Marriage and Family Therapist
Editor & Co-owner,
Journal of Holistic Psychology
oakland therapist & couples counselor
Mindful-Being Psychotherapy &
Increased Therapist Efficacy
In addition to mindfulness-based and mindfulness-informed therapy, I suggest a third, equally important category of mindfulness integration: the therapist’s being mindful in the moment with the client, which I call mindful-being. Of course, I could simply call this mindful psychotherapy, but that title doesn’t delineate which part of the therapy is mindful. Mindful-being is the therapist’s way of being in session, touching every aspect of therapy, for example, what is noticed, interventions, counter-transference, compassion, or insight. This has more of a bearing on how the client experiences the therapy than what is said to the client.
I have the intention of always offering mindful-being therapy, although in some session’s moments my level of mindfulness fluctuates. I believe that the most effective therapists are mindful, a point outlined in the following paragraphs and in other writing on this website. Mindfulness has been proposed as a common factor of successful therapy regardless of the therapist’s theoretical approach.
Evidence suggests that the therapeutic relationship is the strongest predictor of therapeutic outcome. Lambert found that 30% of the variance in therapeutic outcome can be attributed to common factors present in most therapy (with 40% to static factors like age, gender, social support; 15% to placebo effect; and 15% to the specific treatment modality). Weinberger identified several of these common factors between distinct yet similarly effective therapies. The strongest indicators of therapeutic outcome were relationship variables. Bohart, Elliot, Greenberg, and Watson highlight empathy, congruence between therapist and client, and unconditional positive regard as characteristics leading to the most beneficial therapeutic relationship. Therefore, therapists’ ability to foster a relationship built on trust, acceptance, and wisdom is likely the most important factor in helping clients moderate their suffering. 
If we assume that the therapeutic relationship is one of, if not the, most important part of successful therapy, then therapists’ development of characteristics to strengthen and maintain this relationship is paramount. Many, myself included, recommend mindfulness meditation practice as a path to therapists’ developing these essential characteristics. I suggest six interrelated characteristics that strengthen the therapeutic relationship (adapted from Shapiro & Carlson) and increase therapist efficacy: attention, presence, attunement, empathy, compassion, and attitude. Mindfulness is an aide in cultivating and improving on all of these qualities. As well as strengthening therapuetic relationship, these characteristics improve clinical proficiency in a variety of ways.
1. Anderson, D.T. (2005). Empathy, psychotherapy integration, and meditation: A Buddhist contribution to the common factors movement. Journal of Humanistic Psychology, 45, 483-502.
2. Bohart, A. C., Elliot, R., Greenberg, L. S., & Watson, J. C. (2002). Empathy. In J.C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 89-108). New York: Oxford University Press.
3. Fulton, P. D. (2005). Mindfulness as clinical training. In C. K. Germer, R. D. Siegel, & P. D. Fulton (Eds.) Mindfulness and psychotherapy. New York, NY: The Guilford Press.
4. Germer, C. K. (2005). Mindfulness: What is it? What does it matter?. In C. K. Germer, R. D. Siegel, & P. D. Fulton (Eds.) Mindfulness and psychotherapy. New York, NY: The Guilford Press.
5. Martin, J. R. (1997). Mindfulness: A proposed common factor. Journal of Psychotherapy Integration, 7, 291-312.
6. Lambert, M. J. (2005). Early response in psychotherapy: Further evidence for the important of common factors rather than “placebo effects.” Journal of Clinical Psychology, 61, 855-869.
7. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.
8. Shapiro, S. L., Carlson, L. E. (2009). The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. Washington D.C.: American Psychology Association.
9. Weinberger, J. (2002). Short paper, large, impact: Rosenweig’s influence on the common factors movement. Journal of Psychotherapy Integration, 12, 67-76.
10. Welwood, J. (2000). Toward a psychology of awakening. Boston, MA: Shambala.