What Is Required to Teach Mindfulness Effectively in MBSR and MBCT?

Abstract

Mindfulness-based interventions, in particular, mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), have been implemented and disseminated globally, and their efficacy is supported by evidence from several recent meta-analyses. As MBSR and MBCT are being integrated into the mainstream of society, including the fields of medicine, health care, education and leadership, there is an increasing need to educate and train professionals to teach and deliver these approaches and interventions. However, as capacity needs increase, the central risk is that the quality and integrity of mindfulness-based interventions could be lost if prospective teachers are not adequately trained to deliver such interventions. To help minimise this risk, we argue that the education and training of future MBSR and MBCT teachers need to be carried out through structured and systematic training pathways that are founded in mindfulness practice and study and closely examined and attended to by senior teachers with many years of contemplative practice and teaching experience. Indeed, prominent people in the field argue that the ongoing formation of mindfulness-based teachers is critical to maintaining and protecting the quality and integrity of MBSR and MBCT. Committed to translating and integrating mindfulness into a twenty-first century context and lexicon—while honouring the universal essence and deep roots of mindfulness practice arising out of classical Buddhist meditation practices—modern scientific research has been conducted, education and professional training standards have been proposed and tools for assessment of mindfulness-based teaching competencies have been developed and applied, all in service of this implementation, dissemination and capacity building process.

Introduction

In a book on Mindfulness and Buddhist-derived Approaches in Mental Health and Addictions, why devote an entire chapter to the subject matter of skills, capacities and competencies required to teach mindfulness effectively? Might it not be sufficient simply to read the treatment manuals to familiarise oneself with the structure and content of specific mindfulness-based intervention programmes? Let us consider the background for even addressing such a question in the first place.

The majority of mindfulness-based intervention programmes, which are now increasingly being integrated into fields of medicine, health care, education, business, social care and leadership, are either based on or derived from mindfulness-based stress reduction (MBSR), which was developed by Jon Kabat-Zinn in the late 1970s and subsequently refined in close collaboration with his colleagues at the Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School (Kabat-Zinn, 2013; Santorelli, 1999).

MBSR is the coming together of two distinct epistemological traditions or ways of knowing: contemporary empirical science and traditional contemplative practice. Since the development of MBSR, scientific research has been carried out to investigate its health-related benefits. During the last few decades, there has been a dramatic and exponential rise in the number of peer-reviewed published articles on mindfulness, including numerous clinical trials documenting the beneficial effects of mindfulness-based interventions (Williams & Kabat-Zinn, 2011).

In this chapter, mindfulness-based interventions (MBIs) refer to MBSR and programmes modelled on MBSR that have been adapted to specific clinical and nonclinical populations. The two main MBIs we will focus on are MBSR (Kabat-Zinn, 2013) and mindfulness-based cognitive therapy (MBCT) (Segal, Williams, & Teasdale, 2013). These programmes are well structured, based on systematic training in mindfulness meditation, and have an extensive base of scientific evidence. Indeed, as the empirical evidence has grown strong, MBSR and MBCT are now supported by results from several recently published meta-analyses (e.g. Hoffmann, Sawyer, Witt, & Oh, 2010; Khoury et al., 2013; Piet & Hougaard, 2011; Piet, Würtzen, & Zachariae, 2012).

While the results derived from empirical investigation are highly promising, it is worth noting that in the majority of published studies of MBSR and MBCT, the intervention was carried out by highly skilled and well-trained MBI teachers, many of whom are dedicated long-term students of contemplative practice with deeply integrated and embodied knowledge of mindfulness acquired through decades of ongoing daily practice of mindfulness meditation, coupled with a detailed grasp of the MBSR/MBCT curriculum and solid interpersonal and didactic teaching skills.

However, it cannot be taken for granted that the inherent integrity and quality of the first generation of MBI teachers have been or will be successfully passed on to future generations. Indeed, as mindfulness is becoming increasingly popular and integrated into the mainstream of society, the proposition becomes more tenuous. Many health-care professionals, who are oriented towards evidence-based clinical interventions, now seek professional education and training in MBSR and MBCT without prior experience of training in mindfulness meditation. While this is encouraging, it also presents a huge challenge to the people responsible for training future MBI teachers. Given the statement below by Jon Kabat-Zinn, the professional training of MBI teachers may be of uttermost importance to ensure the quality and integrity of interventions based on training in mindfulness:

… the quality of MBSR as an intervention is only as good as the MBSR instructor and his or her understanding of what is required to deliver a truly mindfulness-based programme. (Kabat-Zinn, 2011, pp. 281–282)

Indeed, if the teacher is a significant moderator of the intervention outcome, in particular, the extent to which he or she embodies genuine knowledge and understanding of mindfulness and the specific mindfulness-based programme, then inadequate training of novice teachers, with no prior experience of mindfulness meditation, will have serious implications for future research. The worst-case scenario is that future studies with inadequately trained MBI teachers may no longer find and report any beneficial effects of MBSR and MBCT, nor be able to replicate positive findings found in previous studies. As such, we strongly suggest that the professional trajectory for educating and training teachers to competently deliver a mindfulness-based programme is a critical necessity for maintaining the quality and integrity of MBSR and MBCT as well as their adaptations.

Effective Teachers

The attempt to write and decide on the main content of a chapter on effectively teaching mindfulness within MBSR and MBCT is immediately humbling. Why is that? One might ask. Experiencing highly effective MBSR teachers over long periods of time, aspiring professionals often report observing the following: these teachers are apparently not using any specific technique; they rarely respond in a stereotypical manner; they do not give lectures to the programme participants; they do not put on a professional attitude or persona; they often make no attempt to position themselves as teachers, and they do not appear to be so caught up in the tendency of wanting to be liked. They are deeply and personally engaged in teaching. They are not afraid to turn towards people in the midst of suffering, as suffering takes the form of pain, loss, anger, aggression, sadness, sorrow, despair, doubt, agitation, jealousy, etc. They appear to really listen to what is being said, sometimes you may even get the impression that they manage to comprehend the fuller meaning of what is being expressed beneath the spoken words, as they are not exclusively focussed on the verbal forms of communication. They appear to be in tune with what is unfolding in the present moment. Importantly, independent assessors, using the mindfulness-based interventions–teaching assessment criteria (MBI:TAC), have observed the embodiment of these teacher qualities and competencies (Crane et al., 2013). However, as we shall see below, these ‘advanced’ teachers are not ‘special’. In fact, they exhibit a lot of the same qualities of any well-seasoned teacher across a wide array of fields.

In the educational literature, the question of ‘what makes an expert teacher?’ has been thoroughly investigated. Similar to the description of highly effective MBSR teachers, expert teachers across disciplines are characterised by traits such as autonomy and flexibility. Moreover, their teaching reflects a rich and integrated knowledge base, they demonstrate a high degree of awareness of important contextual variables, they have accurate pattern recognition, and they show creative problem-solving together with highly developed improvisational skills for relating to the immediacy and unpredictability of classroom events (Tsui, 2003; Berliner 2004a, 2004b).

Apparently, innate talent is not the most critical factor for the development of a high degree of expertise. Rather, people identified as experts have all studied with devoted teachers and practised intensively while being deeply engaged in the demanding process of continuously learning from feedback (see Ericsson, Charness, Feltovich, & Hoffman, 2006). According to Ericsson, Prietula, & Cokely (2007), the development of genuine expertise involves struggle, sacrifice and honest and often painful self-assessment.

While seasoned and highly effective mindfulness teachers, like most expert teachers in general, often function as a source of great inspiration, as living evidence of what might be possible in terms of learning and growing as a human being on the path of becoming a teacher, their level of integrity and competency should not represent ‘the’ benchmark for prospective teachers in terms of what is required to begin teaching. This is simply because the traits and qualities that such expert teachers manifest and embody are the consequence of many years of deliberate practice and teaching in a process of being highly committed to lifelong learning.

To help guide prospective and novice MBSR and MBCT teachers, it is therefore much more appropriate to explore professional training and teaching skills and competencies that may be considered competent or ‘good enough’ to begin teaching. In fact, models have been proposed that may serve to provide systematic and sustained guidance as one enters into the territory of becoming an MBI teacher.

In the following parts of this chapter, we identify key elements of professional teacher education and training, standards for teaching and proposed competencies considered ‘good enough’ to effectively deliver mindfulness-based interventions.

An Integrative Model of Quality and Integrity

In the Japanese Zen tradition, the term koan is sometimes used to refer to a story, question or statement to be meditated upon in order to reach a deeper understanding of aspects of reality, not merely based on logic and intellectual reasoning. The koan of this chapter, so to speak, is to try to uncover the very fabric that good teachers are made of. What makes a teacher effective? Is it their academic background? Is it their professional training as a mindfulness instructor? Is it because they are in alignment with established good practice standards of teaching mindfulness-based interventions? Is it a matter of acquired competencies or skills? Is it the ethical foundation of their behaviour? Might it concern the teacher’s ability to be fully human, knowing intimately the human condition? If so, can this be taught? Or might it have everything to do with the first-person experience of being committed to a life fully lived? Is it possible that highly effective MBI teachers may at times hold an awareness that sees things as they are, with great compassion and the urge to relieve suffering? Might they in their interaction with others be guided by a form of perception that is not clouded by personal preferences, opinions, strategies and agendas and therefore able to relate much more directly in order to actually be of service? How many of us teachers can live up to such standards? Perhaps at our inherent ‘best’, we all can, as the potential for awareness and compassion is already ours, already intact and ‘simply’ needs to be discovered or uncovered, nurtured and applied through practice and teaching.

To begin with, let’s have a look at one available map of the territory of becoming a competent teacher. Figure 4.1 is an extension of a working model presented by Crane et al. (2012) of three interconnected aspects of quality and integrity in teaching mindfulness-based courses, namely, (a) professional training, (b) good practice standards and (c) teaching competencies. To highlight that the process of becoming an effective teacher is by far a professional undertaking alone, we have added an outer circle to the model called ‘life practice’ based on an ‘inner ethical foundation’ and ‘awareness as the essential ground’ for living and teaching mindfulness, together with an orientation towards ‘contemplative traditions and lineages’ that have been deeply engaged in cultivating and refining mindfulness over millennia.

Fig. 4.1

The life practice of integrity and quality in teaching mindfulness

As such, the model serves to illustrate how an all-integrating view of teaching mindfulness may support the field in the long-term perspective of maintaining integrity and quality among mindfulness-based teachers. We find it especially important that teaching mindfulness is not viewed as some professional endeavours separate from the foundational intention and practice of bringing awareness to all aspects of one’s life nor separate from the vast wisdom of contemplative traditions and practicing lineages. The different interconnected components of the model will be explained in detail in the following parts of this chapter.

Professional Training and Education

Because mindfulness is a capacity of mind that cannot be discovered and refined through intellectual understanding alone, the act of teaching mindfulness takes on a certain complexity different from that of other forms of academic knowledge acquired and assimilated primarily through reading and study. Teaching mindfulness can be likened to the well-known metaphor of a finger pointing at the moon. If you look too much at the finger, you are likely to miss the full beauty of the moon and, more so, the ‘moon-like’ qualities within you that allow you to ‘recognise’ the moon. In parallel, the instructions given in the guided practices of MBSR and MBCT invite participants to explore their own innate capacity for attending to the full range of human experiences, the pleasant, the neutral and the unpleasant, with an awareness that is inherently nonjudgemental, kind and compassionate. They are discovering something that they already are. Meanwhile, for some people, it is possible that this way of being in relationship to experience is something that has not previously been nurtured or trained—at least not by means of intentional and systematic daily practice.

Regarding the role of the teacher, the fact of the matter is that mindfulness is being transmitted or revealed not only through the spoken words and guidance of the teacher but essentially by his or her way of relating to the unique configuration of the present moment, including the expression of difficult emotions from class participants in distress. Ideally, the teacher is capable of showing a different way of meeting suffering by relating with a spacious and kind mind that does not try to fix, alter or escape from what might initially by some participants be conceived of as a problem to be solved, avoided or suppressed. Therefore, any well-designed professional MBI teacher-training path is intended to try to prepare students for entering into the great work and challenge of teaching mindfulness in ways that are actually transformative and effective.

Importantly, this involves knowing how to provide the present moment space and ground needed for genuine learning to take place among class participants. It resembles what Robert Kegan, expanding on the work of D. H. Winnicott, has termed a healthy holding environment characterised by (1) ‘confirming’ people where they are while validating their absolute rightness; (2) skilfully introducing ‘contradiction’, often using questions to spur curiosity and further investigation; and (3) offering ‘continuity’ to support learning over time (for a detailed description of these three core processes within the context of teaching MBSR, see Santorelli, 2015).

As mindfulness continues to be integrated within the mainstream of society, professional training institutes have been established within university settings around the world. These include Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School (http://www.umassmed.edu/cfm/); Oxford Mindfulness Centre, University of Oxford (http://oxfordmindfulness.org); Centre for Mindfulness Research and Practice, Bangor University (http://www.bangor.ac.uk/mindfulness/); Danish Center for Mindfulness, Aarhus University Hospital (http://mindfulness.au.dk).

Any professional training path that remains true to the integrity of mindfulness-based interventions such as MBSR and MBCT will often include the following successive phases:

• 1. Prerequisites

  To begin with, prospective teachers must complete the relevant MBI as a class participant. This initial phase provides an opportunity for learning from the inside what it actually means to be engaged in bringing mindfulness into everyday life by participating in a structured mindfulness-based programme.

  Throughout the teacher training and beyond, this first-person perspective of direct experience of mindfulness is further cultivated, strengthened, refined and stabilised through ongoing daily meditation practice as well as regularly attending mindfulness meditation retreats. Indeed, attending 5–10 days silent teacher-led retreat is usually another prerequisite for embarking on a path of professional teacher training in MBSR or MBCT. Furthermore, a professional degree in mental or physical health care, education or social care and prior knowledge and experience of the particular clinical or nonclinical population, for whom the intervention is adapted for, are often required.

• 2. Foundational teacher training

  This phase involves attending several professional training courses intended to prepare the students to begin teaching. One such training course might include attending the 8-week MBSR or MBCT programme as a so-called participant-observer. This involves full participation in the programme with fellow class participants, followed by weekly reflection, and study together with other prospective teachers, led by a senior teacher. This format is highly praised as it allows future teachers to enter into dialogue and inquiry with an experienced teacher about the actual unfolding of each in vivo session of the 8-week programme. Likewise, it mirrors an aspect of mindfulness practice itself: the capacity to both observe (observer) and feel (participant) the full range of body sensations, thoughts and emotions arising in the continually changing field of awareness. Bhante Gunaratana says it like this:

  Mindfulness is participatory observation. The meditator is both participant and observer at one and the same time. If one watches one’s emotions or physical sensations, one is feeling them at that very same moment. Mindfulness is not an intellectual awareness. It is just awareness. The mirror-thought metaphor breaks down here. Mindfulness is objective, but it is not cold or unfeeling. It is the wakeful experience of life, an alert participation in the ongoing process of living. (Gunaratana, 2011, p. 135)

  Usually, completion of one or more 5–10 days silent, teacher-led mindfulness meditation retreat is required before attending the next level of professional training. Retreats are considered an absolute necessity for developing one’s own meditation practice, for refining and stabilizing attention and awareness, for cultivating greater kindness towards oneself and others, and for developing one’s understanding and effectiveness as a teacher (Santorelli, 1999, 2015; Kabat-Zinn, 2011). Additional training courses are often weeklong intensive trainings in which the cultivation of mindfulness is closely interwoven with learning and observing specific core teaching skills. Furthermore, at this stage, led by experienced teacher trainers, students may start to guide one another in a series of different mindfulness practices while learning how to give and receive nuanced and constructive feedback.

  In this second phase, essential study courses are also offered, including subjects on, for example, the science of mindfulness, stress physiology, psycho-education on depression, interpersonal mindfulness, group dynamics, the use of story and metaphor in teaching, introduction to relevant aspects of Buddhist psychology, etc.

• 3. Advanced teacher training

  In addition to further teacher training, aimed at refining essential teaching skills, this phase encourages teachers to enter into a period of teaching under supervision by an experienced senior MBI teacher. This allows for a deepening of their understanding of the 8-week programme as well as of themselves as an MBSR or MBCT teacher, including shedding light on any barriers that may prevent effective teaching. As for all other phases in the formation of teachers, attending silent meditation retreats is a mandatory discipline.

• 4. Ongoing professional and personal development

  This phase involves a deep commitment to sustain and refine mindfulness through daily formal and informal practice, as well as attending silent retreats on a regular basis. Also, the teacher needs to keep up with the relevant literature and evidence base of mindfulness. Supervision when needed is strongly recommended as well as familiarisation with the current good practice standards for teaching MBSR and MBCT. In addition, ongoing participant evaluation of intervention outcome is regarded as good practice. Finally, this phase may include a teacher certification review.

Good Practice Principles and Standards

For people wishing to teach mindfulness as a mind-body intervention, in ways that ideally correspond with the quality and integrity of the original MBSR approach, good practice guidelines, principles and standards are now available.

The following six points to be considered and embodied over time by any teacher of MBSR and related MBIs have been emphasised by Kabat-Zinn (1996). They include the guiding principles of:

• (a) Making experience and the act of observing one’s life mindfully an adventure to be lived and a challenge to be met

• (b) Prioritising individual effort, motivation and discipline in the daily formal practicing of mindfulness, regardless of whether one ‘feels’ like it or not

• (c) Understanding the immediate change of lifestyle required to fully participate in MBSR, given extensive daily homework

• (d) Deliberately prioritising the full experience of each unfolding moment during formal and informal practice

• (e) A group format and time-limited structure with an educational orientation as the foundation for forming a community of learning and practicing to cultivate ongoing support and motivation together with feelings of acceptance and belonging

• (f) A generic approach focussing on common humanity, and what is right with people rather than what is wrong, on deep inner resources rather than limitations and on active involvement in one’s own healing process rather than adopting a passive attitude

Although substantial research has found therapeutic effects of MBSR (e.g. reduced symptoms of stress, anxiety and depression), it has been underscored that MBSR is ‘not’ therapy; it is a way of being (Kabat-Zinn, 2006).

More recently, a number of standards and guidelines have been proposed to promote good practice in teaching mindfulness to people in the mainstream of society and to help maintain and protect the quality and integrity of research-supported mindfulness-based intervention programmes. The key principles and aspects of these standards and guidelines are summarised below:

• 1. MBI teachers need to have a strong commitment to the practice of mindfulness meditation sustained through (a) daily practice and (b) ongoing participation in retreats, in order to deepen their own practice and understanding which provide the very ground of teaching mindfulness.

• 2. Adherence to the principle of never asking more of participants in terms of daily practice requirements than you as a teacher ask of yourself. On a similar account ‘Do not teach what you do not know’. For example, by not guiding participants in mindfulness practices that you do not know intimately through your own direct experience or so-called first-person perspective. This form of knowledge, while rooted in the present moment, is gained from the teachers’ own long-term practice of mindfulness meditation practice.

• 3. Understanding the noninstrumental nature of teaching mindfulness. That mindfulness, rather than being a set of techniques to be acquired or a particular mental state to be attained, essentially is a way of being in wise relationship to experience.

• 4. Commitment to ongoing learning and development as a teacher through (a) further training and regular supervision by senior MBI teachers, (b) continuing collaboration with MBI colleagues, (c) keeping updated with the relevant scientific literature on mindfulness and (d) gaining an understanding of the historical roots of mindfulness by studying some of the essential texts from relevant contemplative traditions, in particular Buddhism, that are grounded in mindfulness practice and remain informative for bringing mindfulness into the lives of people in modern society. To begin an exploration of mindfulness at the intersection of science and dharma, Contemporary Buddhism, volume 12, issue 1, is a helpful place to start.

• 5. Adherence to ethical guidelines, including a fair pricing structure for mindfulness-based courses as well as for professional training of mindfulness-based teachers.

In addition, in a paper on practical recommendations for teaching mindfulness effectively, Shonin and Van Gordon (2014a, 2014b) have emphasised the importance of remembering to practice mindfulness while teaching and guiding others. To support this intention, they strongly recommend taking time to restabilise attention and re-establish oneself in the present moment immediately before teaching a class or group of people. Such an effort, to actually pause before teaching MBSR or MBCT, can provide a powerful shift from (a) the usual doing mode of mind to (b) being present and available to others in ways that embody the practice of mindfulness.

Furthermore, these authors caution teachers against trying to appear ‘too mindful’. They also point out some of the characteristics that may define a teacher who does not have much presence of mind. These include (1) an overly pious demeanour, (2) constant and/or inappropriate smiling, (3) not being able to introduce genuine joy and light-heartedness into their teachings and (4) doing things excessively slowly when others are watching while rushing around mindlessly at other times. These characteristics may be worth looking for, at least in ourselves as teachers, as they are all based on a ‘mental idea’ of how a teacher who is mindful should behave, rather than actually teaching from within present moment awareness in ways that are embodied, authentic, relaxed and transparent to reality. In addition to a regular practice of mindfulness, it may be very beneficial continuously to remind oneself that the work of teaching mindfulness is all about being at the service of other people. To actually be at service may require that we learn to get out of our own way. Being caught up by our personal preferences, needs and agendas, e.g. the need to be seen, heard and respected, can easily create a barrier for helping others towards growth and well-being. In Buddhism, too much attachment to one’s ego or self-image is a root cause of suffering, and it may indeed be the greatest hindrance for maturing as a person and teacher to effectively teach mindfulness. While many people may begin teaching with pure intentions, there is a real risk for all of us to become inflated and corrupted by even the slightest bit of fame or success (ibid.). This is one reason why it is important for mindfulness teachers to have (1) a mentor (teacher), (2) access to teachings and practical guidelines for travelling the path of awakening (dharma) and (3) a community (sangha) of fellow meditation practitioners. Such fortunate circumstances, in Buddhism referred to as the three jewels, can provide immediate feedback and regulation to protect against crucial pitfalls on the journey of becoming an authentic and effective teacher.

For further details on standards of good practice of teaching MBSR and MBCT, please see the following documents, as well as practical recommendations for teaching mindfulness by Shonin and Van Gordon (2014a, 2014b):

• http://www.umassmed.edu/cfm/stress-reduction/mbsr-standards-of-practice/

• http://www.umassmed.edu/cfm/training/principles--standards/ http://mindfulnessteachersuk.org.uk

In addition, at the Center for Mindfulness in Medicine, Health Care, and Society (CFM), University of Massachusetts Medical School, standards of practice for trainers of MBSR instructors have been outlined. Apart from having (1) completed the MBSR professional training path, (2) taught a minimum of 15 8-week MBSR courses and (3) received MBSR teachers certification granted by the CFM, MBSR teacher trainers are required to (4) engage in ongoing MBSR teacher training consultation, (5) regularly attend teacher-led silent meditation retreats, (6) maintain a sustained personal practice of mindfulness meditation and mindful Hatha yoga and (7) embody learner-centred teaching skills, a capacity for deep listening, regard and compassion for all participants, highly developed sensitivity to the use of language, knowledge of the art of dialogue and inquiry with class participants and an ability to create and maintain a safe container for exploration and learning in the face of stress, pain, illness and suffering (for details, see http://www.umassmed.edu/cfm/training/principles--standards/). Similarly, the UK Network for Mindfulness-Based Teacher Trainer Organizations has proposed good practice guidelines for trainers of mindfulness-based teachers (see http://mindfulnessteachersuk.org.uk).

Teaching Skills and Competencies

Given the effort of novice teachers to adhere to the professional standards of practice, committing oneself to the path of meditation, and being called by the imperative to begin to turn towards suffering with skilful means, what essential teaching competencies might hopefully be discovered, developed and refined over time?

First of all, the foundation or basic ground of teaching mindfulness within MBSR and MBCT is awareness itself. For mindfulness to be truly effective, the capacity for nonjudgemental awareness, clear seeing and genuine compassion needs to be directly known and embodied by teachers, in their life and in their teachings. By genuine compassion, we mean compassion that is felt and experienced from the inside to the extent that it naturally and effortlessly flows out in the form of deeply caring about the well-being of others. When such qualities of being are embodied by the teacher, and inform the teaching process moment by moment, it allows for being in direct relationship to other people with an open mind and heart that is capable of listening deeply by offering a form of attention that is not caught up in discursive thinking based on theory and analysis, or personal ideas, beliefs, preferences and opinions, all of which may characterise our ‘default’ state of mind. Therefore, as emphasised in a paper on dialogue and inquiry in the MBSR classroom:

The MBSR teacher’s capacity for appreciating and cultivating mutually-ennobling relationships with participants, for sympathetic resonance, gratitude, warmth, clarity and flexibility in making moment-by-moment choices in response to class participants’ experiences requires them to be firmly committed to a keen and persistent observation of their own experience. (Santorelli, 2015)

This of course is asking a lot of people, perhaps especially of those who may enter into a professional training pathway to learn MBSR or MBCT based on the assumption that mindfulness is simply a set of skills or competencies that can easily be observed, learned, imitated and then applied in order to successfully carry out the intervention. While some people, these days, may come to a professional training pathway with a limited understanding of what it takes, many may, over time, come to see that a lot more is at stake. In fact, this recognition may give rise to an even deeper motivation and reorganisation of their initial intention for learning and studying MBSR or MBCT.

In a book on teaching mindfulness, McCown, Reibel and Micozzi (2010) identify four sets of interrelated skills that appear to be shared among MBI teachers. These are:

• 1. ‘Stewardship’ of the group, which emphasises a nonhierarchical, participatory-oriented form of teaching in which the teacher holds the space in a certain way that creates a sense of freedom and belonging to allow participants to explore and share their direct experience of the joys and sorrows of the human condition.

• 2. ‘Homiletics’ , used by the authors to refer to a certain way of delivering didactic material to convey principles of the pedagogy of MBSR. Rather than presenting information from an ‘expert lecturing’ stance, information is co-created by engaging participants using skilful questioning, reflections, stories and poetry. This approach can provide a starting point for delivering didactic material in ways that make central themes of MBSR (e.g. perception, stress and communication) personally relevant. For example, people in an MBSR class already know a lot about stress in terms of their direct personal experience, and probing this knowledge may be very helpful in order to cocreate and unfold knowledge about stress physiology.

• 3. ‘Guidance’ of formal and informal practices and exercises using language that is non-commanding and invitational in ways that allow people to feel and experience what they are actually feeling and experiencing beyond judgements or expectations. Most importantly, the teacher needs to be anchored in the present moment in order to effectively guide others towards paying attention nonjudgementally to the unfolding of different aspects of their moment-by-moment experience.

• 4. ‘Inquiry’ into participants’ direct experience of practicing mindfulness. Inquiry is a form of conversation or dialogue based on the presence, openness and curiosity on behalf of the teacher in ways that support participants in exploring, acknowledging and discovering the full territory of their own direct experience of themselves and their lives.

Interestingly, the authors emphasise that these four skill sets completely depend upon the teacher’s authenticity, authority and friendship, in particular, the teacher’s capacity for remaining present and responding thoughtfully and compassionately to whatever arises in the present moment (ibid.). The topic of dialogue and inquiry between teacher and class participants in MBSR and MBCT is further addressed later in this chapter.

In parallel, in a series of papers, Crane et al. (Crane et al., 2010, 2012, 2013) have proposed a number of core competencies for teaching mindfulness-based interventions that provide the foundation for assessing MBSR/MBCT intervention integrity. These competencies are reflected in the following six domains:

• 1. Coverage, pacing and organisation of each session

• 2. Relational skills

• 3. Embodiment of mindfulness

• 4. Guiding mindfulness practices

• 5. Conveying course themes through interactive inquiry and didactic teaching

• 6. Holding the group learning environment

Based on the above six domains (or teaching assessment criteria), the scale developed by Crane and colleagues, the mindfulness-based interventions–teaching assessment criteria (MBI:TAC), has been reported to be a reliable and valid tool for evaluating the integrity of MBSR/MBCT by means of assessing teacher competencies (Crane et al., 2013). The MBI:TAC may prove useful for assessing teacher competencies in order to:

• (a) Support the development and formation of future MBI teachers in professional training programmes by monitoring their level of competency. Such routine may help to both evaluate the effectiveness of the professional training process and to identify specific skills that need further refinement before prospective teachers are ready to deliver MBSR/MBCT in real-world settings in alignment with the integrity of the approach.

• (b) Optimise the quality and integrity of MBSR/MBCT in future research studies. In particular, the MBI:TAC may help to select highly competent teachers to ensure a high degree of teacher fidelity in future clinical trials. Indeed, several reviews and meta-analyses (e.g. Baer, 2003; Grossman et al., 2004) have pointed to the lack of assessment of teacher fidelity in trials investigating the effects of mindfulness-based interventions. As discussed earlier in this chapter, the quality and integrity of the MBSR/MBCT teacher may actually be a significant moderator of the intervention effect. Although plausible, this hypothesis remains to be tested, confirmed or rejected, by empirical research.

Life Practice

As emphasised previously in this chapter, the foundation for teaching mindfulness rests on the capacity of the teacher to stay present and open with a nonjudgemental attitude. This way of being in relationship to whatever arises in the field of awareness, even in the midst of difficult situations and painful experiences, is very different from the usual habit of relating to experience through the filter of judgement and personal opinions of right and wrong. Indeed, it may be, in and of itself, a radical form of loving-kindness.

Initially, we have the rich texture of our personal life as a training arena to explore and implement new ways of being in wise relationship to our own suffering. This work of individual liberation over a lifetime is informed by our meditation practice. In Buddhism, it is sometimes referred to as the journey of the foundational vehicle, which is considered necessary for learning how to stay present to other people who are suffering (Trungpa, 2013a, 2013b).

From this perspective, teaching mindfulness is not separate from the intention to be present to what Jon Kabat-Zinn has called the full catastrophe, namely, life itself. The term life practice or integral life practice is sometimes used to refer to specific complementary and mutually supportive practices for developing one’s body, mind, emotional capacities and interpersonal skills (see Leonard & Murphy, 1995; Wilber, Patten, Leonard, & Morelli, 2008; Risom, 2010). However, we use the term life practice in a broader sense to refer to the intention of bringing the same quality of awareness and attention that is cultivated through the formal practice of mindfulness meditation into every imaginable aspect of life, sometimes called informal practice, including the interpersonal domains, the act of cooking and eating, working, exercising, making love, taking out the garbage, caring for the children, etc. It also involves periodically going into therapy to help resolve or coming to terms with personal trauma as well as other aspects of one’s personality and relational patterns that may at times in very real ways prevent one from relating to others with clarity and compassion.

This ongoing commitment to personal growth and self-development together with several other factors—including a sustained practice of mindfulness meditation, consistent silent retreats, regular mentoring and supervision by senior teachers, as well as self-inquiry into the questions of who and what I am—is what Saki Santorelli has called ‘the real work of an MBSR teacher’ (Santorelli, 2015).

A lack of this kind of knowledge of oneself may cause a great barrier to being effective as an MBSR or MBCT teacher. For example, unresolved anger or sadness may arise in a teaching situation, and to the extent that the teacher is taken over by such strong emotions, it may completely prevent him or her from seeing the situation clearly. Rather than responding with clarity and kindness, it may lead to automatic and fearful reactions based on old habitual patterns. This therapeutic work, which is considered part of an integrative life practice leading to greater self-knowledge, may be required in order to start navigating more freely in one’s life and teaching—perhaps in ways that may at times to some degree dissolve the perceived barrier between oneself and others. The Japanese Zen meditation master Dogen beautifully expresses the way of transcending the experience of being an isolated self that is separate from others:

To study the Way is to study the self. To study the self is to forget the self. To forget the self is to be enlightened by all things. To be enlightened by all things is to remove the barriers between one’s self and others. (Dogen, 2002)

Thus, we view teaching mindfulness as something that is by no means separate from one’s life. Awareness is the essential ground of all of life, including teaching others to discover their own full potential for attention and awareness as necessary means for learning, and growing, and for coming to terms with things as they are. For a clear and simple presentation of mindfulness meditation as a practice of life awareness, please see Risom (2010).

Ethical foundation

MBSR is at its healthiest and best when the responsibility to ensure its integrity, quality, and standards of practice is being carried by each MBSR instructor him or herself. (Kabat-Zinn, 2011, p. 295)

Integrity of the approach is fundamentally carried by each individual teacher and therefore involves carefully attending to how we as teachers live our personal and professional lives. This endeavour is supported by the intention to bring full awareness to the present moment, including one’s own state of body and mind, in order to skilfully relate in ways that prioritise right conduct and the well-being of others. For many of us, to actually be in touch with awareness of our interior experience in a moment-by-moment manner, while relating to others, may not be all that easy. However, it can be cultivated, stabilised and refined through the practice of mindfulness. Indeed, this present moment capacity, to know one’s emotional state with the configuration of thoughts that usually comes along with it, can make a real difference by virtue of awareness itself that allows for freedom to choose to respond (or not to respond) in alignment with the intention to benefit others. This contrasts the usual process in which we are normally hooked and triggered by potentially harming emotional states such as anger, rage, jealousy, envy, pride, etc. With no awareness of our own interior landscape, we run the risk of being driven by automatic habitual reactions that manifest through words and behaviour that can cause unforeseen harm to our relationships and to ourselves.

As such, ethics are not primarily guided by a set of external values, rules or guidelines. Rather ethical behaviour arises from having, to some extent, developed genuine empathy and compassion for others and also from having gained insight into the causes of suffering. In teaching mindfulness, this involves present moment skilful means in order to differentiate between (a) behavioural responses, including any form of communication, that may support others to discover their own innate capacity for awareness, wisdom, kindness and compassion and (b) behavioural responses that are likely not to be helpful to the learning, growing and healing of other people.

This perspective on ethics, the imperative of the teacher to live with care and attention, invites there to be no separation between one’s practice and one’s life. At the same time, MBSR and MBCT rest on an ethical foundation that lies at the very root of medicine and health care, namely, the Hippocratic oath or principle of primum non nocere, meaning above all ‘to first do no harm’. It is remarkable how this guiding principle at least to some extent resembles the Bodhisattva vow which in classical and contemporary Buddhism reflects the intention to devote one’s life to work for the well-being of others (Kabat-Zinn, 2011; Harvey, 2013; Santorelli, 1999, 2015). For a more detailed description of the ethos of MBSR, please see Santorelli (2015).

Tradition, Lineage and Modern Society

MBSR is simply a contemporary expression of a twenty-six hundred year old meditation tradition that has at its heart, the cultivation of a human being’s familiarity with the one awareness that already is. (Santorelli, 2015)

Given that the practice of mindfulness meditation within many ancient contemplative traditions, in particularly Buddhism, has been passed on from one generation to the next for at least 2500 years, let us consider some of the traditional requirements for teaching mindfulness.

In general, within these traditions, you would receive authorisation to teach the dharma (the teachings of the Buddha), including guiding practitioners in the lifelong process of working with mindfulness meditation, through what is commonly known as ‘lineage transmission’. Traditionally, this responsibility was, and still is, granted by lineage holders within each particular contemplative tradition, only to highly devoted, gifted and dedicated long-term students, who, in their way of conducting themselves with integrity of thought, speech and action, to a large extent, embody what the dharma is all about. This embodied knowledge and insight are presumably acquired through intensive and prolonged study and practice of the dharma, including formal and informal practice of mindfulness meditation. However, lineage can be transmitted in several different ways, e.g. oral transmission, written transmission or mind-to-mind transmission. Ultimately, and beyond any formal means of transmission and approval, a lineage holder is someone who embodies genuine presence with the mark of wisdom, unconditional compassion and steadfast awareness. Therefore, inner realisation of the dharma, recognition of the essence of consciousness, may be the only true credential that counts (for details on lineage transmission, please see Shonin & Van Gordon, 2014a, 2014b). For readers interested in a nuanced description of the functions of ordinary consciousness that covers the essence of mind, please see Bertelsen (2013).

Thus, traditionally, only relatively few people had achieved a level of personal maturation considered adequate for effectively teaching others the practice of meditation.

A basic view in many traditions of contemplative practice is that the innate human capacity for clarity of awareness, kindness and compassion and essentially the wisdom needed to respond in a manner that does not cause harm to people, is something that can be nurtured and developed through sustained practice and right livelihood. In many of these traditions, and explicitly addressed in Mahayana Buddhism, a fundamental motivation is the cultivation of bodhichitta , which means ‘mind of awakening’, and metta which means ‘loving-kindness’, namely, human qualities needed to effectively guide and help suffering beings. To take on this lifelong work and responsibility—to nurture and cultivate these important aspects of the human mind and heart to relieve suffering in oneself and others—may be exactly what is needed, not only for the future generation of mindfulness-based teachers but for humanity all together. We are as a species, and as part of the larger order of sentience, in a very precarious place in human history. Potentially, we could do enormous damage to the planet and all life forms that inhabit this small sphere. It is well known that we, due to ever-greater consumption, have depleted the Earth of many of its resources. According to Rifkin (2009), we now have a world in crisis that more than ever needs a global shift towards greater empathy to save the Earth and improve on our species’ ability to survive and flourish in the future. The practice of mindfulness meditation is one means of bringing about such a shift towards greater empathy and compassion.

Now, as mindfulness is increasingly integrated within the mainstream of society, including health care, education, business and leadership—mainly due to scientific research documenting the effect and applicability of MBSR and MBCT in a broad range of clinical and nonclinical populations—there is a need to increase the capacity of people who can effectively deliver interventions based on mindfulness.

The downside to the popularisation of mindfulness, what we might call worst-case scenarios, is the training courses offered for becoming a certified mindfulness instructor by attending a single weekend course or two. Such initiatives run the risk of seriously compromising the quality and integrity of mindfulness-based interventions. These interventions, carried out by less competent teachers, are in fact likely not to be based on mindfulness. If mindfulness, as a core trait and way of being in relationship to oneself, others and the world, could be taught and acquired in just a few days or weeks, without previous experience of practicing mindfulness, this would be no problem. But it turns out—as with training of any genuine human capacity, including the acquisition of different languages, mathematics, athletics and musical skills—that it takes time and effort to develop, nurture and refine the inherent capacity for being present to whatever is unfolding in the mind-body-heart moment by moment.

The rigorous traditional requirements for teaching mindfulness, embodied by some living teachers within contemplative traditions, may provide an inspiring perspective in terms of the potential possibilities for human growth and development. However, as described in the beginning of this chapter, it is not helpful to view the marks of an expert as standards of what is required to begin teaching—simply because the characteristics of an expert teacher are the result of decades of practice and learning. Rather, to sum up, we suggest that the proposed MBI teacher competencies and standards of good practice, outlined in this chapter, reflect what might be considered adequate or ‘good enough’ to begin teaching mindfulness in MBSR and MBCT.

To assist novice teachers in the process of further growth and development, a competent mentor or senior teacher is highly recommended. In the poem below, the Sufi master Rumi beautifully describes the process of transformation from being raw to being cooked by one’s teacher and undone by the heat of life. All in service of one day becoming effective as a teacher—capable of teaching others to discover their own innate capacity for living life fully with awareness and the courage of an open heart that is responsive and responsible to oneself, others and the world—perhaps with an increasing sense that the perceived separation between self and others may be somewhat artificial.

Chickpea to Cook

• A chickpea leaps almost over the rim of the pot where it’s being boiled.

• ‘Why are you doing this to me?’

• The cook knocks him down with the ladle.

• ‘Don’t you try to jump out. You think I’m torturing you. I’m giving you flavour, so you can mix with spices and rice and be the lovely vitality of a human being. Remember when you drank rain in the garden. That was for this’.

• Grace first. Sexual pleasure, then a boiling new life begins, and the friend has something good to eat.

• Eventually, the chickpea will say to the cook, ‘Boil me some more. Hit me with the skimming spoon. I can’t do this by myself. I’m like an elephant that dreams of gardens back in Hindustan and doesn’t pay attention to his driver. You’re my cook, my driver, my way into existence. I love your cooking’.

• The cook says, ‘I was once like you, fresh from the ground. Then I boiled in time, and boiled in the body, two fierce boilings. My animal soul grew powerful. I controlled it with practices, and boiled some more, and boiled once beyond that, and became your teacher’.

Rumi, translated by Coleman Barks (Coleman & Moyne, 1995). Reprinted with permission by Coleman Barks

Relevance of the Four Noble Truths

In addition to principles and standards of teaching mindfulness, agreed upon by experts in the field, a number of complementing facets of what is actually required to teach mindfulness effectively need to be highlighted with reference to the four noble truths, as described in various Buddhist traditions.

The first noble truth of the Buddhadharma, which in essence is no different from a universal dharma operating independently of Buddhism or any other religion for that matter, is the recognition that suffering (stress) is part of the human condition.

A helpful distinction is often made between (a) a first order or natural form of suffering caused by sickness, old age and death, including the inevitable loss of people we love, and (b) a second order or extra form of suffering, sometimes referred to as adventitious suffering, which causes the majority of suffering in a human being’s life (Kabat-Zinn, 2012). Mark Twain is known for having expressed this heart breaking observation in the following sentence: ‘I am an old man and have known a great many troubles, but most of them never happened’. This extra form of suffering is self-imposed on top of the unavoidable natural suffering, and according to Buddhism, it is largely caused by (a) the tendency to try to secure our own happiness by grasping on to pleasant experiences while trying to avoid the unpleasant and (b) ignorance of the impermanent and interconnected nature of ourselves and reality. Indeed, the second noble truth of the Buddha is the recognition that there is a cause to all suffering, including this form of self-created suffering. The third noble truth recognises that the cessation of this suffering is possible, while the fourth noble truth concerns the actual path of the dharma that may eventually lead to the liberation of self-imposed suffering. By practicing meditation, we gradually come to see many ways in which we actually cause and maintain our own suffering.

The path of becoming a teacher of mindfulness and the dharma in its universal manifestation essentially involve the courage to meet the suffering of this world. Initially this involves turning towards one’s own suffering in order to begin learning to relate to suffering in new ways, rather than trying to avoid or deny its existence. Through meditation practice, by relating directly to the experience of one’s own suffering, the wish and urge to be at service to alleviate the suffering of others may arise naturally over time. Indeed, the teacher may then gradually come to view and prioritise the well-being of other people as equally or more important than their own well-being. This radical orientation may arise from the recognition or insight that others are not fundamentally separate from oneself.

Dialogue and Inquiry

To navigate as a teacher by means of intimately knowing the present moment is central to the process of dialogue and inquiry. In the context of MBSR and MBCT, the terms inquiry and dialogue refer to the open intimate conversation between teacher and participants in ways that allow for further exploration and investigation of the experience of being alive and awake to the present moment. This includes bringing close attention to the full range of experiences’ characteristic of the human condition—the full catastrophe of life with all of its joys and sorrows.

Interestingly, ‘dialogue’ in MBSR has been described as the outward counterpart to the inward cultivation of present-moment-centred, nonjudgemental awareness (Santorelli, 1999; Kabat-Zinn, 2012). It is radically different from the process of ‘discussion’, which tends to be the norm or stereotype of verbal communication in the interpersonal domain. Discussions are often characterised by strong personal opinions and strategies and often driven by hidden agendas and power differentials between people. Dialogue on the other hand provides a relational space of openness and safety based on the faculty of nonjudgemental deep listening and seeing that can allow each and every voice to be heard and known as a valid contribution to the collective process of inquiry and investigation (Kabat-Zinn, 2012). Such a sensitive approach to communication may lead to important insight and discovery that cannot be uncovered if the process is primarily fuelled by personal and fixed agendas. With fundamental attitudes, such as nonjudgemental deep listening and no attachment to outcome, the process of dialogue and inquiry may provide enough relational space for new knowledge to emerge. This in turn may guide action in more creative, innovative and compassionate ways.

In the MBCT treatment manual (Segal, Williams, & Teasdale, 2013), the practice of inquiry has been described in terms of three concentric circles or layers. The first layer is concerned with the direct experience of the practice of mindfulness by inviting participants to describe any thoughts, feelings and bodily sensations that they were aware of during the practice. The second layer involves skilful questioning and reflection to place experience in a personal context of understanding. In the third layer, however, learning is generalised and situated to a larger context, making it relevant for the whole group of participants.

A note of caution: If this step-by-step model to dialogue and inquiry is rigidly applied with too much interruption and intervening, driven by a perceived directionality and goal-oriented behaviour on behalf of the teacher, the risk may be that participants are not allowed enough space to investigate and express their actual experience, whatever it may be. The authors seem to be well aware of this. In fact, they underscore what may be one of the most important aspects of inquiry and dialogue, namely, the quality of the relationship to experience that is lived and embodied by the teacher. If this relationship is one of awareness infused with kindness, gentleness, compassion and understanding, especially towards difficult and painful experiences, it may help participants themselves to integrate this way of being in relationship to their own experience. Indeed, it may serve as a powerful antidote to self-criticism and self-judgement, which is not an uncommon habitual response to difficult experiences. To witness the conduct of a human being or expert teacher with such capacity of mind and heart can make a long lasting impression and is a powerful inspiration for practicing mindfulness meditation, at least in our experience.

According to Santorelli (2015), while detailed frameworks and maps of the process of inquiry and dialogue may have limited value, there is no doubt that as a teacher, with the intention to ‘first do no harm’, the capacity to mindfully investigate one’s own experience of being human essentially provides the context required to actually meet other people in ways that are helpful for human growth and transformation. A fundamental view of human nature, embedded in the teachings of MBSR, is expressed in the following line: ‘As long as you are breathing, there is more right than wrong with you’ (Kabat-Zinn, 2013). In other words, the capacity to live this human life with awareness is available within each of us as a deep resource for healing and for coming to terms with things as they are and as such not restricted by adversity, loss, illness and pain.

Based on the ethos of MBSR, Santorelli (2015) has outlined 21 guiding principles that express the essence of the dialogue and inquiry process within MBSR. Some of these guiding principles are the following: Dialogue and inquiry are an expression and reflection of mindfulness meditation practice. They are grounded in the body and grounded in present centred awareness. Dialogue and inquiry are respectful and directed towards inner growth and the implications of this learning in everyday life. Dialogue and inquiry are non-goal oriented, and they are not directed towards changing or fixing anyone or anything. Even when painful, they are always directed towards the sovereignty of every human being and the principle of ennobling. Through direct experience, they are a learning to ‘turn towards’ the difficult and/or unwanted. Importantly, dialogue and inquiry occur in a community that learns to bear witness to the self-revealing of another without giving advice (ibid.).

While inquiry is an art form that essentially is creative and responsive to the unique configuration of the present moment, Santorelli (2015) has described a typology of Socratic questions that can be integrated into the MBSR learning environment. These types of questions include (1) ‘conceptual clarification’ which invites participants to expand on and clarify what they report from their own experience; (2) ‘wondering about assumptions’ that participants may have about themselves, others and the world; (3) ‘probing rationale and evidence’ for a certain point of view; (4) ‘challenging viewpoints and perspectives’ that may no longer serve; (5) ‘probing implications and consequences’; and (6) asking questions about questions (ibid.). How do you know this? Are you sure? Do you benefit from this view? What might happen if…? What do you make of that? These are a few examples of such open questions. Now, the teacher’s willingness to live with and inside such open questions, to inquire into their own experience of life, is exactly what provides them with the licence to ask such questions to their students (ibid.). Again, this is not a technique or manual-based approach but rather a response in the form of a question arising from deep listening and attending to participants as they communicate and express their experience of being aware in the present moment. The intention is to be at service to others with great sensitivity to the present moment and to be in touch with the range of present-moment information that can provide the foundation for responding with wisdom and skilful means in ways that may allow each individual as well as the group to further their understanding and growth towards wholeness and greater well-being.

Closing Comments

If the principles of ‘first do no harm’ and ‘teach only what you know’—along with a direct recognition that MBSR and MBCT ‘rest in the view that the essential nature of human beings is luminous and unimpeded’ (Santorelli, 2015)—become an embodied ethos within an MBI teacher and they continue their deep commitment to practice and study and silent retreats and a working relationship with a teacher and with life itself, they may be able to do some genuine good in this world.