Counseling Today, Features

A healthy mind-set

Jonathan Rollins October 7, 2006

Judy Maris was halfway through her counseling internship and foundering. In her early 50s, she had decided to make a drastic career change and entered Montana State University’s mental health counseling program. Now, with the finish line in sight, self-doubt was threatening to overtake her.

“I was finding myself knocked off my feet again and again during my internship,” she says. “I was getting caught up in the client narratives and going immediately to problem solving. I was trying really hard to do it ‘right’ each day and instead ended up feeling clumsy and awkward. Struggling had become my M.O.”

At the same time, Maris was beginning a counseling elective course taught by her practicum supervisor, John Christopher. There was double incentive for Maris’ enrollment in the class. First, “I had a lot of respect for John,” Maris says. “He is an incredibly ‘present’ person. Even if you don’t know that concept, you understand quickly that here is someone who is truly ‘with’ you. I wanted to have that, too.” Her second reason? “The class didn’t seem too hard,” she admits. “I basically thought it was a yoga class.”

Christopher’s class, Mind-Body Medicine and the Art of Self-Care, does involve yoga. It also involves meditation, relaxation techniques and qigong, a Chinese discipline of gentle, graceful movements related to tai chi. Christopher, a counseling professor and member of the American Counseling Association, designed the course six years ago primarily to improve students’ self-care through mindfulness-based stress reduction techniques. To his surprise (and to the surprise of many counseling students, who assume they are simply signing up for an “easy” course), the class has had an even more significant impact. “I’ve been shocked at how powerful the course has been,” Christopher acknowledges. “It was really more about self-care. I wasn’t expecting the overflow into the students’ counseling practices to be so profound.”

Maris, who earned her master’s degree in 2005 and is now working in a private practice under supervision as she pursues licensure, believes the class ultimately altered the course of her counseling career. “My internship supervisor (at Montana State) started noticing a change in my work before I did,” she says. “As I was taking the (Mind-Body Medicine) class, my work took on a new organic quality, showed much more spontaneity and was enlivened. I started getting great results as far as shifts in my clients, and it had nothing to do with problem solving. I was learning how to genuinely feel positive regard for my clients, let go of judgments and be present in the moment. I was learning to contain clients’ anxiety without joining in. We’re told over and over again (as counseling students) that this is what we need to do, but no one had told us how.”

Christopher didn’t exactly tell Maris how either, but his course did something even better — it showed her. “It was the class that had the most impact on both my clinical work and on my personal life,” she says. “It was a transformative experience for me.”

Lessons in self-care

Stress, burnout and even vicarious trauma are facts of life for counselors. Surprisingly, Christopher says, relatively few counseling programs teach students how to deal with those problems. “Self-care is something we mostly give lip service to,” he says. “We all recognize that self-care is central to the field, but we don’t have many techniques for helping students to achieve that.”

Christopher first got interested in yoga, meditation and the martial arts as avenues to tap into human potential as a young man. He later became a yoga instructor and then went back to school for a degree in counseling. “For years,” he says, “I didn’t know how to integrate my commitment to spiritual practices with my counseling practice or my thinking about clients. They were two different worlds.”

But approximately eight years ago, a nurse at Montana State returned from a seminar and approached Christopher about helping her to run some mindfulness-based stress reduction programs at the local hospital. From there, a colleague suggested that Christopher design a similar course for counseling students.

Students in Christopher’s Mind-Body Medicine course meet twice a week and spend the first 75 minutes of each class practicing qigong, yoga and meditation. Different students are drawn to each of the specific disciplines. “The multiple methods show them that there are different avenues into the mind,” Christopher says. The next 45 minutes are spent reviewing readings and empirical research articles on the disciplines and discussing their applications to counseling.

Students are also expected to practice the disciplines outside of class for 45-minute sessions four times per week. In addition, students maintain experiential journals in which they comment on the readings and reflect on the mindfulness-based practices. “Their journals are really kind of works of art,” Christopher says. “Oftentimes, they’re very open about their personal struggles and how this course is impacting them.”

Maris remembers vividly the unexpected challenges posed to her early on in class by the seemingly simple process of meditating. “It was very challenging for me to sit still and quiet my mind,” says Maris, a member of the American Mental Health Counselors Association, a division of ACA. “It was staggering to find out the cacophony of noise going on in my mind all the time. I became aware that it was controlling my life.”

While those revelations can be startling, says Christopher, part of the process of self-care is becoming more aware of when we’re feeling stressed out and frazzled. “Mindfulness-based practices are really about slowing down,” he explains. “There’s something really healing about that. A lot of the strategies in our culture are based on avoidance or denial. Mindfulness is about directly encountering one’s emotional fatigue and stress, going through the experience fully and coming through the other side when you’re ready. It’s about allowing ourselves to have moments of surrender or dying and rebirth.”

That principle holds true even for the most experienced professional counselors, Christopher says. “After a difficult session with a client, you should give yourself five minutes to sit in a chair and let everything you’re feeling flood through you. That process serves as a release. But we often don’t do that. Instead we rush to get another cup of coffee.”

From classroom to counseling room

“I think counselors, as a group, are really pretty hard on themselves,” Maris says. “The biggest piece of self-care for me was letting go of beating myself up all the time. I let go of the judgments and let go of the need to control everything. I’ve learned to just accept whatever is in this moment, whether that’s fatigue or a cramp in my leg or the phone ringing. … Doing ‘nothing’ (in response to a problem) runs counter to our whole culture, but for me, learning to do that happened while meditating on the cushion. For me, the heart and soul of the course was sitting by myself on a cushion in silence.”

What has become more apparent with each year that Christopher teaches his class is that the mindfulness practices meant to help students manage their stress are also having a dynamic impact on their actual counseling skills. According to Christopher’s published research, students report that the course:

  • Increases their comfort with a client’s silence or expression of strong emotions
  • Increases their clarity of thought and capacity for reflection
  • Increases their capacity for empathy and compassion
  • Enhances their listening abilities
  • Improves their ability to focus on clients and the therapeutic process

Being “present” is a struggle for most people, Christopher says, but mastering that concept is especially important for counselors, who must be focused on their clients. Mindfulness practices help counselors do exactly that. “Learning listening skills requires a kind of discipline,” Christopher says. “This is similar to the kind of discipline required for and cultivated by mindfulness practices. It’s a learned discipline to live in the moment — to stay in the present — instead of dwelling in the past or future.”

Maris says that engaging in low-impact activities such as yoga, qigong and meditation on a daily basis helped her both physically and emotionally. “It’s a way of beginning each day being aware of your own body instead of the hundred things you need to do,” she says. “I found myself more at ease and sleeping better at night.”

Now that she is out of the classroom and working full time as a counselor, Maris has fallen out of the habit of practicing yoga. But meditation remains a part of her daily routine, and the tools she acquired in Christopher’s class are still integral to her therapeutic approach. “I have my days when I’m not centered and back into the mode of following the client’s narrative,” she says, “but I usually take three to five minutes before each session to focus my mind, attention and breathing.” Inspired by her experience in Christopher’s class, Maris even went on a 10-day meditation retreat, spending 13 hours a day on the meditation cushion.

Getting clients centered

The mindfulness practices that have proved so successful with counselors-in-training can also be of great benefit to clients, Christopher says. In particular, he believes the disciplines can help clients who are struggling with anxiety or depression, who are overly self-critical, who have a tendency to be spectators rather than actively engaged or who haven’t learned to be comfortable with the full range of emotional experiences. Even so, Christopher says, “I don’t teach students about how to introduce these practices to clients because you first have to be really dedicated to practicing them on your own.”

Still, many of Christopher’s students have gone on to integrate elements of mindfulness practices into their counseling sessions with clients. Maris regularly develops mindfulness practices for her counseling clients, sometimes leading them through a meditation exercise as they sit on a cushion, other times simply sitting in silence with them. “It’s not traditional stuff,” Maris says, “but for clients who are able to become mindful in session, it helps transition them from the chaos of their lives to the present moment and to become more in tune with themselves. It’s a way to begin to disconnect from your reactivity.”

Not every client is able to enter mindfulness, Maris says. Still, she does what she can to calm their minds. When she works with clients who exhibit high anxiety levels, for instance, she notices that their breathing is shallow and rapid. Before learning mindfulness-based practices, Maris says, she likely would have fed off the clients’ anxiety. Now, she attempts the opposite approach — getting anxiety-ridden clients to feed off of her calm. She begins by intentionally slowing her own breathing and talking to the clients in a soft, measured tone. After some time, clients often fall in line with Maris’ deep, unhurried breathing, releasing tension and relaxing their minds without ever being verbally instructed to do so. “That seems to bring them as close to mindfulness as they’re able to be at the moment,” Maris says.

Maris is up front about her belief in the usefulness of mindfulness practices and meditation with clients and always asks permission before using them in therapy. Client reaction has been exceedingly positive, she says, but she won’t attempt to use mindfulness techniques with certain clients. “A moment of silence would be too terrifying for them,” she says. “The noise of their lives in their minds is a safety factor for them.” She adds that she is also cautious about using mindfulness practices with certain trauma victims.

Christopher’s research has shown that the Mind-Body Medicine class at Montana State is consistently transformative for counseling students. He is undertaking a follow-up study to determine the course’s long-term impact. “Our preliminary analysis indicates that about half the students remain committed to some type of formal practice,” he says, “and the vast majority find ways to incorporate mindfulness principles into their everyday lives and self-care strategies.”

There has been some discussion about making the course a requirement for counseling students at the university. Maris is a proponent of that thought. “I can’t think of anything that has as far-reaching a positive effect as developing some type of meditation practice,” she says. “We (counselors) deal with a lot of human suffering. To be able to deal with that fully and compassionately, we have to be able to be compassionate with ourselves first.”