Clinical Social Work Journal

, Volume 42, Issue 3, pp 218–227 | Cite as

The Clinician as Neuroarchitect: The Importance of Mindfulness and Presence in Clinical Practice

  • Lisa L. BaldiniEmail author
  • Suzanne C. Parker
  • Benjamin W. Nelson
  • Daniel J. Siegel
Original Paper


Interpersonal neurobiology provides a framework from which to examine the incorporation of mindsight and mindfulness into clinical practice, employing the brain’s capacity for neuroplasticity to move oneself and one’s clients toward greater well-being. Through the lens of interpersonal neurobiology, this article will examine the benefits of mindfulness for clinicians, clients, and the therapeutic relationship. Lasting changes associated with mindfulness practices, including the hypothesized potential to alter one’s previously insecure attachment patterns, will also be discussed. An explanation of how to cultivate mindfulness by starting with presence and sustaining the practice with compassion will then be presented. Finally, practices that cultivate growth within the therapist–client relationship will be explained, along with clinical applications and recent research demonstrating the neural correlates of these practices and how they are effective at the level of the brain itself.


Interpersonal neurobiology Mindsight Mindfulness Presence 


  1. Carr, L., Iacoboni, M., Dubeau, M. C., Mazziotta, J. C., & Lenzi, G. L. (2003). Neural mechanisms of empathy in humans: A relay from neural systems for imitation to limbic areas. Proceedings of the National Academy of Sciences, 100(9), 5497–5502.CrossRefGoogle Scholar
  2. Cassidy, J., & Shaver, P. R. (Eds.). (2008). Handbook of attachment: Theory, research, and clinical applications (2nd ed.). New York: Guilford Press.Google Scholar
  3. Christopher, J. C., Chrisman, J. A., Trotter-Mathison, M. J., Schure, M. B., Dahlen, P., & Christopher, S. B. (2011). Perceptions of the long-term influence of mindfulness training on counselors and psychotherapists a qualitative inquiry. Journal of Humanistic Psychology, 51(3), 318–349.CrossRefGoogle Scholar
  4. Condon, P., Desbordes, G., Miller, W., DeSteno, D., Hospital, M. G., & DeSteno, D. (2013). Meditation increases compassionate responses to suffering. Psychological Science, 24(10), 2125–2127.Google Scholar
  5. Craig, A. D. (2003). Interoception: The sense of the physiological condition of the body. Current Opinion in Neurobiology, 13(4), 500–505.PubMedCrossRefGoogle Scholar
  6. Craig, A. D. (2008). Interoception and emotion: A neuroanatomical perspective. In M. Lewis, J. M. Haviland-Jones, & L. F. Barrett (Eds.), Handbook of emotions (pp. 272–292). New York, NY: Guilford Press.Google Scholar
  7. Creswell, J. D., Way, B. M., Eisenberger, N. I., & Lieberman, M. D. (2007). Neural correlates of dispositional mindfulness during affect labeling. Psychosomatic Medicine, 69(6), 560–565.PubMedCrossRefGoogle Scholar
  8. Damasio, A., & Carvalho, G. B. (2013). The nature of feelings: Evolutionary and neurobiological origins. Nature Reviews Neuroscience, 14(2), 143–152.PubMedCrossRefGoogle Scholar
  9. Davidson, R. J., & Begley, S. (2012). The emotional life of your brain: How its unique patterns affect the way you think, feel and live—and how you can change them. New York: Penguin.Google Scholar
  10. DiNoble, A. (2009). Examining the relationship between adult attachment style and mindfulness traits. Unpublished doctoral dissertation, California Graduate Institute of the Chicago School of Professional Psychology.Google Scholar
  11. Dunn, P. M., Arnetz, B. B., & Homer, L. (2007). Meeting the imperative to improve physician well-being: Assessment of an innovative program. Journal of General Internal Medicine, 22(11), 1544–1552.PubMedCentralPubMedCrossRefGoogle Scholar
  12. Farb, N. A., Anderson, A. K., & Segal, Z. V. (2012). The mindful brain and emotion regulation in mood disorders. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 57(2), 70.PubMedCentralPubMedGoogle Scholar
  13. Farb, N. A., Segal, Z. V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., et al. (2007). Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience, 2(4), 313–322.PubMedCentralPubMedCrossRefGoogle Scholar
  14. Feldman, R. (2007). Parent–infant synchrony: Biological foundations and developmental outcomes. Current Directions in Psychological Science, 16, 340–345.CrossRefGoogle Scholar
  15. Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M. (2008). Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology, 95(5), 1045.PubMedCentralPubMedCrossRefGoogle Scholar
  16. Geller, S. M., & Greenberg, L. S. (2002). Therapeutic presence: Therapists’ experience of presence in the psychotherapy encounter. Person-Centered & Experiential Psychotherapies, 1(1–2), 71–86.CrossRefGoogle Scholar
  17. Germer, C. K. (2009). The mindful path to self-compassion: Freeing yourself from destructive thoughts and emotions. New York: Guilford Press.Google Scholar
  18. Goodall, K., Trejnowska, A., & Darling, S. (2012). The relationship between dispositional mindfulness, attachment security and emotion regulation. Personality and Individual Differences, 52(5), 622–626.CrossRefGoogle Scholar
  19. Goodman, M. J., & Schorling, J. B. (2012). A mindfulness course decreases burnout and improves well-being among healthcare providers. The International Journal of Psychiatry in Medicine, 43(2), 119–128.CrossRefGoogle Scholar
  20. Greater Good Science Center. (2013). How to cultivate compassion? Retrieved from
  21. 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
  22. Gu, X., Gao, Z., Wang, X., Liu, X., Knight, R. T., Hof, P. R., et al. (2012). Anterior insular cortex is necessary for empathetic pain perception. Brain, 135(9), 2726–2735.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Hasson, U., Ghazanfar, A. A., Galantucci, B., Garrod, S., & Keysers, C. (2012). Brain-to-brain coupling: A mechanism for creating and sharing a social world. Trends in Cognitive Sciences, 16(2), 114–121.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Henry, W. P., Schacht, T. E., & Strupp, H. H. (1990). Patient and therapist introject, interpersonal process, and differential psychotherapy outcome. Journal of Consulting and Clinical Psychology, 58(6), 768.PubMedCrossRefGoogle Scholar
  25. Iacoboni, M. (2007). Face to face: The neural basis of social mirroring and empathy. Psychiatric Annals, 37(4), 236–241.Google Scholar
  26. Iacoboni, M. (2009). Imitation, empathy, and mirror neurons. Annual Review of Psychology, 60, 653–670.PubMedCrossRefGoogle Scholar
  27. Irving, J. A., Dobkin, P. L., & Park, J. (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary Therapies in Clinical Practice, 15(2), 61–66.PubMedCrossRefGoogle Scholar
  28. Jacobs, T. L., Epel, E. S., Lin, J., Blackburn, E. H., Wolkowitz, O. M., Bridwell, D. A., et al. (2011). Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology, 36(5), 664–681.PubMedCrossRefGoogle Scholar
  29. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.CrossRefGoogle Scholar
  30. Kane, M. J., Brown, L. H., McVay, J. C., Silvia, P. J., Myin-Germeys, I., & Kwapil, T. R. (2007). For whom the mind wanders, and when. Psychological Science, 18(7), 614.PubMedCrossRefGoogle Scholar
  31. Kearney, D. J., Malte, C. A., McManus, C., Martinez, M. E., Felleman, B., & Simpson, T. L. (2013). Loving-kindness meditation for posttraumatic stress disorder: A pilot study. Journal of Traumatic Stress, 26(4), 426–434.PubMedCrossRefGoogle Scholar
  32. Klimecki, O. M., Leiberg, S., Lamm, C., & Singer, T. (2013). Functional neural plasticity and associated changes in positive affect after compassion training. Cerebral Cortex, 23(7), 1552–1561.PubMedCrossRefGoogle Scholar
  33. Krasner, M., Epstein, R., Beckman, H., Suchman, A., Chapman, B., Mooney, C., et al. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA: The Journal of the American Medical Association, 302(12), 1284–1293.CrossRefGoogle Scholar
  34. Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., et al. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112.PubMedCrossRefGoogle Scholar
  35. Lazar, S. W., Kerr, C. E., Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway, M. T., et al. (2005). Meditation experience is associated with increased cortical thickness. NeuroReport, 16(17), 1893.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  37. MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552.PubMedCrossRefGoogle Scholar
  38. Mikulincer, M., & Shaver, P. R. (2007). Boosting attachment security to promote mental health, prosocial values, and inter-group tolerance. Psychological Inquiry, 18(3), 139–156.CrossRefGoogle Scholar
  39. Neff, K. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101.CrossRefGoogle Scholar
  40. Neff, K. (2011). Self-compassion: Stop beating yourself up and leave insecurity behind. New York: HarperCollins e-books.Google Scholar
  41. Neff, K. D. (2012). The science of self-compassion. In C. Germer & R. Siegel (Eds.), Compassion and wisdom in psychotherapy (pp. 79–92). New York: Guilford Press.Google Scholar
  42. Neff, K. D., & McGeehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adults. Self and Identity, 9, 225–240.CrossRefGoogle Scholar
  43. Nelson, B. W., Parker, S. C., & Siegel, D. J. (2013). Interpersonal neurobiology, mindsight, and the triangle of well-being: The mind, relationships & the brain. In E. Tronick, B. Perry, & K. Brandt (Eds.), Infant & early childhood mental health (pp. 129–144). Washington, DC: American Psychiatric Publishing.Google Scholar
  44. Parker, S. C, Nelson, B. W., Epel E., Siegel, D. J. (in press). The science of presence: A central mediator of the interpersonal benefits of mindfulness. In K. W. Brown, J. D. Creswell, & R. M. Ryan (Eds.), Handbook of mindfulness: Theory and research. New York: Guilford Press.Google Scholar
  45. Ryan, R. M., Brown, K. W., & Creswell, J. D. (2007). How integrative is attachment theory? Unpacking the meaning and significance of felt security. Psychological Inquiry, 18, 177–182.CrossRefGoogle Scholar
  46. Salzberg, S. (2004). Lovingkindness: The revolutionary art of happiness. Boston, MA: Shambhala.Google Scholar
  47. Santorelli, S. F., & Kabat-Zinn, J. (2009). Mindfulness-based stress reduction professional training resource manual: Integrating mindfulness meditation into medicine and health care. Worcester: University of Massachusetts Medical School.Google Scholar
  48. Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., et al. (2012). Burnout and satisfaction with work–life balance among US physicians relative to the general US population. Archives of Internal Medicine, 172(18), 1377–1385.PubMedCrossRefGoogle Scholar
  49. Shapiro, S. (2013). Does mindfulness make you more compassionate? Retrieved from
  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.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.CrossRefGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar
  53. Siegel, D. J. (2007). The mindful brain: Reflection and attunement in the cultivation of well-being. New York: W.W. Norton & Company.Google Scholar
  54. Siegel, D. J. (2009). Mindful awareness, mindsight, and neural integration. The Humanistic Psychologist, 37(2), 137–158.CrossRefGoogle Scholar
  55. Siegel, D. J. (2010a). The mindful therapist: A clinician’s guide to mindsight and neural integration. New York: W.W. Norton & Company.Google Scholar
  56. Siegel, D. J. (2010b). Mindsight: The new science of personal transformation. New York: Bantam.Google Scholar
  57. Siegel, D. J. (2012a). The developing mind, second edition: How relationships and the brain interact to shape who we are. New York: Guilford Press.Google Scholar
  58. Siegel, D. J. (2012b). Pocket guide to interpersonal neurobiology: An integrative handbook of the mind. New York: W.W. Norton & Company.Google Scholar
  59. Siegel, D. J., & Hartzell, M. (2003). Parenting from the inside out: How a deeper self-understanding can help you raise children who thrive. New York: Tarcher.Google Scholar
  60. Sroufe, L. A., Egeland, B., Carlson, E., & Collins, W. A. (2005). Placing early attachment experiences in developmental context: The Minnesota longitudinal study. In K. E. Grossmann, K. Grossmann, & E. Waters (Eds.), Attachment from infancy to adulthood: The major longitudinal studies (pp. 48–70). New York: Guilford Publications.Google Scholar
  61. Sroufe, L. A. & Siegel, D. J. (2011). The verdict is in: The case for attachment theory. Psychotherapy Networker, March–April.Google Scholar
  62. Standen, A. (2012). Through meditation, veterans relearn compassion. Retrieved from
  63. Zylowska, L., Ackerman, D. L., Yang, M. H., Farrell, J. L., Horton, N. L., Hale, T. S., et al. (2008). Mindfulness meditation training in adults and adolescents with ADHD a feasibility study. Journal of Attention Disorders, 11(6), 737–746.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Lisa L. Baldini
    • 1
    Email author
  • Suzanne C. Parker
    • 2
  • Benjamin W. Nelson
    • 3
    • 4
  • Daniel J. Siegel
    • 5
    • 6
    • 7
    • 8
  1. 1.Center for Health Care EvaluationVA Palo Alto Health Care SystemMenlo ParkUSA
  2. 2.University of MiamiCoral GablesUSA
  3. 3.UCLA Semel Institute for Neuroscience and Human BehaviorLos AngelesUSA
  4. 4.Department of PsychologyUniversity of OregonEugeneUSA
  5. 5.Mindsight InstituteLos AngelesUSA
  6. 6.UCLA School of MedicineLos AngelesUSA
  7. 7.UCLA Mindful Awareness Research CenterLos AngelesUSA
  8. 8.Foundation for Psychocultural Research-UCLA Center for Culture, Brain, and DevelopmentLos AngelesUSA

Personalised recommendations