Volume 38/N um ber 4/O ctober 2016/Pages 3 6 0 -3 7 4 /doi: 10 .17744/mehc.38.4.

06

Mindfulness, Self-Compassion, and

C ounselor Characteristics and Session
Variables
Cheryl L. Fulton
Texas State University

Mindfulness has garnered interest as a counselor development tool for enhancing the therapeu­
tic relationship and increasing counselor trainee effectiveness, yet empirical study o f counselor
mindfulness is limited. A study o f the relationship between mindfulness and client perceived
empathy among 55 client-counselor trainee dyads is reported. The relationships between coun­
selor trainee mindfulness, self-compassion and ambiguity tolerance, experiential avoidance,
and session depth were also examined in this exploratory study. Counselor trainee mindfulness
was associated with client perceived empathy and both mindfulness and self-compassion were
associated with lower experiential avoidance and greater session depth as rated by the counselor
trainee. Self compassion was positively related to tolerance for ambiguity. Implications for
counselors, educators, and supervisors and suggestions for practical application o f mindfulness
for counselor development are discussed.

There are a number of counselor capabilities considered important to

effective counseling including empathy (Rogers, 1957), tolerance for ambigu­
ity (Bien, 2004; Levitt & Jacques, 2005), and affect tolerance, also called expe­
riential avoidance in its negative form (Bien, 2004; Fulton, 2005). Counselor
empathy is important to the development of the therapeutic relationship
(Rogers, 1957), working alliance (Trusty, Ng, & Watts, 2005), and counseling
outcomes (Elliott, Bohart, Watson, & Greenberg, 2011). Thus, empathic
ability is an essential counselor training outcome. Empathy, as a counseling
process, must first be experienced by the counselor, before it can be commu­
nicated and, in turn, received by the client (Barrett-Lennard, 1981). Although
there are methods (e.g., microskills training) for teaching empathy skills (e.g.,
reflective listening), there are not equivalent methods for developing and main­
taining one’s empathic capacity (e.g., Greason & Cashwell, 2009). Further,
anxiety, which is inherent in counselor training, can impede the ability for
empathy (Fliebert, Uhlemann, Marshall, & Lee, 1998).

Cheryl L. Fulton, D e p a rtm e n t o f Counseling, Leadership, A d u lt Education, and School Psychology, Texas
State University Correspondence concerning this a rticle should be addressed to: Cheryl L. Fulton, 601
University Dr., EDUC 4026, San Marcos. TX, 78666. E-m ail: clfu lto n @ tx s ta te .e d u .

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 Mindfulness, Self-Compassion, and Session Variables

Affect tolerance and tolerance of ambiguity are purported to be important

to empathic ability and effective counseling (Bien, 2004; Fulton, 2005; Levitt
& Jacques, 2005). Bien (2004) proposed that tolerance of ambiguity be con­
sidered an addendum to Roger’s (1957) necessary conditions for therapeutic
change because counselors must tolerate complex client situations without
pushing for a premature solution, becoming apathetic, or sharing in the client’s
despair. Ambiguity refers to being open to more than one interpretation, or
being uncertain (Levitt & Jacques, 2005). Ambiguous situations are those that
are complex, novel, and insoluble (conflicting information) and may promote
stress, avoidance, delay, suppression, or denial (McClain, 2009). Clients are
complex, often presenting contradictory feelings and concerns which can be
challenging, particularly for trainees and novice counselors (Borders & Brown,
2005); ambiguity can be a barrier to understanding and promote frustration
(McClain, 2009). Levitt and Jacques (2005) argued that ambiguity is inherent
in counseling and the training process itself, therefore, educators need methods
that support students to embrace ambiguity.
Experiential avoidance involves an unwillingness to remain in contact
with sensations, emotions, thoughts, even when doing so is unproductive
(Bond et ah, 2011). Experiential avoidance may be important to empathy as
counselors are confronted with clients’ painful emotions which they must be
present for, and empathize with, without personal distress, over-identification,
or avoidance (Bien, 2004; Rogers, 1957); this may be difficult for trainees newly
developing empathy skills. Further, because willingness to experience difficult
thoughts, feelings, and sensations is central to many theoretical approaches,
counselors must be able to model an appropriate relationship to these experi­
ences (Bien, 2004). Bien (2004) recommended that counselors develop their
inner life through practices such as meditation; however, empirical support for
meditation as a means to develop affect tolerance among counselors is needed.

MINDFULNESS
Mindfulness has garnered attention as a potentially useful counselor train­
ing tool, particularly with regard to the development and maintenance of coun­
selor empathy and the therapeutic relationship (e.g., Buser, Buser, Peterson,
& Seraydarian, 2012; Fulton & Cashwell, 2015; Greason & Welfare, 2012).
Mindfulness, rooted in the Buddhist tradition, is defined as intentional present
moment awareness without judgment and requires an “affectionate attention”
(Kabat-Zinn, 2012, p. 53) achieved by bringing kindness, compassion, equa­
nimity, patience, curiosity, and trust to one’s awareness (Kabat-Zinn, 1994).
Thus, mindfulness training typically includes both mindfulness practices that
produce awareness and insight, and loving-kindness and compassion practices
that foster compassion for both self and others. Self-compassion involves having
feelings of concern for one’s own suffering and approaching one’s shortcomings
with kindness, non-judgment, understanding, and awareness that shortcomings
are part of the common human experience (Neff, 2003). Scholars have been
uncertain as to whether compassion is considered an outcome of mindfulness

0 Journal of Mental Health Counseling 361

or a component of it (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006). As
a result, researchers often include study of both mindfulness and self-compas­
sion, as they can be differentially or synergistically related to outcome variables
such as empathy (Fulton & Cashwell, 2015).

Mindfulness, Self-compassion, and Empathy

Based on Buddhist psychology, empathy is viewed as a capacity that
can be cultivated through mental training, such as meditation (Greason &
Cashwell, 2009). Neff and Pommier (2013) found that experienced medita­
tors scored higher on measures of compassion for humanity and empathic
concern than community or undergraduate samples. Based on controlled
neuroscientific studies, researchers found mindfulness practices affected neural
processes associated with enhanced empathic responses to social stimuli (Lutz,
Brefczynski-Lewis, Johnstone, & Davidson, 2008) and increased grey-matter
density in parts of the brain associated with empathy (Holzel et al., 2011).
Likewise, based on self-report, self-compassion has been associated with social
connection and empathy (Birnie, Speca, & Carlson, 2010; Neff, 2003).
Although sparse, there is evidence of a positive association between both
mindfulness and self-compassion and empathy among counselors based on
correlational studies (e.g., Fulton & Cashwell, 2015; Greason & Cashwell,
2009) and an early quasi-experimental study of mindfulness training among
counselor trainees (Lesh, 1970). These studies, however, were based on a
counselor’s self report of empathy. In a lone study, Greason and Welfare (2013)
found mindfulness was related to client rated therapeutic factors (e.g., positive
regard), however, it was not related to empathy. The researchers recommended
that data on the length of the counseling relationship be included in future
studies as this may have influenced the relationship between counselor mind­
fulness and empathy in their study.

Mindfulness, Experiential Avoidance, and Tolerance for Ambiguity

Mindfulness-based interventions are designed to help individuals attend
to aversive stimuli, including sensations, cognitions, and emotions, with open,
non-reactive, non-judging, present-moment awareness (Baer, 2003). Bishop
et al. (2004) posited that acceptance during mindfulness practice leads to
decreased experiential avoidance and greater affect tolerance, coping, and
increased self-observation which, in turn, leads to greater emotional awareness
and cognitive complexity. Empirically, Farb et al. (2010) found that partic­
ipants in an 8-week mindfulness training group (n = 18) had a similar sad
reaction to watching a sad film as a control group (n = 18), however, those with
mindfulness training had less neural activity (based on fMRI) while watching
the sad film than the control group and compared to baseline. The researchers
concluded that mindfulness meditation increased the ability to regulate emo­
tion without necessarily avoiding or detaching from it. This has relevance for
counselor trainees who must learn to sense and be present for a client’s affec­
tive state without becoming immersed in it (Rogers, 1957). Further, methods

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 M i n d f u l n e s s , S e lf - C o m p a s s io n , a n d S e s s io n V a r ia b le s

aimed at reducing experiential avoidance such as acceptance and commitment

therapy incorporate mindfulness and have shown promise (Hayes, Luoma,
Bond, Masuda, & Lillis, 2006), however, such approaches are designed for
client concerns, and there is little study of how mindfulness may relate to
experiential avoidance among counselors.
Tolerance of ambiguity is important, given the ambiguity' encountered
in counselor training as well as in client presentations (Bien, 2004; Levitt
& Jacques, 2005). Unfortunately, most studies of ambiguity tolerance in
counseling are decades old and yielded few results (Levitt & Jacques, 2005).
McClain (2009) created a new measure for ambiguity tolerance as he argued
that older measures were weak conceptually and psychometrically; thus, the
topic warrants reconsideration for study. Such studies are warranted, given that
ambiguity tolerance is considered important for counselor trainees (Levitt &
Jacques, 2005), and mindfulness is theorized to help individuals approach the
present moment with equanimity (Kabat-Zinn, 1994) so they can remain open
and flexible.
In sum, empathy, affect tolerance, and low experiential avoidance are
important training variables. Mindfulness may be a potential means to address
these variables, however, empirical study among counselors has been limited.
The goal of this study was to extend previous studies in several ways. First, study
of the relationship between counselor mindfulness and empathy among coun­
selors has been based on counselor self report, and researchers have suggested
that client feedback about this relationship is an important next step (Fulton
& Cashwell, 2015; Greason & Cashwell, 2009). Further, Greason and Welfare
(2013) recommended obtaining data regarding the length of the counseling
relationship in future studies of counselor mindfulness and client perceived
empathy, as this may have limited their ability' to find a relationship between
counselor mindfulness and empathy in their study. Second, mindfulness out­
comes such as affect tolerance and ambiguity tolerance have been theorized as
important counselor attributes and associated with mindfulness, however, no
current studies investigating these relationships among counselors were found.
Third, because of the potential role of self-compassion and mindfulness out­
comes, I included study of the relationship between self-compassion and study
variables. Lastly, because there is limited knowledge of how counselor mind­
fulness impacts a counseling session, for both client and counselor trainee,
session depth was examined. Session depth is the perceived power and value of
the counseling session and the counselor’s perceived effectiveness (Reynolds
et ah, 1996; Stiles & Snow, 1984). Fligher counselor- and client-rated session
depth have been associated with greater client return rate (Tryon, 1990) and
the perception that the session was a good vs. bad therapy hour (Reynolds et
ah, 1996). Because mindfulness involves greater attention and patience in the
present moment, it seems reasonable to explore its impact on both client-per­
ceived empathy and session depth as session outcome variables.
The purpose of this study, therefore, was threefold: 1) to investigate the
relationship between counselor mindfulness (and its facets) and client per­
ceived empathy; 2) to determine the relationship between mindfulness and

4 Journal o f M ental Health Counseling 363

self-compassion and counselor attributes, including affect and ambiguity toler­
ance; and 3) to assess whether mindfulness and self-compassion are associated
with session dynamics (i.e., session depth) as rated by both the client and the
counselor. The following research questions were addressed: 1) Does mind­
fulness have a significant relationship with client perceived empathy? Which
mindfulness facets best predict this relationship? 2) What are the respective
relationships between mindfulness, self-compassion, and session depth? 3)
What are the respective relationships between mindfulness and self-compas­
sion and two counselor characteristics, experiential avoidance and ambiguity
tolerance? Concordantly, I hypothesized that 1) there would be a positive rela­
tionship between mindfulness and client perceived empathy; no predictions
were advanced regarding which facet would be most impactful; 2) mindfulness
and self-compassion would be positively related to session depth (client and
trainee); and 3) mindfulness and self-compassion would be negatively related
to experiential avoidance and positively related to tolerance for ambiguity.

METHOD
Participants
Following institutional review board approval, a convenience sample of
master’s counseling students were recruited from practicum and intermediate
methods courses in a CACREP-accredited counseling program at the research­
er’s university. Intermediate methods courses differ from practicum primarily
in that fewer clients are seen during the semester in the intermediate meth­
ods courses. The researcher obtained faculty support for the study and they
agreed to have the researcher distribute and collect informed consent forms
and questionnaires during class as well as to have trainees invite one client to
participate. Eligible clients were university students and community members
seeking services at the program’s clinic who were 18 years of age or older and
able to voluntarily consent. Client-counselor trainee pairs participated in the
study after at least three sessions so a therapeutic relationship could be estab­
lished before client-perceived empathy was assessed. A total of 59 students
from the total invited sample of 64 volunteered to participate yielding a 92%
response rate. Four surveys were not useable due to incomplete data.
Based on the total sample, 48 (87.3%) were women, and 7 (12.7%) were
men, with a mean age of 32.0 (SD = 7.3; Range = 23-50). Participants identi­
fied as European American (n = 43, 78.3 %), Hispanic/Latino/a (n = 7, 12.7%),
and Biracial/Multiracial (n = 5, 9.0%). The majority of participants were in the
clinical mental health track (n = 27, 49.1%), followed by couple and family (n
= 12, 21.8%), school (n = 10, 18.2%), and dual track (n = 6, 10.9%). Seventy
percent were in practicum classes and 30% in intermediate methods classes.
Approximately 64.2% of trainees reported having a mindfulness practice, how­
ever, their practice was primarily described as yoga, occurring less than weekly;
some meditation and prayer were also noted. Lastly, 39.6% of trainees reported
exposure to mindfulness education, primarily yoga classes, personal counsel­
ing, or books. For client participants, 48 (87.3%) were women, and 7 (12.7%)

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 M indfulness, Self-Com passion, and Session Variables

were men; client mean age was 36.4 (SD = 13.3; Range = 19-61). Participants
identified as European American (n = 34, 61.8%), Hispanic/Latino/a (n = 15,
27.2%), African American (n = 3,5.5%), and Biracial/Multiracial (n = 3,5.5%).

Procedure
Counselor trainees were provided with a script to read to their clients
inviting them to participate. The script included information that participation
was voluntary and in no way tied to receiving services and was followed with
obtaining client consent (100% of invited clients participated). Participants
were blind to the study variables and both clients and counselor trainees were
each given $3.00 as incentive for participation. Clients and trainees completed
surveys in separate rooms and the majority of clients turned in surveys directly
to the researcher as they exited the clinic. In the researcher’s absence, clients
returned surveys via sealed envelope to their counselor; these were in turn
collected by the instructor and returned to the researcher.

Instrumentation
Counselor trainees completed the Five Facet Mindfulness Questionnaire
(FFMQ; Baer et ah, 2006), Self-Compassion Scale (SCS; Neff, 2003), Session
Evaluation Questionnaire-Form 5 (SEQ; Stiles & Snow, 1984), Acceptance
and Action Questionnaire - II (AAQ-II; Bond, et ah, 2011), and Multiple
Stimulus Types Ambiguity Tolerance Scale-II (MSTATS; McClain, 2009).
Counselors also completed the Therapeutic Presence Inventory (Geller,
Greenberg, & Watson, 2010) which was used to answer research questions
not addressed in this article. Clients completed a demographics questionnaire,
tire SEQ, and the Barrett-Lennard Relationship Inventory-Client Form (BLRI;
Barrett-Lennard, 1962).
Mindfulness. The FFMQ (Baer et ah, 2006) is a 39-itenr self-report ques­
tionnaire designed to measure mindfulness in daily life. The FFMQ consists
of five mindfulness facets (subscales): Observe, Describe, Act with Awareness,
Non-judge, and Non-react. Items are rated on a 5-point scale ranging from 1
(never or rarely true) to 5 (very often or always true) and each subscale is scored
and the five factors combined to form a total score of mindfulness. The FFMQ
has shown adequate construct validity and good internal consistency, with sub­
scale alphas ranging from .75 to .91 and a full scale alpha of 0.96 (Baer et ah,
2006). The alpha coefficient in the current sample was .90 for the total scale
and ranged from .80 to .92 for subscales.
Session depth. The SEQ (Stiles & Snow, 1984) is a 21-item questionnaire
developed to measure client and counselor perspectives of immediate session
impact. Specifically, the SEQ measures whether a counseling session was
judged as good or bad based on two dimensions: 1) powerful and valuable ver­
sus weak and worthless (session Depth) and 2) relaxed and comfortable versus
tense and distressing (session Smoothness). Two additional subscales measure
participants’ post session mood, Positivity and Arousal. Participants endorse
adjectives on a 7-point bipolar adjective format. The first 11 items measure

$ Journal o f Mental Health Counseling 365

session evaluation (depth and smoothness) using words such as “bad-good”
and “valuable-worthless”. Ten items measure post-session mood and include
adjectives such as “angr\’-pleased” and “calm-excited”. The authors reported
that factor-analytic studies confirmed all four dimensions as underlying coun­
selor-client session ratings. Internal consistency was high (ranging from .81-.93)
for all dimensions across a variety of conditions and settings (Reynolds et al.,
1996). In this study, the independent dimension of session Depth was used to
evaluate participants’ most recent counseling session as this was deemed more
theoretically relevant to counselor mindfulness. Greater ability to attend to a
client’s experience should theoretically influence the client’s sense that the
session was valuable, however, it may not necessarily equate with the percep­
tion that the session was relaxed. The alpha coefficient for session depth in the
current sample was .77 (counselor) and .68 (client).
C lient perceived empathy. The BLRI (Barrett-Lennard, 1962) comprises
four subscales: Level of Regard, Empathy, Unconditionality, and Congruence,
which are based on Rogers’s (1957) theory of the necessary conditions for
promoting therapeutic change in the counseling relationship. Clients rate the
extent to which they felt their counselor understood them in the session using
a 6-point scale (e.g., “My counselor nearly always knows exactly what I mean”).
Gurman (1977) reported that factor-analytic studies support the underlying
dimensions of the BLRI and that the mean internal consistency was high
(ranging from .74 - .91) across 14 studies. The Empathy subscale (16 items)
was utilized as a measure of client perceived empathy in the current study.
The alpha coefficient for the Empathy subscale was .75 for the study sample.
Self-compassion. Counselor trainees were given the 26-item SCS (Neff,
2003) which assesses positive and negative aspects of three components of
self-compassion: Self-Kindness (e.g., “I try to be loving towards myself when I’m
feeling emotional pain”) versus Self-Judgment (reverse-coded; e.g., “I’m disap­
proving and judgmental about my own flaws and inadequacies”); Common
Humanity (e.g., “I try to see my failings as part of the human condition”) versus
Isolation (reverse-coded; e.g., “W hen I fail at something that’s important to me,
I tend to feel alone in my failure”); and Mindfulness (e.g., “W hen something
upsets me I try to keep my emotions in balance”) versus Over-Identification
(reverse-coded; e.g., “When something upsets me I get carried away with my
feelings”). Responses are given on a 5-point scale ranging from 1 (almost never)
to 5 (almost always). Neff and Germer (2012) suggested that the mindfulness
subscale of the SCS is distinct from general mindfulness (e.g., FFMQ) in two
ways. First, mindfulness as an aspect of self-compassion is narrower, referring
to awareness of negative thoughts and feelings associated with personal suf­
fering as opposed to a full range of experience (positive, negative, or neutral)
with acceptance and equanimity. Second, mindfulness in self-compassion is
more person-focused than experience-focused. Neff (2003) found evidence of
adequate construct validity and high internal consistency (Cronbach’s alpha of
.92). In the current study, the alpha coefficient for the SCS was .94.
Experiential avoidance. The AAQ-II (Bond et al., 2011) is a seven-item
questionnaire used to measure psychological flexibility and experiential avoid-

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 Mindfulness, Self-Compassion, and Session Variables

ance. Counselor trainees respond to a 7-point scale ranging from 1 (never true)
to 7 (always true) on items such as “I’m afraid of my feelings” and “Worries
get in the way of my success”. Bond, et al., (2011) found support for construct
validity and high internal consistency (Cronbach’s alpha of .88). In the current
study, the alpha coefficient for the AAQ-11 was .82.
Ambiguity tolerance. Counselor trainees were given the 13-item MSTATS
(McClain, 2009) which assesses ambiguity tolerance defined as an orientation
ranging from aversion to attraction, toward stimuli that are complex, unfa­
miliar, and unsolvable. Responses are given on a 7-point scale ranging from
1 (strongly disagree) to 7 (strongly agree) on items such as “1 don’t tolerate
ambiguous situations well” and “I would rather avoid solving a problem that
must be viewed from several different perspectives”. McClain found support for
construct validity and high internal consistency (Cronbach’s alpha of .83). In
this study the alpha coefficient was .88.
Demographics. Counselor trainees were queried about age, gender, race/
ethnicity, program track, field experience, meditation practice (and what type),
and exposure to mindfulness training in their counseling program (and what
type). Counselors also indicated the number of counseling sessions completed
at the time of the study. Clients were queried about age, gender, and race/
ethnicity.

RESULTS

Preliminary Analyses
An a priori sample size (Soper, 2016) was calculated and 55 dyads were
deemed sufficient for a medium effect size of .3 (Cohen, 1988) and power of
.80 at the .05 level for F-tests for linear and multiple regressions. Preliminary
analysis of the data indicated that there were no outliers and data approximated
normal distributions for all instruments. Mean item replacement was used for
five items missing across the dataset.
Although the majority of students (70%) were in practicum classes, as
a preliminary analysis, the difference in mean scores for session related vari­
ables (i.e., client perceived empathy and session depth) between students in
the practicum and intermediate methods courses were calculated to assess
whether developmental level would predict results. Based on f-tests, no statis­
tically significant differences were found between practicum and intermediate
methods students for session related variables, thus students were combined
for analyses. However, a non-significant difference between practicum and
intermediate methods courses does not necessarily mean they are equivalent
(Weigold, Weigold, & Russell, 2013). Additionally, at least three completed
sessions were required to participate and the average number of sessions at the
data collection point was 6.0 (SD = 2.0; Range = 3-8). There was no signifi­
cant relationship between client perceived empathy and session number (r =
.22, p = .11) possibly reducing the likelihood that more than the three mini­
mum required sessions for participation impacted results for client perceived
empathy; however, it is still possible results may have been different with more

0 Journal of Mental Health Counseling 367

 sessions. Lastly, there was concordance between client and counselor ratings
on session d e p th (r = .28, p = .04). Further, there was no significant difference
in counselor vs. client ratings of session depth (f = .86, d f = 108, p = .39) and
the effect size was small (C o h e n ’s d - .17).

Main Analyses
An alpha level of .05 was used for all main analyses. For research question
one, a Pearson product-moment correlation was used to test whether FFMO
was significantly and positively related to BLRI-Empathy and a multiple linear
regression analysis was used to explore which mindfulness facets most contrib­
uted to the relationship. Overall FFMQ had a significant relationship with
BLRI-Empathy (r = .35, p = .01). Further, a model of the FFMQ facets had a
significant relationship with BLRI-Empathy (F(5, 49) = 2.82, p = .03) explain­
ing 14.9% of the variance, however, Non-judge (b = .32, p = .03) was the only
facet significantly predictive of BLRI-Empathy (See Table 1).
For research question two, Pearson product-moment correlations were
used to test the hypotheses that FFMQ and SCS would each have a significant
negative relationship with a second session outcome variable, SEQ-Depth
(client and trainee). As predicted, both overall FFM Q (r = .37, p = .007) and
SCS (r = .37, p = .006) had a significant positive relationship with trainee SEQ-
Depth (coincidentally the same), however, unexpectedly, neither was related to
SEQ-Depth as rated by the client (See Table 2).
For research question three, Pearson product-moment correlations were
used to test the hypotheses that FFMQ and SCS would each have a significant
negative relationship with AAQ-II and a significant positive relationship with
MSTATS. As predicted, FFM Q (r = -.50, p < .001) and SCS (r = -.65, p < .001)
each had a strong and significant negative relationship with AAQ-II among
trainees. Interestingly, only SCS had a significant positive relationship with
MSTATS (r = .44, p = .001).

DISCUSSION
The purpose of this study was to explore the relationship between coun­
selor trainee mindfulness and client’s perception of counselor empathy, as

Table I M u ltip le Regression o f M in d fu ln e s s Facets as P red ictors o f C lie n t Perceived E m p a th y

Variable B SE P t

Observe .26 .21 .19 1.21

Describe .38 .20 .25 1.90

Act with Awareness .14 .24 .09 .58

Non Judge .41 .19 .32 2.18*

Non React -.48 .31 -.25 -.1.54

* p < .05; A d j. R 2 = 14.9%

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 M in dfu ln e ss, Self-C om passion, a nd Session Variables

Table 2 Pearson Product-Moment Correlations for Study Variables

Variable SCS AAQ-II MSTAT BLRI SEQ-D-T SEQ-D-C

FFMQ .64 -.50 .20 .35 .37 .13

SCS - -.65 .44 .10 .37 .06

Note: *p < 0.05 level, **p < 0.0 1 level. FFMQ = Mindfulness; SCS = Self-Compassion; M Q - ll = Experiential
Avoidance, MSTAT= Ambiguity Tolerance; BLRI = Client Perceived Empathy; SEQ-D-T= Session Depth-Trainee;
SEQ-D-C = Session Depth-Client

well as how both counselor mindfulness and self-compassion were related

to counselor characteristics and session impact. Based on results, counselor
trainee self-report of mindfulness was directly related to clients’ perceptions
of counselor empathy. Further, both counselor self-reported mindfulness and
self-compassion were predictive of lower experiential avoidance and greater
session depth (counselor rated), however, only self-compassion was predictive
of greater ambiguity tolerance and neither was related to session depth as rated
by the client.
Finding that counselor mindfulness was related to client perceived empa­
thy supports and extends studies in which mindfulness was related to empathy
based on counselor trainee self-report (Fulton & Cashwell, 2015; Greason &
Cashwell, 2009). Furthermore, length of the relationship was obtained and
data collected after three sessions to increase the likelihood of development of
the therapeutic relationship, which may explain the positive results for the cur-

Table 3 Instrum ent Means and Standard Deviations

Instrument M SD

Mindfulness Total 132.2 15.03

Observe 27.51 5.25

Describe 30.49 4.67

Act with Awareness 25.45 4.69

Non-judge 27.30 5.52

Non-react 21.45 3.62

Self-Compassion 13.91 2.51

Experiential Avoidance 19.11 5.58

Ambiguity Tolerance 53.23 11.10

Session Depth - 5.54 0.85

Session Depth - Client 5.69 1.00

Client Rated Empathy 77.60 7.00

Note: N = 55 pairs

^ Journal o f M ental H e a lth C ounseling 369

 rent study as compared with a similar study by Greason and Welfare (2013) in
which length of the relationship was not assessed and no relationship between
counselor mindfulness and client-perceived empathy was found. Possibly
Greason and Welfare’s negative results were a consequence of assessing partici­
pants who had not yet developed a therapeutic relationship with the counselor.
Non-judging of present moment experience was the one mindfulness facet
associated with client perceived empathy, however, no studies examining coun­
selor mindfulness and empathy at the facet level were found for comparison.
Perhaps the ability to embrace one’s own experience without judgment aids
in the ability to be non-judging of others’ experience; understanding without
judgment is important to the therapeutic relationship (Rogers, 1957). Further,
the mindfulness facet non-judge was previously found to be negatively associ­
ated with anxiety among counselors (Fulton & Cashwell, 2015). Anxiety can
impede the ability for counselor empathy (Hiebert et al., 1998) and self effi­
cacy (Greason & Cashwell, 2009), therefore, it is possible that counselors with
higher mindfulness also had lower anxiety and greater counseling confidence,
which increased their capacity for empathy; further studies are needed to test
these relationships. Also, although facet analysis was possible, a larger sample
is warranted and may produce different findings.
Mindfulness-based interventions are designed to help individuals attend
to aversive sensations, cognitions, and emotions (Baer, 2003). In the current
study, both counselor mindfulness and self-compassion were strongly and
significantly related to lower experiential avoidance. As this study was the first
to explore mindfulness, self-compassion, and experiential avoidance among
counselors, there were no studies with which to directly compare results; how­
ever, findings are consistent with a neuroscientific study in which mindfulness
training resulted in decreased experiential avoidance among a community
sample (Farb et al., 2010). It seems possible that if mindfulness and self-com­
passion are associated with a greater ability to be in contact with one’s full
experience, counselors stronger in these abilities may be better able to model
such openness to experience for their clients. Future studies are needed to cor­
roborate and extend findings from the current study to fully understand these
relationships.
Self- compassion was related to higher tolerance for ambiguity among the
study sample. It was surprising that mindfulness was not related to ambiguity
tolerance given that mindfulness training encourages an attitude of equanimity,
however, self-compassion focuses more directly on being gentle with one’s self
when confronted with difficult experiences and is negatively associated with
harsh self-judgment (Neff, 2003). Perhaps greater self-compassion enables
individuals to approach ambiguous situations more readily because they know
failure will not be met with self-criticism, but rather with self kindness.
Lastly, both mindfulness and self-compassion were associated with greater
session depth as evaluated by the couuselor only, even though counselor and
client rated depth were significantly related. This is similar to results obtained
by Daniel, Borders, and Willse (2015) who found that counselor mindfulness
was associated with session depth as rated by the supervisor, but not the super-

370 0 Journal o f Mental Health Counseling

 M in d f u ln e s s , S e lf- C o m p a s s io n , a n d S e s s io n V a r ia b le s

visee. It seems both more mindful counselors and supervisors perceive greater
session depth than do their clients or supervisees. This may not be surprising
because sessions that involve collaborative engagement are associated with
higher ratings of depth, particularly by the counselor; although there is also
evidence that both counselor and client rated session depth is important to a
good counseling hour (Tryon, 1990).

Implications for Counselors, Educators, and Supervisors

Mindfulness has been associated with empathy based on client-perceived
empathy in the current study and previously with counselor trainee self-re­
ported empathy (Fulton & Cashwell, 2015; Greason & Cashwell, 2009), devel­
opment of the therapeutic relationship (Buser et ah, 2012), and positive client
outcomes (Grepnrair et ah, 2007). Taken together, there is growing evidence
that mindfulness training may be a useful method for developing qualities
important to an effective therapeutic relationship, and in turn, positive client
outcomes. Further, the mindfulness skill, non-judging present moment experi­
ence, was most predictive of client-rated empathy. Activities (e.g., compassion
meditations) that enhance a counselor’s ability to maintain a non-judgmental
stance toward their own internal experience may be particularly apt for expe­
riencing empathy toward a client. Randomized controlled studies of the effect
of mindfulness on non-judging within the counselor, and in turn, within the
counseling process, are needed to investigate this possibility.
Self-compassion was strongly associated with greater ambiguity tolerance
in the current study and has been associated with many other potential ben­
efits to counselors such as less anxiety and emotional exhaustion (Birnie et
ah, 2010). Thus, incorporating self-compassion exercises into training and/
or supervision may be fruitful, particularly given the difficulty students have
coping with the ambiguity inherent in counselor training (Levitt & Jacques,
2005). Self-compassion practices may also be useful to counselor trainees as
tolerance for ambiguity is important to promoting deep exploration and change
during counseling (Bien, 2004). Both mindfulness and self-compassion were
strongly negatively associated with experiential avoidance in the current study.
Educators and trainees may find mindfulness worth exploring as a way to lower
experiential avoidance so that students can better tolerate the feelings and
thoughts that arise when confronted with the range of difficult emotions and
concerns expressed by clients and during the training process overall.
Mindfulness can be incorporated into counseling training and ongoing
development in a number of ways. For example, Hahn (1975) suggested that
mindfulness can be practiced informally, such as by taking a moment to focus
on the breath or giving any activity one’s full attention, in the present moment
without judgment or elaboration. Formal mindfulness practice involves an
“activity” used to cultivate mindfulness such as sitting meditation (Baer, 2003).
Both formal and informal practices could be incorporated into class or supervi­
sion. Educators could also adapt the well-established mindfulness-based stress
reduction program (MBSR; Kabat-Zinn, 1990) for use across the curriculum,

0 Journal o f Mental Health Counseling 371

however, additional research is needed to determine the best timing and con­
text for this training (e.g., supervision, class, practicum). MBSR courses are
readily available online and in-person so that any practicing counselor could
benefit from such training. Lastly, supervisors may encourage mindfulness and
self-compassion through modeling and skill-building (e.g., practice observing
one’s self without judgment or modeling self-compassion).

Limitations and Future Research

Results, while promising, need to be considered within the context of
limitations of the study design and sample. Participants were mostly female,
European American trainees from a single CACREP-accredited program;
results may not generalize to other programs, non-accredited programs, men,
or other ethnicities. A larger, more diverse sample is recommended for future
studies. Session data were based on trainees’ relationship with one client in one
session, limiting the range and variability of client responses. It is possible that
session depth may have been atypical, thus, researchers should consider collect­
ing evaluative session data over several sessions. Additionally, all instruments
were self-report measures which can be influenced by degree of self-knowledge
and social desirability. Lastly, because this study was correlational, causation
cannot be determined. Randomized controlled studies designed to measure
specific changes as a result of mindfulness training are needed so educators
and supervisors can confidently use mindfulness training to improve counselor
performance and client outcomes.
In conclusion, despite the study limitations, the current study offers
support for the suggestion that both mindfulness and self-compassion are asso­
ciated with important counselor variables such as client-perceived empathy,
affect tolerance, ambiguity tolerance, and session dynamics. Further studies are
needed to corroborate these findings and to further explore the role of affect
tolerance and tolerance for ambiguity in the counseling process. Ultimately,
if mindfulness is to be considered a useful counselor development method,
researchers must demonstrate that such training will improve counseling per­
formance and client outcomes.

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