practice mindfulness since 1996.
Contact: doc.sharkey@gmail.com
or 086-2136125.
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Introduction
Mindfulness has been described
as “paying attention in a
particular way: on purpose, in
the present moment, and non-
judgmentally.” (Kabat-Zinn, 1994,
p. 4). It is a technique where one
focuses on the present, gradually
letting go of thoughts about the
past or the future. Mindfulness
is becoming more popular as a
technique to help people manage
stress. Research suggests, for
example, that individuals who have
higher levels of mindfulness have
increased performance in attention
and cognitive exibility (Moore &
Malinowski, 2009); report higher
levels of relationship satisfaction
(Kozlowski, 2013), and lower levels
of perceived stress (Roeser et al.,
2013). As a therapeutic technique
mindfulness has been shown to
be effective through, for example,
Mindfulness Based Cognitive
Therapy and Mindfulness-Based
Stress Reduction (Nevanper, 2012).
Aims of Research
The argument offered here is that
mindfulness is likely to act in the
same way as other types of coping
i.e. that it is not a ‘silver bullet’
and that it is likely to be a preferred
strategy used by some and not
others. The aim of this research
therefore is to compare the impact
of mindfulness compared to other
types of coping on well-being -
operationalised as happiness, self-
compassion and stress.
Self-compassion refers to the
extent to which one is forgiving of
one’s failures and inadequacies and
it has been found to be positively
associated to mindfulness.
Self-compassion has also been
associated with optimism and self-
efcacy (Alberts et al., 2014), and
to increases in self-esteem and
happiness (Umphrey & Sherblom,
2014).
What do we mean by Coping?
Lazarus and Folkman (1984)
dened coping as:
‘constantly changing cognitive
and behavioural efforts to manage
specic external and/or internal
demands that are appraised as
taxing or exceeding the resources
of the person’ (Lazarus and
Folkman, 1984, p. 141).
The research in this area has
broadly focused on problem and
emotion based coping. Both can
be used in effective and ineffective
ways but problem-based coping
tends to be more goal-orientated
and associated with a more
positive outcome. It involves
actively attempting to overcome the
issue that is causing distress, such
as making a tasks list, seeking
support, planning and executing
that plan. Those who used problem-
focused coping strategies are
signicantly more likely to report
lower emotional and behavioural
difculties compared to those
who used emotion-focused coping
(Folkman, 1997).
Emotion-focused coping is
commonly used when a distressing
problem is perceived as outside
the person’s control (Lazarus &
Folkman, 1984). Both active and
avoidant coping strategies can be
used to manage one’s emotional
reaction to stress (Green, Choi,
& Kane, 2010). Emotion-focused
coping strategies can include
positive reframing, the use of
emotional or instrumental support,
humour and acceptance. (Carver,
1997).
Avoidance-based coping refers
to attempts to direct attention
away from the emotional distress.
Mindfulness –
As a Coping Strategy
by Dr. Chris Gibbons & Hazel Morgan
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coping but they are adaptable and
able to draw on a range of coping
resources.
Methodology
The sample consisted of 521
participants; 76 male (14.6%) and
419 female (80.4%) and the age
range was 18 to 75. Participants
were invited to ll out an online
questionnaire through Facebook
via a personal account. A volunteer
sample was used along with
snowball sampling.
A survey method and correlational
design was used with the predictor
variables being age, gender,
mindfulness and problem- and
emotion-based coping. The
outcome measures were Self-
compassion, happiness and
general psychological well-being as
measured by the General Health
Questionnaire. The coping inventory
measured fourteen types of coping
drawn from Carver’s (1997) coping
scale. The mean Cronbach’s alpha
coefcient has been reported at
.89 for this scale (Carver, 1997).
The Mindful Attention Awareness
Scale is a 15-item scale that
measures open or receptive
awareness and attention to the
present - a core characteristic
of dispositional mindfulness.
The Cronbach’s alpha has been
consistently reported to be above
.80 (Brown et al., 2011). This
study then is not measuring if
respondents formally practice
mindfulness, rather ‘mindfulness’
in this context refers to the extent
to which the individual shows
receptive awareness and attention
to the present.
The Self-Compassion Scale (Neff,
2003) is a 26-item scale. It was
only the Self-Kindness sub-scale
that is the focus of this research.
The Cronbach’s alpha coefcient
has been reported at .92 (Neff,
2003).
The General Health Questionnaire
(Goldberg, 1972).
The 12 item version of the General
Health Questionnaire was used to
measure transitory distress. Each
of the twelve items have a four
response option and Goldberg’s
scoring rubric was used to measure
the extent to which one was at
risk of developing a stress-related
illness. Cronbach’s alpha coefcient
has been reported at .88 (Picardi,
Abeni & Pasquini, 2001).
Happiness was measured by
asking respondents to rate how
happy they were on a scale from
1-10, 1 being ‘not at all happy’ and
10 ‘very happy’ Deiner (2000). This
is a one item measure and research
has shown itself to be a valid
predictor of subjective well-being
(Deiner, 2000).
Results
See Figure 1.
Discussion
Happiness
The rst model explained 37.4% of
the variance in happiness scores.
Mindfulness was the strongest
predictor - as it increased so did
happiness. This corresponds with
the earlier ndings of Kozlowski
(2013) and Roeser et al (2013) on
the association between mindfulness
and relationship satisfaction and
stress management. Self-blame
was negatively related to happiness
- the more one used this type of
coping the less happy one was.
However, one has to caution against
necessarily assuming self-blame is
mainly or always an example of poor
coping. Other research has found
Typical strategies can include:
denial, self-distraction, behavioural
disengagement, venting, self-
blame, and substance use and
they are commonly associated with
poorer psychological outcomes
(Gibbons, Dempster & Moutray
2009). Avoidance-based coping is
ineffective coping and even if it is
used only occasionally it was been
found to be a strong predictor of
adverse well-being (Gibbons, 2010).
Mindfulness is one of a range
of strategies that has been found
to be helpful in managing stress.
Other powerful coping resources
include support (Gibbons, 2010
and Taylor et al., 2004), pursuing
optimism (Seligman, 2002),
developing a sense of ‘ow’
(Csikszentmihalyi, 2000) and
developing a sense of control
(e.g. Rotter, 1966 & Gibbons
2010, 2012). No one strategy or
resource is a ‘silver bullet’, rather
the focus should be on using a
range of strategies and to identify
those that match with one’s
preference. Gibbons, Dempster
and Moutray (2010) found, for
example, that support was not
equally effective across samples of
nursing and psychology students
but effective most for those who
had a preference for it and those
with this preference were most
distressed when expected support
was not available. Control is
normally construed as an effective
strategy but Gibbons (2010)
found that those high in control
were most distressed when they
faced demands where they could
not draw on this preferred coping
style - those high in control were
more distressed than those low in
control! This highlights the point
that those who cope well tend not
just to have a preferred style of
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may well add to their perception of
stress. Another way of viewing this
is that a perception of some level
of stress is necessary to perform at
the optimum. This is referred to as
‘eustress’ and where ‘self-blame’
adds to one’s performance it is
likely to be because it increases the
perception of eustress (Gibbons,
2008).
The more one disengages from
others the less happy one is. This
concurs with earlier research with
this type of coping broadly being
equivalent to Maslach’s (1996)
measure of depersonalization (a
component of burn-out). Essentially,
the more one feels disengaged,
alienated and removed from those
one works with the lower are the
scores on work satisfaction and
happiness. This study did not limit
respondents to their experience of
this type of coping in a work context
but to life in general. This suggests
that isolation and disengagement
are important indicators that one is
not coping and not happy and should
be seen as a signal for remedial
action rather than as a tendency to
continue using this strategy.
Consistent with this nding is that
as emotional support increased so
did happiness. While the Beta value
is small, support contributed to the
nal model and it is important to
remember that of the seventeen
variables measured - fourteen
types of coping, mindfulness, age
and gender - it is those in the nal
model that are the key factors.
As expected, as substance use
increased happiness declined.
This suggests that it is ineffective
coping and it is likely to be used as
a form of avoidance in the same way
disengagement may be an attempt
to avoid other perceived stressors.
Self-compassion
The nal model explained 59.5%
of the variance in scores on self-
compassion. Again the variable that
explained the most variance was
mindfulness. As it increased so did
self-compassion. Mindfulness is
clearly very effective at nurturing this
quality or vice versa.
The more one used self-blame
the lower was the score on self-
that those high in self-blame are also
likely to score high on diligence, to
see a task through to its completion
and to have a tendency to take
responsibility for large areas of work.
For those with this quality who work
in human-service professions (e.g.
teaching, nursing, retail etc.) they are
more likely to be valued and rated
as very competent (Gibbons, 1998,
2008), but, at the individual level, it
Figure 1: Results
Final regression model - happiness
Model
Unstandardized
Coefficients
Standardized
Coefficients
t Sig.B
Std.
Error Beta
1(Constant) 3.552 .486 7.302 .000
Mindfulness .187 .024 .326 7.865 .0001
Substance use -.095 .039 -.094 -2.437 .015
Emotional support .073 .033 .080 2.188 .029
Behavioural disengagement -.176 .051 -.147 -3.427 .001
Self-blame -.213 .041 -.235 -5.130 .0001
R squared .381, Adjusted R squared .374
Final regression model with Self-kindness (Self-compassion)
Model
Unstandardized
Coefficients
Standardized
Coefficients
t Sig.B
Std.
Error Beta
1(Constant) 5.858 1.116 5.247 .000
Age .023 .011 .068 2.212 .027
Mindfulness .716 .052 .497 13.835 .0001
Emotional support .229 .073 .101 3.158 .002
Behavioural disengagement -.233 .106 -.076 -2.192 .029
Acceptance .230 .091 .084 2.526 .012
Self-blame -.629 .086 -.278 -7.345 .0001
R squared .601 Adjusted R squared .595
Final regression model with GHQ
Model
Unstandardized
Coefficients
Standardized
Coefficients
t Sig.B
Std.
Error Beta
1(Constant) 1.192 1.120 1.064 .288
Mindfulness -.208 .059 -.158 -3.539 .0001
Self-distraction .274 .092 .123 2.978 .003
Denial .285 .121 .101 2.364 .019
Behavioural disengagement .590 .128 .217 4.605 .0001
Positive reframing -.187 .090 -.084 -2.076 .039
Self-blame .514 .097 .253 5.295 .0001
R squared .398, Adjusted R squared .389
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interpretations offered here show
that self-distraction and denial are
ineffective ways of coping and this
corresponds with the ndings with
GHQ – as it increased so did scores
on these types of coping. The two
ways of coping that had a benecial
effect were mindfulness and positive
reframing with mindfulness having a
far more powerful inuence.
If one scores 3 or more on the
GHQ one can be categorised as ‘at
risk’ of developing a stress-related
illness and T-test comparisons
between those ‘at risk’ and ‘not
at risk’ revealed that those ‘not at
risk’- the ‘good-copers’ effectively,
were happier and scored signicantly
higher on mindfulness; religious
beliefs; levels of acceptance and
positive reframing and signicantly
low on denial and behaviour
disengagement.
That mindfulness was reported
as the largest Beta value by some
margin across all the models
indicates that it is the single
most benecial inuence on
promoting self-compassion; in
managing the effects of distress
(GHQ) and in happiness. The rst
nding is less surprising given the
practice or qualities associated
with mindfulness are likely to
promote self-compassion but it is
a testament to mindfulness that
it appears to be a far stronger
inuence on well-being than the
wide variety of coping strategies
measured here, such as humour,
support, positive reframing,
planning, active coping and religion,
all of which have a strong track
record in the research literature on
coping and enhancing well-being.
Conclusion
The overall variance explained by
each model suggests that there
were many factors not measured
that also contribute to each of the
outcome measures. It is rarely
the case that a regression model
explains more than 50% of the
variance in an outcome measure
and here is no exception. There
were limitations to the study
too - the sample size was an
exceptionally good one for what
had started out as a piece of
undergraduate research but the
sampling was voluntary and it was
likely that the procedure attracted
a higher proportion of individuals
already predisposed to mindfulness.
The sample size was sufcient to
test the number of factors that
were entered into each model
and the ndings were statistically
robust. The interpretations arrived
at suggested that avoidance;
in the form of self-distraction,
disengagement from others or
substance use, had adverse effects
on well-being. Self-blame was also
associated with distress but also
with achievement and it is important
to strike the right balance between
setting one’s goals high but avoiding
being too self-critical. Consistent
with earlier research was the value
of support, acceptance and positive
reframing. However, a key nding
was that mindfulness was the
strongest inuence and not just in
promoting these qualities but which,
in its own right, promotes well-being
and effective coping.
References
Alberts, H. J., Mulkens, S., Smeets, M.,
& Thewissen, R. (2010). Coping with
food cravings. Investigating the potential
of a mindfulness-based intervention.
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Brown, K. W., West, A. M., Loverich, T.
M., & Biegel, G. M. (2011). Assessing
compassion. It makes sense that
the more one is critical of oneself
(self-blame) the less likely one
will simultaneously show self-
compassion. To achieve in one’s
endeavours, however, one has to
strike a balance between being
critical of one’s standards and efforts
while simultaneously being willing
to forgive one’s own mistakes. As
has been mentioned, those high in
self-blame do tend to achieve to high
standards but being too self-critical
and taking on too much responsibility
(self-blame), adversely affects
well-being and, in the long-term,
performance. It is a game of ne
margins to strike this balance!
As support and acceptance
increased so did self-compassion,
and behaviour disengagement
negatively related to self-
compassion – that is to say that
as one becomes disengaged
from others one runs the risk of
being less in tune with one’s own
emotional needs (as indicated by
measures on the self-compassion
scale).
General Health Questionnaire (GHQ)
The greater the scores on GHQ the
greater is the risk of developing a
stress-related illness. This model
explained 38.9% of the variance in
GHQ scores. The largest variance
was explained by the self-blame
coping strategy - the more one
used self-blame the greater was the
risk of developing a stress-related
illness. Similarly, the more one
coped by disengaging from others -
be that work colleagues, friends or
family - the greater was the risk of
developing a stress-related illness.
The earlier explanation offered
for these variables in relation to
happiness, is likely to apply here
too. Earlier research and the
18 Irish Association for Counselling and Psychotherapy
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scaled version of the General Health
Questionnaire. Psychological medicine,
9(01), 139-145.
Green, D. L., Choi, J. J., & Kane, M.
N. (2010). Coping strategies for
victims of crime: effects of the use of
emotion-focused, problem-focused,
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of Human Behavior in the Social
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Kabat-Zinn, J. (1994). Wherever you go,
there you are: Mindfulness meditation in
everyday life. Hyperion.
Kozlowski, A. (2013). Mindful mating:
exploring the connection between
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Lazarus R.S. & Folkman S. (1984)
Stress, Appraisal, and Coping. Springer,
New York.
Maslach, C., Jackson, S. E., & Leiter,
M. P. (1996). Maslach burnout inventory
manual. Consulting Psychologists Press.
Moore, A., & Malinowski, P. (2009).
Meditation, mindfulness and cognitive
exibility. Consciousness and cognition,
18(1), 176-186.
Neff, K. D. (2003). The development
and validation of a scale to measure
self-compassion. Self and identity, 2(3),
223-250.
Nevanper, N. (2013). Psychological
exibility, occupational burnout and
eating behavior among working women.
Picardi, A., Abeni, D., Mazzotti, E.,
Fassone, G., Lega, I., Ramieri, L.,
... & Pasquini, P. (2004). Screening
for psychiatric disorders in patients
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study of the 12-item General Health
Questionnaire. Journal of psychosomatic
research, 57(3), 219-223.
Roeser, R. W., Schonert-Reichl, K. A.,
Jha, A., Cullen, M., Wallace, L., Wilensky,
R., & Harrison, J. (2013). Mindfulness
training and reductions in teacher
stress and burnout: Results from two
randomized, waitlist-control eld trials.
Journal of Educational Psychology,
105(3), 787.
Rotter, J. B. (1966). Generalized
expectancies for internal versus external
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monographs: General and applied,
80(1), 1.
Seligman, M. E. (2002). Positive
psychology, positive prevention, and
positive therapy. Handbook of positive
psychology, 2, 3-12.
Taylor, S. E., Sherman, D. K., Kim, H. S.,
Jarcho, J., Takagi, K., & Dunagan, M. S.
(2004). Culture and social support: who
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Umphrey, L. R., & Sherblom, J. C.
(2014). The relationship of hope to
self-compassion, relational social skill,
communication apprehension, and life
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Wellbeing, 4(2).
Dr Chris Gibbons
Dr Chris Gibbons is a lecturer in
psychology at Queen’s University
Belfast and at Dublin Business School.
His research interests are positive
psychology and stress and coping, with
a particular focus on ‘eustress’ - that
level of stress needed to help one
achieve.
Contact: chris.gibbons@dbs.ie
Hazel Morgan
Hazel Morgan is a graduate of
psychology in DBS and has been
practising mindfulness for over two
years. This research was undertaken as
part of the nal degree.
Contact: h.morgan_91@hotmail.com
adolescent mindfulness: validation of
an adapted Mindful Attention Awareness
Scale in adolescent normative and
psychiatric populations. Psychological
assessment, 23(4), 1023.
Carver, C. S. (1997). You want to
measure coping but your protocol
is too long: Consider the brief cope.
International journal of behavioral
medicine, 4(1), 92-100.
Csikszentmihalyi, M. (2000). Beyond
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Diener, E. (2000). Subjective well-
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proposal for a national index. American
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Folkman, S. (1997). Positive
psychological states and coping
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medicine, 45(8), 1207-1221.
Gibbons, C (2012) Stress, positive
psychology and the National Student
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18 (2), 22-30.
Gibbons, C., Dempster, M. and
Moutray, M. (2010), Stress, coping and
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(47) 1299-1309.
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M. (2009), Index of sources of stress in
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analysis. Journal of Advanced Nursing,
Vol. 65 (5), 1095-1102.
Gibbons, C., Dempster, M. and Moutray,
M. (2008) Stress and eustress in
nursing students, Journal of Advanced
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the effects of organisational change on
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Goldberg, D. P., & Hillier, V. F. (1979). A
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Methods employed in
managing counselling
self-efficacy anxiety.
Introduction
Self-Efficacy
The concept of self-efcacy refers
to “beliefs in one’s capabilities
to organise and execute the
courses of action required to
produce given attainments”
(Bandura, 1997, p.3). The above
author explains:
The self-assurance with which
people approach and manage difcult
tasks determines whether they make
good or poor use of their capabilities.
Insidious self-doubts can easily
overrule the best of skills. (p. 35.)
Faced with an incalculable
number of potentially relevant
‘variables’, a counsellor/
psychotherapist must possess
sound (though realistic) perceptions
of their capabilities if they are to
endure the ambiguity inherent in
counselling work with ‘real life’
clients.
Counselling self-efcacy (CSE)
is dened as “one’s beliefs
or judgments about her or his
capabilities to effectively counsel
a client in the near future” (Larson
& Daniels, 1998, p. 180). CSE
beliefs are seen as subjective
assessments of competence in
counselling; that is, individuals
with strong CSE believe they are
highly capable to counsel, whereas
persons with low CSE do not
believe they have adequate skills
to perform counselling. Daniels and
Larson (1998) examined 32 studies
suggesting the predictive strength
of CSE in its relationship to other
important counsellor variables such
as counsellor anxiety, counsellor
performance, and the supervision
environment. Barnes (2004) details
some implicit assumptions of
CSE theory: (a) CSE is a primary
mechanism through which effective
counselling occurs, (b) strong
CSE beliefs result in enhanced
counsellor trainee perseverance in
the face of difcult tasks, and (c)
counsellor trainees who experience
strong CSE are better able to
receive and incorporate evaluative
feedback into their learning
experiences than are trainees who
do not possess robust CSE beliefs
(Larson, 1998). Studies have
found that CSE is positively related
to counsellor training level and
experience, counsellor self-concept
(Larson et al., 1992), counsellor
development (Leach, Stoltenberg,
McNeill, & Eicheneld, 1997),
and expectations of counselling
outcomes (Sipps, Sugden, & Faiver,
1988). Furthermore, researchers
have demonstrated a negative
relationship between CSE and
counsellor anxiety (Larson et al.,
1992).
Risks to Therapists and Effects
of Low Self-Efficacy:
According to Bandura (1997), a
sense of efcacy can activate
a broad range of biological
processes that inuence human
health and disease. Many of
by Eoin O’Shea & Dr. Freja Petersen
20 Irish Association for Counselling and Psychotherapy
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formulation of anxiety (Clark &
Beck, 2010).
Methodology:
Participants:
Participants in this study were
comprised of 70 counsellors and
psychotherapists who responded
to a posted questionnaire (56
female/14 male). Mean age was
54.5 years with a SD = 6.84. The
oldest person was 69 with the
youngest being 35. Respondents’
mean number of years providing
therapy was 13.8 with a SD =
5.96. Most and least experienced
respondents had been providing
counselling for 30 and ve years
respectively. There were no
problematic ethical dilemmas
envisioned in the study which was
approved by a Research Ethics
Committee at UCC.
Materials & Procedure:
The research questionnaire was
posted to 300 therapists who
were selected (using an online
random number generator)
from the Irish Association of
Counselling and Psychotherapy’s
(IACP) members’ listings of
over 900 individuals. Of the
300 members, 70 completed
and returned the questionnaire
containing the research question,
“What, if any, methods have
you employed to deal with/work
through fears, anxieties, or doubts
regarding your abilities as a
counsellor since you have begun
such work? (Responses need
not only include professionally-
recommended methods such as
supervision, etc, but can include
your own personal/idiosyncratic
ways of dealing with such
anxiety)”. Demographic items
regarding age, sex, and number
of years engaged in providing
professional counselling/therapy
were also included. These were
accompanied by a stamped,
self-addressed envelope for
ease of response and a cover
sheet detailing the purposes
of the research, assurances of
anonymity, etc. Following return
of these questionnaires and
completion of initial stages of
research, a thematic analysis was
conducted on the data.
Thematic Analysis:
Roulston (2001) suggested
that thematic analysis is a
poorly demarcated and rarely
acknowledged, yet widely used
qualitative analytic method within
and beyond psychology. Braun and
Clarke (2006) have attempted to
‘ll the gap’ of theory and practice
relating to thematic analysis (TA)
and have presented a step-by-step
guide to employing TA as a data
analytic method. They dene TA as
“a method for identifying, analysing
and reporting patterns (themes)
within data. It minimally organises
and describes your data set in
(rich) detail” (p.79). The authors
go on to delineate a step-by-step
process through which a thematic
analysis is conducted. These steps
include: (1) Familiarising yourself
with the data; (2) generating initial
codes, i.e. whereby the researcher
groups related words, concepts,
or comments together due to an
apparent similarity in meaning, (3)
searching for themes, (4) reviewing
themes, (5) dening and naming
themes, and (6) producing the
report. The third of these stages
also marks the point at which
one examines relations between
themes with a view to generating
‘sub-themes’ where appropriate.
these effects arise when coping
with acute or chronic stressors
in our everyday lives. Stress
(an emotional state generated
by perceived threats and taxing
demands) has been implicated
as an inuential contributor
to many physical dysfunctions
(Cohen, Evans, Stokols, & Krantz,
1986). Encountering stressors
(without perceived or actual
control) activates neuroendocrine,
catecholamine, and opioid
systems and impairs the
functioning of the immune system
(Shavit & Martin, 1987). The
intensity and chronicity of stress
is governed largely by perceived
control over the demands of
one’s life. Both epidemiological
and correlational studies have
shown that lack of behavioural
or perceived control over
environmental demands increases
our susceptibility to bacterial
and viral infections, contributes
to the development of physical
disorders, and accelerates the
rate of progression of disease
(Peterson & Stunkard, 1989;
Schneiderman, McCabe, & Baum,
1992; Steptoe & Appels, 1989).
The present article is the
second part of a research study
(O’Shea & O’Leary, 2009) which
investigated the events or
circumstances associated with
counselling self-efcacy anxiety.
The research question in that
article read: “What are/have been
the typical fears, anxieties, doubts
regarding your perceptions of your
own abilities as a counsellor since
you have begun such work?” The
broad inclusion of fears, anxieties,
and doubts in this wording was
intended to capture a wide range
of relevant experiences and is
also in keeping with a cognitive
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by regular individual and group
supervision.
Personal Reflection, Self-Talk and
Past Work:
Reection was helpful in relation
to fears, overactive “superegos”,
taking adequate time before and
after sessions to reect, and
honesty/integrity of examining
both oneself and one’s work.
Possible counter-transference
was considered at such times
along with potential vicarious
traumatisation and “stuckness”
with clients. Emotional awareness
offered an opportunity to process
needs, consider boundaries,
examine vulnerabilities, and
integrate insights. One could
question perceived failures in
considering how things could have
been done differently with a view
to moving on. Self-talk included
“afrmations” and “[p]ositive
thinking” used to “surrender
and let go of fears”, e.g. “You
are a trained counsellor and you
have the skills and attributes
necessary for the work at
hand”. This helped respondents
to “accept [their] limits” and
appreciate the “privilege” that
such work represented. Focusing
on past work/successes, e.g.
“reminding myself of work that
went well”, was used to alleviate
anxieties regarding self-efcacy.
Respondents formed a “positive
attitude based on evidence”, e.g.
growth in one’s private practice
and referrals. A specic practice
mentioned in facilitating self-
reection was journal-keeping.
Continuing Professional
Development (CPD):
CPD included “further education
and training”, “ongoing
professional development/
training”, with specic examples
including “workshops”, “reading”
(of articles and books, mostly –
but not all – related to psychology,
counselling and psychotherapy),
further educational qualications
(e.g. “M.A. in Further Education”),
“T.V.”, “the Internet”, and
“constant involvement with
accrediting bodies regarding
standards and training”. A number
of items paired ‘professional’
with ‘personal’ development
and this seems to indicate an
overlap of the two at times.
Respondents reported achieving
“new insights”, upgrades of
knowledge, and “conrmation
of knowledge” from CPD
involvement. As with supervision,
a number of individuals saw CPD
as “essential”, “inuenc[ing]
good practice”, and “believe[d]
strongly” in it.
Peer/Collegial Support:
Peer/Collegial support was
distinguished from the supervision
theme in that it represented a
less formal, often less structured,
and free support. Peer support
was provided by co-workers. Most
items were broadly expressed
without explanatory detail,
e.g. “peer/colleague support”,
“consultation with peers”, etc.
Such peer contact ‘normalised’
the fears and anxieties
experienced through sharing
with others while another found
that this “helps as most have
the same doubts/fears”. Both
individual and group involvement
was suggested in responses.
Some items indicated such
support was engaged in at work
whereas other individuals had
formed groups/arrangements
based on work friendships
Thematic Report:
“What, if any, methods have
you employed to deal with/work
through such fears, anxieties,
or doubts? (Responses need
not only include professionally-
recommended methods such as
supervision, etc, but can include
your own personal/idiosyncratic
ways of dealing with such
anxiety”.
Supervision:
Supervision was the most
common method that respondents
used to deal with self-efcacy
anxieties, such prevalence
matched by items positing it
as the most salient or effective
method, e.g. “chief method of
dealing with my doubts/fears/
anxieties” and “supervision would
be my main resource”. Responses
indicated the most useful
instances for respondents, i.e. in
cases of suicidal risk, emotional
support, personal exploration of
fears, consideration of errors in
practice, and assurance regarding
therapeutic interventions and
strategies. Unsurprisingly,
“experienced”, “challenging”,
and “competent” supervisors
were preferred. Individual and
group supervision was indicated,
the former being more common.
Supervision provided a safe,
accepting, and yet at times
challenging space in which to
“unload and thrash out what’s
going on” and be “vulnerable”.
Frequency of attendance varied,
e.g. 1-1.5 hours/week or one
4-hour group session/month.
Only one respondent indicated
that supervision was “way over-
rated as a tool for therapist
support”. Respondents generally
felt “relaxed” and “assured”
22 Irish Association for Counselling and Psychotherapy
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Trust in Therapeutic Relationship
and Client Responsibility:
For a number of therapists, trust
in the therapeutic relationship
as a signicant agent of change
encompassed beliefs regarding
client responsibility (and also
capacity) to bring about positive
change. “Skills and experience”
were thought to be of secondary
importance by one respondent
when compared to “trust [in]
the power of the dynamic in an
authentic encounter”. “Being
present and available to the
client” and “acknowledging what’s
in the room” was emphasised
as part of the “the therapeutic
relationship”/”the process”. This
was specied at times in terms
of “the core conditions” and,
more specically, “unconditional
positive regard”. Some could
“leave go of fears and inadequacy
when working by being present to
the client”. ‘Client responsibility’
could be understood in terms of
greater emphasis placed on the
client’s role in the therapeutic
process. Some respondents
advised against seeing therapy
in terms of ‘xing’/‘healing’ the
client, instead “remembering
that [the] client has [their] own
strength and healing ability”.
Another question posed was
“who is doing the needed work –
therapist or client?” Boundaries
of therapists’ responsibility
were viewed as facilitating
unconditional positive regard for
themselves – vital in modelling
the very same for the client.
Spirituality and Meditative
Grounding:
Spirituality, while difcult to
dene in explicit terms, was
thought to involve practices
relating to, or believed to affect,
the spirit or transpersonal
functioning. It sometimes, though
not always, involved practices
considered to be ‘religious’ in
nature. Meditative grounding,
on the other hand, consisted of
practices perceived as relating
to a sense of ‘perspective-
enhancing’ or attentional ‘rooting
in the moment’. As meditation
is often practised within the
context of religious, spiritual, or
transpersonal thought systems,
these two terms were believed to
warrant inclusion under the same
theme. Prayer was mentioned
as an effective method of “self-
regulation” and was sometimes
accompanied by the lighting of a
candle. Techniques designed for
relaxation as well as breathing
exercises were employed by a
number of respondents with
relaxation tapes sometimes being
used. “Meditative music” was
noted as helping therapists to
accept their fears. The importance
of “a good sense of humour”
was cited; this could be a ‘black’
sense of humour and might
alleviate stress. Three symbolic
practices included wearing
specic items of clothing that
held personal signicance for the
wearer, were specic for work, or
going to another room following
a session to “leave behind”
material before returning to the
sessional room.
Personal Therapy:
Relatively little detail regarding the
specic approaches involved were
included – only one respondent
indicated “ecotherapy”. However,
descriptions as “best support”,
“essential”, and “[the] main
tool” suggest its signicance to
developed over years. Group
size indications were scarce
but ranged from 3-6 individuals.
“Fun” was also mentioned in
relation to such meetings; indeed,
this practice was seen as “very
supportive” and ts with the
ndings of some (e.g. Greenglass,
Burke, & Fiksenbaum, 1998) that
such support can protect against
burnout.
Leisure and Hobbies:
One respondent indicated the
grounding function of non-
counselling activities. Specic
forms varied but common
examples included reading
(e.g. “identication” with the
characters of J.R.R. Tolkien’s
work). Music (both listening
and playing) and well as singing
featured as part of this. Related
also were a small number of
responses indicating the use of
dance – movement to music was
seen by one respondent as aiding
in “self-regulation”. Watching
lms/DVDs was also mentioned
along with art forms such as
drawing and sculpture being seen
as helpful “creative work”, e.g.
card-making: “a favourite hobby!”.
Gardening and cooking featured
and these were useful in keeping
some therapists “grounded”,
e.g. maintaining a vegetable
garden and contact with “soil”
and “nature” was suggested as
benecial. As one person said:
“[there is a benet] by engaging in
nature; sea, mountains, animals”.
“Regular” massage was viewed
by one respondent as “vital!”
and language classes received
a mention, as did acupuncture,
“getting physically engaged in
housework”, and “maintaining an
interest in current affairs”.
23
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family members, and friends were
typically mentioned with a notable
exception being a generous
tribute paid to a therapist’s dog
in helping to achieve this ‘work/
social life balance’.
Exercise:
Physical activity was seen by
respondents as important in
managing their self-efcacy
anxieties and references to
“exercise” were numerous. The
most common form was walking.
Long walks, walking with the dog,
and hill-walking, along with the
suggested function of “grounding”,
were the specic details provided
in relation to this. Yoga was also
mentioned frequently along with
one reference to Tai Chi. Also
mentioned were skiing and dance.
A lone response detailing “active
engagement in sports” suggested
relatively little participation in
competitive forms of physical
exercise.
Adequate Holidays:
Responses indicated the
importance of regular breaks from
work, including non-specic items,
e.g. “Adequate rest/holidays”,
and more specic items, e.g. trips
to the Spanish mountains for
personal therapy and fun, a yearly
Zen residential silent retreat,
retreats at a Christian monastery
four times a year. “Active”,
“enjoyable”, and “frequent”
holidays were predictably
favoured. Other forms of ‘holiday’
encompassed time taken from
work (without necessarily ‘going
on holiday’, as such), e.g. “Having
plenty of time out”, “cutting back
on work”, and choosing to “work a
very short week” were mentioned.
Suggested benets included
having “time for myself” and
“avoid[ing] burnout”.
Counselling-Specific Strategies:
Certain practical steps that aided
in allaying anxieties regarding
counselling self-efcacy were
indicated. A number of these
related to issues of time, e.g.
being very clear with clients
regarding time constraints of
sessions. Respondents took
some time (e.g. half an hour)
between sessions to compose
themselves as well as write/
familiarise themselves with notes.
Suicide contracts were advocated
and details of the client’s family/
next of kin were collected also.
One respondent indicated
being “choosy” regarding which
agencies to work with and refused
to work with those perceived as
“unprofessional”. Another found
that being in communication with
a client’s doctor/psychiatrist
relieved anxiety. Therapist safety
was also mentioned, e.g. devising
practical plans when working
with angry clients, not having
potentially dangerous objects in
the counselling room, and working
only when colleagues were in the
building.
Feedback and Clarification:
This theme involved open
communication between therapist
and client regarding the process
of counselling itself and how it
was proceeding. Broad items
included “seeking clarication
and feedback”, “checking out with
client do they believe if something
is useful for them”, stressing the
“voluntary nature” of counselling
along with “condentiality and
terms of contract”. Termination
was dealt with by encouraging the
client to move on and reassuring
them that the therapist would
some. One respondent implied its
importance “for [their] own issues
which may have been triggered”
– its usefulness in combating
potential counter-transference is
apparent here. Another indicated
the belief that therapists “can’t
take clients where [they] haven’t
gone [themselves]”. Explicit
indications of frequency varied,
e.g. “fortnightly” and “when
required”/“when issues arise”.
This suggests that therapists
not in ongoing therapy availed
of it when specic challenges
occurred. More than a third of
respondents were either presently
in/availed of therapy when
needed.
Balance of Work and Social Life:
It is reasonable to assume
that other themes – such as
those pertaining to Leisure
and Hobbies, or Exercise, also
contain items that could as
easily be considered part of the
aforementioned ‘balance’. This
theme instead included responses
that explicitly referred to notions
of such ‘balance’ and which
are not deemed as suitable for
inclusion in the more specic
categories previously mentioned.
Some responses were broad,
e.g. “I maintain a good balance
between work and pleasure”
with others more specic, e.g.
“entertaining friends”, “having fun
by mixing with non-therapists”,
and “meeting friends for coffee”.
Respondents indicated the
importance of ‘leaving work at
work’, e.g. having a mobile phone
specically for work purposes
which was turned off after
work hours. The importance of
achieving this balance “could not
be exaggerated”. Spouses, other
24 Irish Association for Counselling and Psychotherapy
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their counselling abilities broadly
matched previous research.
Suggestions for further reading
include those studies highlighting
the importance of supervision
(e.g. Borders, 2006), self-talk
(e.g. Morran, 1986), continuing
professional development (e.g.
Bor, 2006), peer support (e.g.
Barlow & Phelan, 2007), leisure
and hobbies (e.g. Sowa, May, &
Niles, 1994), issues pertaining
to the therapeutic relationship
(e.g. Skovholt, 2005), spirituality
and meditative grounding (e.g.
Newsome, Christopher, Dahlen,
& Christopher, 2006), personal
therapy (e.g. Kumari, 2011), the
balance of work with social life
(e.g. Bryant & Constantine, 2006),
exercise (e.g. Dixon, Mauzey, &
Hall, 2003), adequate holidays
(e.g. Dubrow-Marshall, 2011),
counselling-specic strategies
(Cox, 1982), feedback and
clarication (McLeod & Cooper,
2011), and recognition of limits
and referral (Shiles, 2009).
Limitations of the present
study include the broadness of
the research question, i.e. the
inclusion of fears, anxieties, and
doubts. This was done to include
as many elements of the cognitive
formulation of anxiety as possible
including experiential elements
of the primary threat mode,
secondary elaborative processes,
and various cognitive products
(Clark & Beck, 2010). However,
additional research might narrow
the scope of anxiety features
whilst maintaining the present
study’s qualitative inclusiveness.
Further studies employing a
similar methodology but focusing
on specic self-care strategies
in more detail may be warranted.
Nevertheless, this study is
posited as further exploring a
sample of the sheer breadth of
strategies employed by practising
therapists when managing
the anxieties they experience
regarding counselling abilities.
References
Bandura, A. (1997). Self-efficacy: The
exercise of control. New York: Freeman.
Barlow, C. A., & Phelan, A. M. (2007).
Peer collaboration – A model to support
counsellor self-care. Canadian Journal of
Counselling, 41, 1, 3-15.
Bor, R. (2006). The society’s CPD
system is live – Chartered counseling
psychologists have risen to the
challenge. Counselling Psychology
Review, 21, 2, 29-30.
Borders, L. D. (2006). Snapshot of
clinical supervision in counseling
and counselor education. The Clinical
Supervisor, 24, 69-113.
Braun, V., & Clarke, V. (2006). Using
thematic analysis in psychology.
Qualitative Research in Psychology, 3,
77-101.
Bryant, R. M., & Constantine, M. G.
(2006). Multiple Role Balance, Job
Satisfaction, and Life Satisfaction in
Women School Counselors. Professional
School Counseling, 9, 4, 265-271.
Clark, D. A., & Beck, A. T. (2010).
Cognitive therapy of anxiety disorders:
Science and practice. London: Guilford.
Cohen, S., Evans, G. W., Stokols, D.,
Krantz, D. S. (1986). Behavior, health, &
environmental stress. New York: Plenum.
Cox, J. G. (1982). Time management
and the college counselling service.
Journal of College Student Personnel, 23,
6, 486-489.
Dixon, W. A., Mauzey, E. D., & Hall, C. R.
(2003). Physical activity and exercise:
continue to be available. Feedback
was “so important” in assessing
what the client needed “more
of/less of”. A method employed
involved regularly ‘checking in’
with clients to assure shared
goals, what the client found
most useful, and clarication of
specic issues such as particular
instructions, arrangements,
etc. Personal disclosure was
sometimes employed though care
in how this was undertaken was
indicated.
Recognition of Limits and
Referral:
This theme related to awareness
of one’s professional boundaries
and how to deal with cases where
these limits were challenged
by some clients. Responses
included general recognitions
of one’s limitations, e.g. “not
always having answers is ok”,
“reality – knowing my limits”,
and “realistic expectations of my
abilities as a counsellor”, with
self-acceptance being implicated.
Discussion of referral with peers
was accompanied by similar
discussion with clients if they
were not consistently attending.
“Alternative therapies” could be
explored with clients and some
respondents were “selective
who [they] take on”, only working
with issues and clients they felt
“comfortable with”. Seeking
referral from general practitioners
made their service “professional;
more appropriate”. Limiting
amounts of work was necessary
so as not to “burn out”.
Discussion:
The present study’s investigation
of therapists’ typical methods
used to help deal with anxieties,
doubts, and fears concerning
25
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Review, 26, 4, 47-58.
Morran, D. K. (1986). Relationship
of counselor self-talk and hypothesis
formulation to performance level.
Journal of Counseling Psychology, 33, 4,
395-400.
Newsome, S., Christopher, J. C.,
Dahlen, P., & Christopher, S. (2006).
Teaching counsellors self-care through
mindfulness practices. Teachers College
Record,108, 9, 1881-1900.
O’Shea, E., & O’Leary, E. (2009).
Counsellor anxiety in working with
clients: A qualitative study. The Irish
Psychologist, 36, 1, 13-22.
Peterson, C. & Stunkard, A.J. (1989).
Personal control and health promotion.
Social Science Medicine, 28, 819-828.
Roulston, K. (2001). Data analysis
and ‘theorizing as ideology’. Qualitative
Research, 1, 279-302.
Schneiderman, M., McCabe, P. M., &
Baum, A. (Eds.). (1992). Stress and
Disease Processes: Perspectives in
Behavioral Medicine. Hillside, N.J:
Erlbaum.
Shavit, Y. & Martin, F. C. (1987). Opiates,
stress, and immunity: Animal studies.
Annals of Behavioral Medicine, 9, 11-20.
Shiles, M. (2009). Discriminatory
Referrals: Uncovering a Potential Ethical
Dilemma Facing Practitioners. Ethics &
Behavior, 19, 2, 142-155.
Skovholt, T. M. (2005). The cycle of
caring: A model of expertise in the caring
professions. Journal of Mental Health
Counseling, 27, 1, 82-93.
Sipps, G. J., Sugden, G. J., & Falver, C.
M. (1988). Counselor training level and
verbal response type: Their relationship
to efcacy and outcome expectations.
Journal of Counseling Psychology, 35,
397-401.
Sowa, C. J., May, K. M., & Niles, S. J.
(1994). Occupational stress within the
counseling profession: Implications for
counselor training. Counselor Education
and Supervision, 34, 1, 19-29.
Steptoe, A., & Appels, A. (Eds.). (1989).
Stress, Personal Control and Health. New
York: Wiley.
Eoin O’Shea
Eoin O’Shea is a counselling
psychologist and cognitive behavioural
therapist who works in private practice
at South Dublin Psychologists. He
is an Associate Fellow of both the
Psychological Society of Ireland and
the British Psychological Society
as well as a member of the British
Association of Behavioural and Cognitive
psychotherapies. His main interests
include CBT, adult and developmental
trauma, and mindfulness-based methods
of working with clients.
Contact: eoinosheapsych@gmail.com
www.southdublinpsychologists.ie
Dr. Freja Petersen
Dr. Freja Petersen is a counselling
psychologist working at Trinity
College Dublin’s Student Counselling
Service. Her preferred approach
is Emotion-Focused Therapy (EFT).
Implications for counsellors. Journal
of Counseling and Development, 81, 4,
502-505.
Dubrow-Marshall, L. (2011). Healthcare
professionals: Commission your own
self-care quality! Healthcare Counselling
& Psychotherapy Journal, 11, 4, 4-11.
Greenglass, E. R., Burke, R. J., &
Fiksenbaum, L. (1998). Workload and
burnout in nurses. Journal of Community
and Applied Social Psychology, 11, 3,
211-215.
Krantz, S. E. (1985). When depressive
cognitions reect negative realities.
Cognitive Therapy and Research, 9, 595-
610.
Kumari, N. (2011). Personal therapy as
a mandatory requirement for counselling
psychologists in training: A qualitative
study of the impact of therapy on
trainees’ personal and professional
development. Counselling Psychology
Quarterly, 24, 3, 211-232.
Larson, L. M. (1998). The social
cognitive model of counselor training
(Monograph). Major contribution for The
Counseling Psychologist, 26, 219-273.
Larson, L. M. & Daniels, J. (1998).
Review of the counseling self-
efcacy literature. (Monograph).
Major contribution for The Counseling
Psychologist, 26, 179-218.
Larson, L. M., Suzuki, L. A., Gillespie,
K.N., Potenza , M.T., Bechtel, M. A., &
Toulouse , A. L. (1992). Development
and validation of the counseling self-
estimate inventory. Journal of Counseling
Psychology, 39, 1, 105-120.
Leach, M. M., Stoltenberg, C. D.,
McNeill, B. W., Eicheneld, G. A. (1997).
Counselor Education and Supervision,
37, 2, 115-124.
McLeod, J., & Cooper, M. (2011). A
protocol for systematic case study
research inpluralistic counselling and
psychotherapy. Counselling Psychology
26 Irish Association for Counselling and Psychotherapy
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Book Review
Title: Awaken to the Wisdom of your Dreams
Author: Kathleen Duffy
Published: December 2014
ISBN: 978-0954574093
Reviewed by: Catherine Tierney MIACP
For those readers who don’t tend to remember their
dreams, this book offers the following challenge:
“When we are prepared to accept that our dreams give
voice to the Psyche seeking wholeness, that every soul
longs to be reunited with its full potential, then doors
can begin to open”.
If you are prepared to take
up that challenge, then this
is a book worth exploring. It
includes almost one hundred
dreams, with detailed
reections on each. The
key approach is Jungian but
also draws on Fritz Perls,
Freud’s Free Association and
Assagioli’s Psychosynthesis to
mention but a few.
James Hollis features also,
primarily because dreams
can assist us in addressing
Hollis’ important existential
questions: “What is the
world asking of me?” for
the rst half of life. For the
second half of life – “What,
now, does the soul ask of
me?” This book is for anyone
approaching (or in) the second
half of life who is willing to
engage with that question, through their dreams. For
those interested in exploring a client’s dream, the
examples given are full of the symbolism and rich
imagery of the dream world, the language of the Soul.
However it may be best to practise on one’s own
dreams rst, to build condence.
What makes this book stand out for me – both
as a psychotherapist and as a presenter of dream
workshops - is the author’s courage and honesty in
sharing dreams which chart pivotal moments along her
own journey. It is a passionate and deeply spiritual
book, steeped in the landscape of the west of Ireland
(the author grew up in Mayo and practices there) and
full of religious symbolism from the strong Christian
tradition of her childhood. In revealing so much of
herself, the author calls all of us to examine where we
are on our own journey.
Two precognitive dreams appear to predict the
deaths of both her parents. Later dreams, after
their deaths, give great comfort. She shares the
disturbing dream of a client who was sexually abused
as a child. The author handles this dream and her
client with tender care and compassion and with great
skill. If I had one wish for the
book it would be for a dream
index at the back. There were
many dreams with wonderful
titles which I wanted to re-
examine for example: themes
of loss, transitions, anxiety,
relationships, anima/animus
struggles but couldn’t relocate
them.
There is a lovely line in the
book: “Consider the loyalty of
our Soul Self in its continual
effort to have us face and
embrace all of who we are”.
One great dream of the author’s
encapsulates this with “a two-
layered hem of black and of
gold”. How Jung would have
loved that perfect allegory for
his beloved dream work, the
dark and the gold. The Shadow
gure can shine a light on our
unlived potential (90% gold according to Jung) but can
also reveal our darkness (e.g. what is repressed or
denied).
Jung spoke of numinous dreams, magical
experiences, which give us a glimpse of the soul itself.
Some of the author’s dreams have this quality and
show how far along the road she has bravely travelled.
This book inspires me to keep travelling!
27
Irish Association for Counselling and Psychotherapy 27
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Workshop Review
COUNSELLING & PSYCHOTHERAPY FOR CLIENTS WITH A PSYCHIATRIC DIAGNOSIS OR WITH CO-MORBIDITY
Presenter: Gerry Farrell
Date: Saturday 21st March 2015
Organised by: Midlands Regional Branch IACP
Reviewed by: Caroline Singh, MIACP
Venue: Tuar Ard, Moate, Co. Westmeath
I was drawn to this workshop as I have spent
nearly twenty years working as a secretary in a GP
practice and trained and now work as a Counsellor/
Psychotherapist. I wanted to learn more about
working effectively with diagnoses from a counselling
rather than medical perspective. It proved to be a very
rewarding, entertaining and informative experience.
The presenter, Gerry Farrell, has a background in
psychiatric nursing in Ireland and the UK including;
care of the elderly, working with addictions,
adolescents, and in residential eating disorder
centres. Over time his eyes were opened to the
possibility of helping individuals in a non-residential
setting. This helped to steer his path into the area
of counselling and psychotherapy. Gerry began by
inviting us to introduce ourselves and outline what
we hoped to gain from the day. Borderline Personality
Disorder, prescribed medication, Narcissism, Bi-Polar
Disorder, Dementia and General Anxiety Disorder
(GAD), were discussed during the workshop.
The facilitator kept the content informative as
well as entertaining with excellent humorous
observations; slipping in and out of character
frequently to give us a taste of the individual
personality types and punctuating the more thought-
provoking and challenging parts of the day with
sufcient levity to keep us interested. He allayed
some fears expressed that counsellors need to be
an expert to work with a specic diagnosis. What
matters more are empathic relationships and creating
the space for a client to tell you what their diagnosis
is like for them. He also stressed the importance of
rolling with any resistance encountered rather than
get drawn into a ‘Yes but....’ dialogue often evidenced
within the diagnosis of Dysthymia or longstanding,
chronic Depression.
There was a diverse range of material presented
here, interspersed with discussions on Schizophrenia,
Bi-Polar and Narcissism. Gerry introduced Charles
Handy’s, ‘Four Gods of Management’, whereby
employees of various organisations can nd
themselves availing of EAP (Employee Assist
Programme) services, as a result of being on the
receiving end of a Narcissistic Personality, particularly
in a Zeus type of organisation.
The systemic dynamic of neurotransmitters was
explained simply and clearly and we learnt about
the roles of each of the six main neurotransmitters
that pharmaceutical drugs can assist in re-balancing,
inhibiting or replacing. With a concise handout to
explain the major prescribed medications we looked
at this technical part of the presentation with ease
and a resultant new depth of knowledge.
In an exploration of Bi-Polar Disorder, Gerry
demonstrated a client presentation which included a
specic and very distinctive rate of speech, grandiose
ideation and a high degree of perception with the
question to participants – ‘How would you feel about
working with a client like that?’ We were given a copy
of a Mental State Examination assessment form
and were guided through the form highlighting the
presence or absence of the listed criteria.
During the afternoon the focus switched to
addictions and how they impact on family systems
where, the facilitator managed to balance theory and
the context of human fragility and connection. When
the content became more detailed Gerry maintained
the knack of lightening the moment with a witty story
or comment providing ample evidence of his passion
for acting and performing. We also learnt about
temperament types - Blue, Red, Yellow and Green
as applicable to Generalised Anxiety Disorder and
Borderline Personality Disorder.
All too soon, the day came to a close and I, along
with several other participants were left feeling like
we wanted more. I eagerly await the opportunity to
attend a follow-up workshop.
28 Irish Association for Counselling and Psychotherapy
Éisteach Editorial Committee – Invitation
Volume 15
l
Issue 2
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Summer 2015
The editorial committee would like to invite members
to both consider volunteering with the committee and
would like to encourage members to submit articles
for potential publication. An on-going issue for the
eld of counselling/psychotherapy is the insufcient
amount of empirical evidence demonstrating the
efcacy of therapy in the eyes of some in the medical
profession and among insurance underwriters. No
doubt, countless potential referrals have been lost
as a consequence. Accordingly, for the coming year,
Éisteach will give precedence to articles which have a
research element, be they quantitative or qualitative
in nature.
The committee will also continue to welcome articles
which reect the diversity of modalities and views
within IACP. Interestingly, some aspects of therapy
seem to generate many more articles than others,
most notably the themes of sexuality and spirituality
in the past year. The committee would like to
encourage articles from areas of counselling and
psychotherapy which have been under-represented in
recent issues.
Those that meet the guidelines for publication,
available on the IACP website, are more likely to be
published. Finally, a word to the wise: writing is a
skill built-up over time through lots of practice, and
not an inborn talent only possessed by a few. Give it
a try! There are some books in HQ available for review
and we welcome requests from members who have
an interest in reading and submitting a review on any
of the following; email dee@iacp.ie
Cóilín Ó Braonáin PhD – Chairperson
eisteachchair@gmail.com
Books Available for Review
The Guided Way: A Counsellor’s Work with Young
People. Seeking Solutions Together through Writing &
Listening – Lucy McCullen
The Backwards Book: Poetry Therapy from Practice to
Theory – Niall Hickey
Mastering Your Self – Mastering Your World (living by
the Serenity Prayer) – John William Reich
The Forgiveness Project: Stories for a Vengeful Age
– Marina Cantacuzino
What You Really Need to Know about Counselling &
Psychotherapy Training – Cathy McQuaid
In Gratitude (The Story of a Gift-Filled Life) –
Catherine McCann
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... This strategy or practice, which has received increasing attention over the past decades (but is not explicitly mentioned in COPE), refers to active presence in the moment and awareness of thoughts and feelings (gradually letting them go). 28 The coping strategies laid out in this section will be used in the interpretive analysis below to elucidate how the bloggers' use of metaphors can be seen to articulate or function as ways of coping. ...
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Living with a life-limiting cancer illness can entail a turmoil of feelings such as constant fear of loss, suffering and dying. Because patients live longer with life-limiting illness, there is a need for enhanced understanding of how people make sense of and cope with the complicated aspects that this life situation brings on. In this article, we explore how bloggers with advanced cancer use metaphors as ways of making sense of their experiences. Our study is theoretically grounded in Conceptual Metaphor Theory, where metaphors are seen as a powerful phenomenon that both reflects and affects our thinking. The data consist of a corpus of blogs written in Swedish by individuals with advanced cancer, and the findings from our linguistic metaphor analysis are consistently interpreted against the backdrop of literature on coping. Our study thus highlights the intersection of linguistic metaphor analysis and psychological theories of coping by illustrating the many and complex functions metaphors can have as part of sense-making processes. Our hermeneutic approach enables us to show some differences among the three most pervasive metaphor domains in our material, battle, journey and imprisonment: the journey and imprisonment domains are more flexible than the battle domain in terms of the different kinds of coping strategies that are actualised by the bloggers’ use of metaphors. One particular finding from our analysis is the way in which the bloggers make use of metaphors to compartmentalise experiences and emotions. Our contention is that careful attention to the metaphors used by patients can improve communication in healthcare and enhance understanding of the complex role language use plays in coping processes more generally. By highlighting the relation between metaphor use and coping, our analysis also provides a way to discuss coping strategies based on the patient’s own use of language.
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Background The COVID-19 pandemic has seen an increase in depression and anxiety among those with and without a history of mental illness. Commonly used forms of psychological therapy improve mental health by teaching psychotherapeutic strategies that assist people to better manage their symptoms and cope with life stressors. Minimal research to date has explored their application or value in managing mental health during significant broad-scale public health crises. Aims To determine which psychotherapeutic strategies people who have previously received therapy use to manage their distress during the COVID-19 pandemic, and whether the use and perceived helpfulness of these strategies has an effect on symptoms of depression and anxiety. Method Data ( N = 857) was drawn from multiple waves of a representative longitudinal study of the effects of COVID-19 on the mental health of Australian adults, which includes measures of anxiety, depression and experiences with psychotherapy and psychotherapeutic strategies. Results Previous engagement in therapy with psychotherapeutic strategies had a protective effect on depressive but not anxiety symptoms. Common and helpful strategies used by respondents were exercise, mindfulness and breathing exercises. Using mindfulness and perceiving it to be helpful was associated with lower levels of depression and anxiety symptoms. No other strategies were associated with improved mental health. Conclusions Prior knowledge of psychotherapeutic strategies may play a role in managing mental health during unprecedented public health events such as a global pandemic. There may be value in promoting these techniques more widely in the community to manage general distress during such times.
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