, Volume 5, Issue 4, pp 351–359 | Cite as

Rethinking Mindfulness in the Therapeutic Relationship

  • Gonzalo Brito


Mindfulness in the Buddhist context does not stand alone as a tool or technique to reduce and relieve stress. On the contrary, mindfulness is seen as a part of a contextualized set of attitudes, exercises, and practices that are employed to facilitate a deeper understanding of the illusion of a solid and separate self, which is believed to be a fundamental source of suffering. This paper explores how a contextually embedded and culturally informed understanding of mindfulness and the spiritual nature of this practice may help enhance therapeutic presence and the therapeutic relationship. First, it presents a review of the empirical literature discussing therapists’ mindfulness and the therapeutic relationship with an emphasis on the therapists’ presence. Second, it offers a critique of how mindfulness has often been understood in a reductionist fashion as an attentional technique instead of a mode of being. Third, it articulates a contextually embedded view of mindfulness, including its inherent transformational aspects. This paper argues for a revision of the current understanding of mindfulness in mainstream psychology, particularly in relation to the therapeutic relationship.


Mindfulness Therapeutic relationship Psychotherapy Buddhism 


  1. Baer, R. A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. doi: 10.1093/clipsy/bpg015.Google Scholar
  2. Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.CrossRefGoogle Scholar
  3. Bruce, N., Manber, R., Shapiro, S., & Constantino, M. (2010). Psychotherapist mindfulness and the psychotherapy process. Psychotherapy: Theory, Research, Practice, Training, 47(1), 83–97. doi: 10.1037/a0018842.CrossRefGoogle Scholar
  4. Chödrön, P., & Berliner, H. (2005). No time to lose: a timely guide to the way of the Bodhisattva. Boston: Shambhala.Google Scholar
  5. Cullen, M. (2011). Mindfulness-based interventions: an emerging phenomenon. Mindfulness, 2(3), 186–193. doi: 10.1007/s12671-011-0058-1.CrossRefGoogle Scholar
  6. Cushman, P. (1995). Constructing the self, constructing America: a cultural history of psychotherapy. Boston: Addison-Wesley.Google Scholar
  7. Dryden, W., & Still, A. (2006). Historical aspects of mindfulness and self-acceptance in psychotherapy. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 24(1), 3–28. doi: 10.1007/s10942-006-0026-1.Google Scholar
  8. Farb, N., Anderson, A., & Segal, Z. (2012). The mindful brain and emotion regulation in mood disorders. Canadian Journal of Psychiatry, 57(2), 70–77.Google Scholar
  9. Freud, S. (1912). Recommendations to physicians on practicing psycho-analysis. In J. Strachey (Ed.), Standard edition of the complete psychological works of Sigmund Freud (Vol. 1, pp. 109–120). London: Hogarth.Google Scholar
  10. Greenberg, L. S., Watson, J. C., Elliot, R., & Bohart, A. C. (2001). Empathy. Psychotherapy: Theory, Research, Practice, Training, 38(4), 380–384. doi: 10.1037/0033-3204.38.4.380.CrossRefGoogle Scholar
  11. Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., Rother, W., & Nickel, M. (2007). Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: a randomized, double-blind, controlled study. Psychotherapy and Psychosomatics, 76(6), 332–338.PubMedCrossRefGoogle Scholar
  12. Grossman, P. (2010). Mindfulness for psychologists: paying kind attention to the perceptible. Mindfulness, 1, 87–97. doi: 10.1007/s12671-010-0012-7.CrossRefGoogle Scholar
  13. Gyatso, T. (XIV Dalai Lama). (1980). Universal responsibility and the good heart. Dharamsala: Library of Tibetan Works & Archives.Google Scholar
  14. Gyatso, T. (XIV Dalai Lama). (2002). How to practice: The way to a meaningful life. New York: Pocket BooksGoogle Scholar
  15. Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford.Google Scholar
  16. Hick, S., & Bien, T. E. (2008). Mindfulness and the therapeutic relationship. New York: Guilford.Google Scholar
  17. Hölzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36–43.PubMedCentralPubMedCrossRefGoogle Scholar
  18. Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Delta Trade Paperbacks.Google Scholar
  19. Kabat-Zinn, J. (1994). Wherever you go, there you are: mindfulness meditation for everyday life. London: Piatkus.Google Scholar
  20. Kabat-Zinn, J. (1996). Mindfulness meditation: what it is, what it isn't, and its role in health care and medicine. In J. Haryuki, Y. Ishii, & M. Suzuki (Eds.), Comparative and psychological study on meditation (pp. 161–170). the Netherlands: Eburon.Google Scholar
  21. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. doi: 10.1093/clipsy/bpg016.Google Scholar
  22. Kabat-Zinn, J. (2005). Coming to our senses: healing ourselves and the world through mindfulness. New York: Hyperion.Google Scholar
  23. Kang, C., & Whittingham, K. (2010). Mindfulness: a dialogue between Buddhism and clinical psychology. Mindfulness, 1(3), 161–173. doi: 10.1007/s12671-010-0018-1.CrossRefGoogle Scholar
  24. Kapleau, P. (1989). The three pillars of Zen: teaching, practice, and enlightenment. New York: Anchor Books.Google Scholar
  25. Kazdin, A. E. (2002). Research design in clinical psychology (4th ed.). Boston: Allyn and Bacon.Google Scholar
  26. Khong, B. (2009). Expanding the understanding of mindfulness: seeing the tree and the forest. Humanistic Psychologist, 37(2), 117–136.CrossRefGoogle Scholar
  27. Kuan, T. (2008). Mindfulness in early Buddhism: New approaches through psychology and textual analysis of Pali, Chinese, and Sanskrit sources. London: RoutledgeGoogle Scholar
  28. Lambert, M. J., & Barley, D. E. (2001). Research summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy: Theory, Research, Practice, Training, 38(4), 357–361. doi: 10.1037/0033-3204.38.4.357.CrossRefGoogle Scholar
  29. Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 139–193). New York: Wiley.Google Scholar
  30. Lambert, M. J., & Simon, W. (2008). The therapeutic relationship: central and essential in psychotherapy outcome. In S. Hicks & T. Bien (Eds.), Mindfulness and the therapeutic relationship (pp. 19–33). New York: Guilford.Google Scholar
  31. Lazar, S., Kerr, C., Wasserman, R., Gray, J., Greve, D., Treadway, M., & Fischl, B. (2005). Meditation experience is associated with increased cortical thickness. Neuroreport, 16(17), 1893–1897.PubMedCentralPubMedCrossRefGoogle Scholar
  32. Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford.Google Scholar
  33. Lutz, A., Brefczynski-Lewis, J., Johnstone, T., & Davidson, R. J. (2008). Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PLoS One, 3(3), e1897. doi: 10.1371/journal.pone.0001897.PubMedCentralPubMedCrossRefGoogle Scholar
  34. Lutz, A., Greischar, L. L., Perlman, D. M., & Davidson, R. J. (2009). BOLD signal in insula is differentially related to cardiac function during compassion meditation in experts vs. novices. NeuroImage, 47(3), 1038–1046. doi: 10.1016/j.neuroimage.2009.04.081.PubMedCentralPubMedCrossRefGoogle Scholar
  35. Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450. doi: 10.1037/0022-006x.68.3.438.PubMedCrossRefGoogle Scholar
  36. Martin, J. R. (1997). Mindfulness: a proposed common factor. Journal of Psychotherapy Integration, 7(4), 291–312. doi: 10.1023/B:JOPI.0000010885.18025.bc.CrossRefGoogle Scholar
  37. May, S., & O’Donovan, A. (2007). The advantages of the mindful therapist. Psychotherapy in Australia, 13(4), 46–53.Google Scholar
  38. McCollum, E. E., & Gehart, D. R. (2010). Using mindfulness meditation to teach beginning therapists therapeutic presence: a qualitative study. Journal of Marital and Family Therapy, 36(3), 347–360.PubMedGoogle Scholar
  39. Mikulas, W. (2007). Buddhism Western psychology: fundamentals of integration. Journal of Consciousness Studies, 14, 4–49.Google Scholar
  40. Mikulas, W. (2010). Mindfulness: significant common confusions. Mindfulness 2(1), 1–7. doi: 10.1007/s12671-010-0036-z.Google Scholar
  41. Moore, P. (2008). Introducing mindfulness to clinical psychologists in training: an experiential course of brief exercises. Journal of Clinical Psychology in Medical Settings, 15(4), 331–337. doi: 10.1007/s10880-008-9134-7.PubMedCrossRefGoogle Scholar
  42. Nhat Hanh, T. (1998). The heart of the Buddha's teaching: transforming suffering into peace, joy & liberation. Berkeley: Parallax.Google Scholar
  43. Ray, R. A. (2008). Touching enlightenment: finding realization in the body. Boulder: Sounds True.Google Scholar
  44. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. doi: 10.1037/h0045357.PubMedCrossRefGoogle Scholar
  45. Rosenbaum, R. (2009). Empty mindfulness in humanistic psychotherapy. Humanistic Psychologist, 37(2), 207–221.CrossRefGoogle Scholar
  46. Salzberg, S. (1995). Lovingkindness: the revolutionary art of happiness. Boston: Shambhala.Google Scholar
  47. Schure, M. B., Christopher, J., & Christopher, S. (2008). Mind–body medicine and the art of self-care: teaching mindfulness to counseling students through yoga, meditation, and qigong. Journal of Counseling and Development, 86(1), 47–56.CrossRefGoogle Scholar
  48. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York: Guilford.Google Scholar
  49. Shapiro, D. H. (1992). A preliminary study of long term meditators: goals, effects, religious orientation, cognitions. Journal of Transpersonal Psychology, 24(1), 23–39.Google Scholar
  50. Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomized trial. International Journal of Stress Management, 12(2), 164–176. doi: 10.1037/1072-5245.12.2.164.CrossRefGoogle Scholar
  51. Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and Education in Professional Psychology, 1(2), 105–115. doi: 10.1037/1931-3918.1.2.105.CrossRefGoogle Scholar
  52. Shapiro, S. L., & Carlson, L. E. (2009). The art and science of mindfulness: integrating mindfulness into psychology and the helping professions. Washington, DC: American Psychological Association.Google Scholar
  53. Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386. doi: 10.1002/jclp.20237.PubMedCrossRefGoogle Scholar
  54. Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21(6), 581–599. doi: 10.1023/a:1018700829825.PubMedCrossRefGoogle Scholar
  55. Siegel, D. J. (2007). The mindful brain: reflection and attunement in the cultivation of well-being. New York: Norton.Google Scholar
  56. Siegel, D. J. (2009). Mindful awareness, mindsight, and neural integration. Humanistic Psychologist, 37(2), 137–158. doi: 10.1080/08873260902892220.CrossRefGoogle Scholar
  57. Trungpa, C. (1973). Cutting through spiritual materialism. Berkeley: Shambhala.Google Scholar
  58. Walsh, R., & Shapiro, S. L. (2006). The meeting of meditative disciplines and western psychology: a mutually enriching dialogue. American Psychologist, 61(3), 227–239.PubMedCrossRefGoogle Scholar
  59. Watts, A. (1971). Psychotherapy: East and West. New York: Ballantine Books.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.School of PsychologySofia UniversityPalo AltoUSA

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