Introduction

Social workers play a vital role in supporting and improving the life circumstances and social well-being of the service users that they work with (Ravalier et al., 2021). Social work can be a challenging occupation with many aspects of the job proving stressful or, at times, overwhelming for practitioners dealing with demanding caseloads, reduced access to adequate supervision and organisational support, public scrutiny, and a blame culture (Acker, 2012; Ravalier, 2019; Kinman et al., 2020; Turley et al. 2021). Social workers have been found to be at higher risk of stress and ultimately burnout because of their job role, particularly when compared to other occupations (Kinman et al., 2020). Turley et al. (2021) point to evidence suggesting that UK social workers have an average working life span of less than 8 years, which is significantly lower than their nursing (16 years) and medical (25 years) counterparts. Stress and burnout not only affect the individual social worker but will inevitably lead to subsequent negative effects for social work organizations and the service users they work with (Ravalier et al., 2021). Social worker turnover has been a serious issue for the profession because is negatively impacts the quality, consistency, and stability of services (Kim & Stoner, 2008).

Self-care strategies have been associated with increased job satisfaction and reduced turnover intention in social work (Acker, 2018). In order to support social workers’ capacities to cope with the consistent emotional, cognitive and physical demands of their profession, the development of self-care skills and strategies is likely to be very important (Kinman et al., 2020). The development of these skills and strategies, which should be seen as important adjuncts to complement organizational interventions, e.g. supervision, would likely help social workers to practice more sustainably over the longer term, in a manner that is more critically reflexive, compassionate, non-judgemental, empathetic and emotionally resilient (Maddock et al., 2021). Mindfulness-based programmes (MBPs) have been recommended as a means by which social workers and students could improve their self-care skills and social work practice (Maddock et al., 2021). There is however a significant lack of research on mindfulness-based programmes that focus primarily on social workers and the unique stressors that social workers face (Beer et al., 2020; Maddock et al., 2021). The work-related constraints that social workers face emphasise the need to develop testable theories of MBPs, which would allow the development of shorter MBPs that are tailored to social worker’s needs (Braun et al., 2019). A theory of this nature could allow the active therapeutic mechanisms of MBPs for social workers to be intensified (Maddock et al., 2019a), in order to help improve feelings of stress, burnout, anxiety, low mood and poor psychological well-being experienced by social workers (Beer et al., 2020; Braun et al., 2019; Maddock et al., 2021).

In response to the need for a shorter, more accessible and social work focussed MBP, Maddock et al., (2021) developed and evaluated the Mindfulness-Based Social Work and Self-Care Programme (MBSWSC) and piloted it with social work students. This online programme was based on an integrative theory of how mindfulness-based programmes might improve the stress, burnout, mental health and well-being of social workers and social work students called the clinically modified Buddhist psychological model (CBPM) (Maddock et al., 2019a, b, 2020a, b). The CBPM allowed this shorter bespoke social work programme to be developed, as the CBPM condenses a vast array of mindfulness mechanisms into an integrative model of how the stress, burnout, mental health and well-being of social workers and students could be improved (Maddock et al., 2019a, b, 2020a, b). The MBSWSC programme focuses on the development of each core component of the CBPM theory using adapted activities e.g. acceptance and self-compassion body scans, which focus on improving each domain of this theory through mindfulness-based practices. Maddock et al., (2021) found that MBSWSC significantly improved each domain of the CBPM theory along with perceived stress, feelings of burnout, anxiety and well-being of social work students. Though more research is needed, these findings provide some initial evidence that the CBPM is not just a potential explanatory theory for how MBPs might work, but is also a positive theory to underpin how reflective social work practice, feelings of stress, burnout, anxiety and well-being of social workers can be improved. The CBPM theory, which is represented in Fig. 1 below, will now be outlined in detail and applied to social work practice and self-care using a relevant case study example in the following sections.

Fig. 1
figure 1

The clinically modified Buddhist psychological model for social work practice and self-care

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The CBPM

The CBPM is underpinned by the most up to date empirical evidence on what the mechanisms of mindfulness might be (Maddock & Blair, 2021), and a number of theoretical models, including the Buddhist psychological model (BPM) (Grabovac et al., 2011), the stress coping theories of both Moos (1984; 2002) and Lazerus and Folkman (1984) along with the response style theory of rumination by Nolan Hoeksema (1998) and Borkovec’s (1994) avoidance theory of worry. In order to illustrate how the CBPM might help to explain effective social work practice and self-care, the author will use a case study example of Jane, a mental health social worker. The following narrative will highlight how: (1) the CBPM might help to explain Jane’s cognitive, emotional and physical reactions to working with two different service users, Brian and Marie, and (2) highlight the ways in which mindfulness practice could support Jane to approach and respond to each cognitive, emotional and physical reaction she experiences, in order to support her social work practice and self-care.

Marie (57 years of age) is a community mental health outpatient. Jane has been supporting Marie, who has a history of recurrent depression, by providing person centred counselling, behavioural activation activities and mindfulness-based approaches. Jane experiences Marie as being warm, friendly and motivated to manage her mental health. Brian (45 years of age) is a mental health hospital inpatient, who was referred to Jane by her multidisciplinary team, for support with accessing suitable accommodation, and anger management. Brian was recently released from prison, and his referral form states that he was ‘sentenced to three years in prison, due to numerous violent offences against members of the public’. Jane, in the past, has been a victim of domestic violence. As we join the case study, Jane has completed an initial assessment with Brian, at the end of which Brian vented his anger at Jane ‘for interfering in his business’ like the social workers that ‘took away my children’. Brian, aware that he needs Jane’s support has agreed to meet Jane again but has advised that he is ‘not happy about it’. Jane leaves the meeting feeling angry, but she feels that she shouldn’t feel angry, because she believes that social workers shouldn’t experience anger towards their clients. She decides to try to forget about the encounter.

Grabovac et al., (2011) outline how awareness in the present moment, occurs when any form of stimuli makes contact with one of our senses (e.g. cold hitting our face) or when a cognition (e.g. a thought, memory) arises in our minds (Grabovac et al., 2011). The awareness of any thought or physical sensation leads to a connected feeling, which can be perceived as either pleasant, unpleasant, or neutral (Grabovac et al., 2011). Grabovac et al., (2011) propose that a person will habitually respond to their feelings by pursuing pleasant feelings and by avoiding negative ones. We re-join Jane a week later. It is 4pm, and after a busy day, Jane has time left in her schedule to meet either Marie, by visiting her at home, or by visiting Brian in hospital. In line with the BPM, if Jane was not aware of her habitual thinking patterns and the effect these can have on her feelings and behaviour, she would be more likely to choose to meet Marie. This may be due to: (1) liking Marie and the knowledge that meeting her may bolster her view of herself as a social worker, or (2) wanting to avoid another negative experience with, or appraisal by Brian (Coffey et al., 2010).

Grabovac et al., (2011) highlight that mindfulness practices could help Jane to be more aware of her habitual thinking patterns and reduce any tendencies she has towards being attached to pleasant feelings and averse (or avoidant) to unpleasant feelings. Grabovac et al., (2011) propose, that through regular mindfulness meditation practice, Jane could develop an increased ability to focus her attention and accept her emotions as they arise. Grabovac et al., (2011) outline how this can lead to Jane having an increased ability to observe the constant arising and passing of positive and negative thoughts, emotions and physical sensations, which accompany her social work practice. This increased attentional awareness could allow Jane to release any need she might have for emotional control of her experience, along with any clinging or mental fixation (e.g. that she can’t be angry with Brian), which could lead to what Grabovac et al., (2011) refers to as mental proliferation, or repeated series of thoughts. In line with the BPM, as Jane has not allowed her anger to enter her conscious awareness and then allowed it to pass, she is likely to experience increased negative thoughts and resultant stress when Brian’s image enters her awareness. In line with the BPM, if Jane practiced mindfulness after the assessment with Brian, she would be in a better position to observe the arising and passing of the negative thoughts (I might not like Brian), emotions (anger) and physical sensations (tension in her neck), that related to the assessment with Brian. This would allow Jane to be in a better position to respond with greater acceptance and non-attachment, allowing these negative thoughts, emotions and physical sensations to arise and then pass. This process would then lead to Jane feeling less stressed and more willing to engage with Brian.

Stress coping – avoidant and approach coping

The CBPM explains how attached and aversive/avoidant responses to difficult thoughts, emotions and physical sensations, which may manifest due to social work practice, impact stress, mental health and wellbeing outcomes, by incorporating theories of stress coping. Lazerus and Folkman (1984) highlight how stress occurs when a person cognitively appraises their ability to cope against what is occurring in their environment. Social work generally occurs at the frontline of practice, in environments which are physically, emotionally and cognitively demanding (Beer et al., 2020). The complex demands that social workers experience every day in practice may lead to social workers appraising practice situations as being unmanageable and highly stressful (Beer et al., 2020), particularly if they are working with a large caseload, with limited supervision and feel that they have limited control in supporting desired service user outcomes (Ravalier, 2019). In our example, Jane has a heavy caseload, and feels that she was not receiving adequate support or supervision in order to process the negative thoughts, emotions and physical sensations that have accompanied working with Brian. Due to this, Jane appraises Brian’s case as being very stressful. Moos (1984) highlighted that a person’s cognitive appraisal of a stressor can lead to the person either engaging with an approach or avoidant coping response to that stressor. Moos (1984) identifies how avoidant coping responses tend to be defensive with a person either trying to escape, ignore or distort aspects of their experience, e.g. feelings of sadness or anger, that they perceive as threatening. There are a number of forms of avoidant coping, which include mental and behavioural disengagement, withdrawal or distraction (Stowell et al., 2001), thought suppression (Wenzlaff & Luxton, 2003), under-engagement with internal experiences (Hayes & Feldman, 2004), avoidance of emotions (Ottenbreit & Dobson, 2004), attachment to particular thoughts and emotions (Maddock et al., 2021), which may divert focus from a stressor and minimise immediate distress (Wethington et al., 2015). In the long run, however, these strategies tend to be maladaptive, as they do not resolve the underlying stressor, which is likely to persist or get worse, thereby increasing distress and amplifying future issues (Menaghan, 1983; Moos et al., 2002).

The concept of mental proliferation in the BPM, is developed further in the CBPM, which identifies how additional repeated negative thinking (RNT) processes can manifest when different forms of attachment and avoidance take place (Maddock et al., 2019a, b, 2020a, b). RNT is intrusive repetitive thinking about negative experiences which is difficult to disengage from (Ehring et al., 2011). The two most common forms of RNT are rumination and worry (Fresco et al., 2002). Rumination is the passive non-goal oriented repetitive negative thinking about the causes of why a person may be feeling low or upset (Nolen-Hoeksema, 1998). Worry is a chain of negative affect-laden thoughts which can feel uncontrollable (Borkovec et al., 1983). Social work involves working with service users and families who may have complex narratives, and rumination and worry can easily manifest for a social worker if they are trying to plan and solve a future practice problem whose outcome is not certain but could contain a number of negative outcomes or permutations (Borkovec et al., 1983). The CBPM outlines how RNT in the forms of rumination and worry may act as maladaptive avoidant stress coping strategies (Moos, 2002), which result when a social worker appraises that their environment or a future outcome is uncertain (Lyubomirsky & Nolen-Hoeksema, 1995). In line with Nolen-Hoeksema et al., (2008), the CBPM suggests that when social workers are worrying, they are uncertain or feel threatened about their ability to attain important social work practice goals or outcomes but believe that if they worry about every possible scenario, they will be more prepared if a negative result occurs. In contrast, when social workers ruminate, they are more certain that important goals or outcomes they are attached to and want to attain are not within their control, e.g. worrying about her next meeting with Brian, or ruminating about the previous assessment, might be an easier coping response for Jane, as she may be unwilling to accept that she may not be the best person to support Brian with his anger issues, due to Brian triggering anger in her, an emotion she has struggled to deal with in her past (Lyubomirsky et al., 1999). The CBPM outlines how worry and rumination may help Jane to avoid: (1) difficult emotions, such as deep sadness about her past experience of being a victim of violence, or anger at Brian, and/or, (2) accepting things she cannot change, by distracting her attention through recursive thinking (Giorgio et al., 2010). The CBPM outlines how this can prevent Jane from becoming aware of the transient nature of these negative emotions, and how these can be effectively processed by allowing them to enter her awareness, be felt in full along with their connected cognitions, before being allowed to pass into memory (Odou & Brinker, 2014). If the avoidance of difficult thoughts, emotions and physical sensations persists, it increases the likelihood that Jane will make anxious or depressive appraisals about her ability to cope with current and future work-related stressors, and/or other clients that could challenge her in a similar way to Brian. These anxious and/or depressive appraisals would then reduce Jane’s capacity to adequately problem solve and deploy more adaptive approach oriented coping resources (Borkovec, 1994; Nolan-Hoeksema, 1998). The CBPM outlines that in the long run, social workers who engage in consistent rumination and worry are likely to experience a number of negative consequences including increased stress, anxiety, depression and decreased well-being (Maddock et al., 2017; Maddock et al., 2021), and also fail to adequately resolve stressors that arose originally e.g. worry might help Jane to feel that she has anticipated every possible threat before a meeting with Brian, but due to the fact that these threats either did not exist or are unlikely to arise, patterns of worry are reinforced by their non-occurance (Borkovec, 1994; Nolan-Hoeksema, 1998). The avoidance of stress has also been identified in both the clinical empirical and theoretical literature as being key mechanisms on the development and maintenance of stress along with emotional disorders, such as anxiety and depression (Salkovskis, 1996; Gross, 2002).

Approach coping, in direct contrast, involves the emotional, cognitive and behavioural turning and moving towards experiences of stress (Moos, 2002). The CBPM outlines how if Jane approached the source of stress, this would be more adaptive than avoiding it, as it would allow her to focus on resolving the stressor. If Jane was to either meditate and/or speak to her supervisor, and by doing so approach, engage and then ventilate the difficult thoughts and emotions she is experiencing, this would reduce her stress levels and allow her to have more headspace (because in this process the worry or rumination she is experiencing would also reduce) to be able to resolve the underlying problems in Brian’s case and her wider work environment (Moos, 2002). This process would allow this stress to be ameliorated and the learning from how to resolve the stress of working with Brian to be assimilated in a manner which would allow Jane to develop increased self-awareness and enhanced approach oriented coping skills (Maddock et al., 2017; Maddock et al., 2021). The deployment of these skills would help to reduce subsequent stress and improve Jane’s well-being and mental health (Weinstein et al., 2009).

CBPM approach oriented coping domains

The CBPM identifies six key approach oriented coping domains of mindfulness, which can have a direct and indirect effect on the stress levels and the mental health and well-being of social workers (Maddock et al., 2021). These are attention regulation/decentering skills, mindfulness, self-compassion, acceptance, non-attachment and non-aversion (Maddock et al., 2021). The CBPM highlights how if Jane engaged in consistent mindfulness practice, the improvements that Jane would experience in each of these domains, would increase her capacity to interrupt and disengage from maladaptive modes of aversion/avoidance (Moos, 2002) and over-engagement (attachment) (Segal et al., 2002) which may manifest as worried and/or ruminative thinking (Hayes et al., 2013), due to stressful cognitive appraisals of her work environment (Chambers et al., 2009). The CBPM outlines how improvement in each domain would support: (1) positive reappraisals of current stressors e.g. Jane would no longer see the practice situation with Brian as being stressful, due to feeling better able to cope with it, and, (2) an increased willingness on Jane’s part to approach and experience the unpleasant thoughts, emotions and physical sensations, which may result from other stressful practice events and experiences (Lazerus & Folkman, 1984). The increased use of each CBPM domain would also enhance Jane’s ability to regulate the often-complex negative emotions triggered by stressful social work practice experiences, such as the anger evoked by Brian, allowing these emotions to arise and be attended to e.g. with self-compassion, acceptance, or a recognition that if they are felt in full, they will pass into memory (Maddock et al., 2021). The increased capacities in each of these CBPM domains would also have a preventative effect, by allowing Jane to feel less threatened or stressed when subsequent difficult practice experiences occur (Arch & Landy, 2015; Maddock et al., 2021). This being due to the fact that Jane will have integrated the learning about how each approach oriented CBPM domain can be applied in order reduce stress e.g. accepting that she cannot change the previous negative interaction with Brian, will allow Jane to recognise that this acceptance helped to reduce the ruminative thoughts and stress that she is experiencing as a result of the negative interaction (Arch & Landy, 2015; Maddock et al., 2021).

Attention regulation and decentering skills

The regulation of attention involves the focusing of conscious awareness on a limited range of experience e.g. on one’s breathing (Shapiro et al., 2006). This allows a heightened sensitivity on this experience which then enhances our moment-to-moment knowing of what is happening in the present (Shapiro et al., 2006). The BPM highlights that only one object (e.g. the breath or area of the body) can be focussed on and held in awareness at any one time (Grabovac et al., 2011). This means that if Jane focusses her attention on any part of their body, such as her breathing, this will interrupt any repeated negative thinking she may be experiencing due to stress (Grabovac et al., 2011; Maddock et al., 2021). However, when Jane’s attention lapses from her breathing, repeated negative thinking can immediately resume (Grabovac et al., 2011). The CBPM expands on the BPM by outlining how attention regulation, and the development of decentering skills through mindfulness practices, can play a role as part of an approach oriented positive reappraisal coping strategy in dealing with difficult thoughts, emotions and physical sensations which may occur as a result of stress (Maddock et al., 2019a, b, 2020a, b). The CBPM highlights how mindfulness practices can encourage Jane to step back and observe her thoughts and internal experiences (e.g. Jane experienced a mixture of worried and ruminative thinking accompanied by feelings of anger when working with Brian), in order to be able to witness the arising and passing of thoughts and emotions that can arise as a result of feeling stressed (Creswell, 2015). The CBPM outlines how this facilitates the realisation that thoughts, feelings, and physical reactions that can occur as a response to stress, are transitory patterns of mental and emotional activity, that they are not necessarily true representations of themselves, or the stressor (Bishop et al., 2004; Shapiro et al., 2006; Van der Velden et al., 2015). An example of this could be if Jane momentarily thought that she was not a good social worker because Brian got angry. Enhanced attention regulation skills would allow Jane to see such a thought, as just a thought, and not a fact (Bishop et al., 2004; Shapiro et al., 2006; Van der Velden et al., 2015). This process involves a shift in perspective, in which thoughts are viewed more objectively, known as decentering (Bishop et al., 2004; Shapiro et al., 2006; Van der Velden et al., 2015). The CBPM outlines how repeated mindfulness practice could help Jane to develop decentering skills, which could enable her to consistently view her thoughts and reactions to stressors as arising and passing in the moment, which would allow a lowering of attachment and identification with these thoughts and emotions (Chambers et al., 2009; Lynch et al., 2015). This decentered perspective would make it less likely that these thoughts and emotions would trigger attempts to control the stressful experience through worry or rumination (Maddock et al., 2019a, b, 2020a, b). This would in turn help to reduce the risk of persistent avoidant responses to stressful thoughts, emotions or physical sensations, which can result as a part of Jane’s social work practice (Lebois et al., 2015). The CBPM identifies that regulating attention, through decentering skills, would make it easier for Jane to approach and evaluate the accuracy of the stressed thought and reappraise the stressor the thought stems from. In our example, improved decentering skills could allow Jane to more accurately assess if Brian’s emotional reaction is the stressor, or if it is the following thought process i.e. ‘I am not a good enough social worker’, that is the main driver of stress (Hayes-Skelton & Graham, 2013). The consistent practicing of mindfulness and the development of decentering skills would allow Jane to have more emotional space to actively approach, feel and process emotions and the connected physical sensations that result from the underlying stressor, all of which would ultimately enhance her subjective well-being and reduce feelings of stress, anxiety and depression (Moos, 2002; Wadlinger & Iaacowitz, 2011). The CBPM highlights how increased decentering skills are also likely to allow Jane to realise more quickly that she is operating out of stressed, worried or ruminative modes of thinking and then apply an approach oriented coping response e.g. accepting the stressor as it is (Neff, 2003; Maddock et al., 2019a, b, 2020a, b). If Jane then approaches and focusses her increased capacity for self-awareness on the stressor that she is avoiding i.e. her next meeting with Brian (Baer, 2003; Bishop et al., 2004), she will be in a better position to positively reappraise the stressor that evoked the initial thought process, as simply temporary negative experiences, the emotional, physical and cognitive reactions to which can be allowed to arise and pass (Maddock et al., 2019a, b, 2020a, b).

Mindfulness

Mindfulness and decentering are closely related but different processes in the CBPM (Gecht et al., 2014). Mindfulness is the state of present focussed awareness that occurs when a person consistently pays attention to the present moment and how their experience unfolds, moment by moment, in a non-judgemental manner (Kabat-Zinn, 2003). All accounts of mindfulness implicate attention as a central feature; with attention regulation being the ability to objectively observe one’s cognitions (Shapiro et al., 2006), and mindfulness being the state of awareness that manifests when one moves their attention toward the direct experience of the present moment (Kabat-Zinn, 2003; Tang & Posner, 2015). The CBPM suggests that mindfulness practices train the mind to be better able to stay in the moment, with curiosity, even during stressful experiences. This present moment orientation can help to interrupt habitual avoidant stress coping responses, which can arise as worried or ruminative thinking (Maddock et al., 2019a, b, 2020a, b). The development of mindfulness skills over time could allow Jane to be more present centred, observant and non-judgmental of her thoughts, emotions and physical sensations when working with Brian (Maddock et al., 2019a, b, 2020a, b). These mindfulness skills could allow Jane to attain an increased awareness of, and insight into how avoidant responses to stress are maladaptive, and can manifest as counter-productive negative thinking, which contribute to and maintain stress, anxiety and low mood (Maddock et al., 2021). With repeated mindfulness practice, increases in mindfulness can lead to associations between difficult thoughts, emotions, physical sensations and maladaptive responses to be broken up, and through positive reappraisal of the stressor, more adaptive approach oriented responses may become increasingly dominant (Maddock et al., 2019a, b, 2020a, b). An example of this in action, would be if Jane chose to approach and speak assertively to Brian about his aggression during the assessment, and also outline what she feels is acceptable within their working relationship. Due to her increased mindfulness, Jane will likely experience a more acute feeling of stress initially, but this would subsequently pass along with underlying stressor, if her awareness stays in the present. The CBPM highlights how the adoption of approach oriented stress coping strategies of this nature would allow Jane to feel less stressed, anxious and to have a greater overall sense of well-being during her case work (Lynch et al., 2015; Maddock et al., 2021).

Self-compassion

Self-compassion is the offering of feelings of kindness or care towards oneself when experiencing suffering and recognising that suffering, personal failures or felt inadequacies are part of being human (Neff, 2003). When having made a mistake, or feeling hurt, it is common for a person experiencing stress or feelings of anxiety to react with self-criticism and blame, which can lead to a re-activation of avoidant coping responses (Svendsen et al., 2017). The CBPM identifies that increased self-compassion, which is strengthened through regular mindfulness practice, will likely reduce Jane’s avoidance of potentially stressful events, thoughts or emotions (e.g. through worry and/or rumination), that may threaten her self-esteem, by engendering positive self-feelings when experiences in practice don’t go as expected (Leary et al., 2007; Moos, 2002; Van Dam et al., 2011). Improved mindfulness when coupled with increased self-compassion increases the opportunities that previously avoided feelings of hurt or difficult emotions (e.g. Brian being angry at Jane may bring up repressed negative thoughts, emotions and physical sensations from her past experience of being a victim of violence), may be allowed to enter awareness, enabling Jane to respond and positively reappraise these experiences with self-compassion, rather than self-criticism (Neff, 2003). This involves attending to the difficult stressful thought or emotion (e.g. memories of her experience of violence in the past) that is causing current suffering with an active wish to relieve the suffering (self-kindness), acknowledged through positive reappraisal (Lazarus & Folkman, 1984), that everyone experiences difficult thoughts and emotions from time to time (common humanity) (Neff, 2003; Svendsen et al., 2017). This approach oriented coping strategy could help Jane to realise that having these stressful thoughts or emotions (e.g. thinking or feeling momentarily that she is not good enough due to Brian’s emotional response) does not mean that she is ineffective or a bad social worker. The CBPM outlines that the consistent practicing of mindfulness, and the improved self-compassion that accrues due to this, can create a domino effect. The increased approaching of stressful experiences reduces longer term stress, which increases the positive reappraisal (Jane would become more confident that if she makes a mistake under stress, she will respond with self-compassion, rather than self-criticism) of stressful situations, which further reduces stress (Brown, 2015; Maddock et al., 2021). Thus, the practice of mindfulness and the development of self-compassion may facilitate and strengthen Jane’s capacity for more consistent positive reappraisal of potentially stressful practice situations, which can help to reduce subsequent stress, psychological distress and improve wellbeing (Lynch et al., 2015).

Acceptance

Acceptance is generally perceived as a process of fully embracing experience in any given moment – welcoming whatever thoughts, emotions and physical sensations life has presented as they are, with curiosity and openness, without defence (Baer, 2003; Hayes-Skelton & Graham, 2013). The BPM highlighted how the consistent focussing of attention required during mindfulness practices leads to the development of increased acceptance of and awareness of our thought processes, along with their connected emotions and physical sensations (Grabovac et al., 2011). The CBPM expands on the BPM by highlighting how the increased acceptance of difficult emotions, thoughts, and sensations can lead to the positive reappraisal of stressful experiences (Lazerus & Folkman, 1984). Improved acceptance, attained through consistent mindfulness practice, would increase Jane’s capacity to approach the sources of her stress, by encouraging her to come into contact with difficult internal experiences (e.g. Jane could allow the anger that she experienced to come into her conscious awareness), accepting and feeling them in full (e.g. if Jane was on her own after the initial meeting with Brian, she could clench her fists to relieve the intensity of the anger she might be feeling), before allowing them to pass, as opposed to attempting to avoid or control these experiences (Moos, 2002). This would allow Jane to have an increased capacity to experience and ventilate her emotions (Bridges et al., 2004) without under-engagement (e.g., through experiential avoidance) (Hayes et al., 1996) or over-engagement (e.g., through worry or rumination) (Borkovec, 1994; Nolen-Hoeksema, 1998).

The CBPM and reflective social work practice

Reflective practice in social work demands that social workers learn from experience (Howe, 2009). It requires social workers to be self-critical in the process of analysing what they thought, felt and did during a service user interaction (Howe, 2009). Defences, defensiveness and avoidant coping processes are common in social work (Trevithick, 2011). There are inevitable experiences and situations in social work practice, where effective reflection in and on practice may be incredibly difficult, too emotionally draining to engage in, or not even possible (Ferguson, 2018). This is particularly true without training on how to cope with or manage the complex thoughts, emotions and physical sensations that manifest due to the engagement in a critical reflection on practice (Maddock et al., 2021). The CBPM outlines that practising mindfulness could enhance a social worker’s internal supervision capacity (Casement, 1985). The improvements in each domain of the CBPM, achieved through mindfulness practice, may increase Jane’s confidence in consciously approaching and reflecting on the difficult or complex thoughts, emotions and physical sensations that can arise from stressful practice situations (Maddock et al., 2021). The increased mindful self-awareness and insights into her coping processes, which would accrue from improvements in each CBPM domain, could allow Jane to choose which of the defended areas in herself are safe to reflect on more deeply (Ferguson, 2018). The consistent engagement with mindfulness or other practices, could facilitate reflective practice by increasing Jane’s openness to self-evaluate as part of an internal supervision process (Casement, 1985); allowing more defended and hurt parts of herself to be approached and self-evaluated non-judgementally, with increased self-acceptance and self-compassion, all of which may allow for deeper self-reflections and awareness to emerge (Maddock et al., 2021). The improved CBPM domains could also allow Jane to be more aware of her internal defensiveness, or avoidance processes (which may manifest as cognitive (e.g. worry or rumination) and/or emotional reactivity) which were getting in the way of the critical reflection process. This could allow more emotionally available, non-judgmental social work practice, e.g. if Jane did not work through and process the negative thoughts and emotions evoked by Brian, she would likely be operating out of a avoidant mode of being, rather than being cognitively and emotionally available to understand and help to meet Brian’s needs (Chinnery & Beddoe, 2011). If Jane was to continue to operate out of this avoidant mode of being, it would likely create barriers to communication and person-centred practice, reducing the overall effectiveness of the intervention (Rogers, 1961). The increased competency in each CBPM domain, could allow Jane to have an increased capacity to be more attentive to, process and learn from the difficult experiences that are being presented for reflection (Maddock et al., 2021). This would allow Jane to have an increased capacity to integrate this cognitive, emotional and/or physical material and integrate it as part of an enhanced personal self-concept, which would in turn would support her professional self-concept and development as a social worker (Birnbaum, 2005; Maddock et al., 2021). As Jane’s mindfulness practice develops and the CBPM domains strengthen, the internal supervision process may also allow Jane to become aware and attuned to their own cognitive narratives (schemas) that manifest in social work interactions, which may be based on assumption and conditioning (e.g. pejorative narratives about oppressed groups, or one’s own experience of trauma) and any negative emotional reactions that might occur due to these (McCusker, 2021). The improved CBPM domains would allow these thoughts and emotions to arise and pass in order to be more attuned to the service user and their needs, while being more clearly able to identify what the best course of action might be, in line with social work best practice (Gockel et al., 2013). As this process unfolds, Jane’s increased capacity to sit more comfortably with her own thoughts and powerful emotions, will allow her to sit with the powerful emotions that Brian may have, non-judgementally with increased acceptance and compassion (Maddock et al., 2021). The increased capacities in mindful self-awareness, empathy, cognitive and emotional self-regulation, which could manifest due to improvements in the CBPM domains are likely to help Jane to accept setbacks in a case as opportunities for growth, let the therapeutic process unfold, develop stronger attuned therapeutic alliances, and wider emotional holding spaces for Brian’s needs to be understood and attended to (Gockel et al., 2013; Maddock et al., 2021). Once the next interaction with Brian comes to an end, Jane could then reflect on this experience, engaging the cognitive, emotional and physical sensations that arise (approach/non-aversion) and then letting them pass (non-attachment) and then prepare to tune into the next client who will attend the next appointment (Maddock et al., 2021).

Conclusions

This article has made an original contribution to the social work literature by proposing the use of the clinically modified Buddhist psychological model (CBPM), as a beneficial lens for understanding how to improve social worker and student reflective practice along with the feelings of stress, burnout, anxiety, low mood and well-being deficits that can result from social work practice. It is hoped that this theory will encourage social work educators to develop mindfulness-based self-care and reflective practice training materials, which are both evidence and theory informed and meet the needs of already very busy social workers. It is also hoped that by condensing a vast array of mechanisms of mindfulness into integrative theory, that the CBPM can support the development of shorter and more effective bespoke stress coping training programmes for social workers, in order to reduce feelings of stress and burnout and resultant attrition in the profession.