Mindfulness and Counseling Self-Efficacy: The Mediating Role of Attention and Empathy

This study examined the predictive relationship between mindfulness and counseling, self-efficacy and the potential mediating effects of attention and empathy. Master's-level counseling interns and doctoral counseling students (N = 179) were surveyed to determine levels of mindfulness. attention. empathy. and counseling selfefficacy. Pearson product-moment correlation coefficients revealed significant pairwise relationships between the 4 variables of interest. A multiple-mediator path analysis supported the hypotheses that mindfulness is a significant predictor of counseling self-efficacy and that attention is a mediator of that relationship, Results suggest that mindfulness may be an important variable in the development of key counselor preparation outcomes. Article: Among the skills considered essential to being an effective counselor are strategically controlling attention during the session and having both a cognitive and affective empathic response to the client (Lambert & Barley. 2001; Orlinsky, Grave, & Parks. 1994; Rogers. 1957. 1975: Wampold, 2001: Watson. 2001). A review of the literature reveals, however, that counselor educators have little empirically based direction on how to cultivate the internal habits of mind necessary for controlling attention and for having a multidimensional (i.e.. cognitive and affective) empathic response. Instead, the majority of training literature focuses on developing those empathic responses that are external and observable, such as mirroring and reflection of feeling. Moreover, some researchers suggest that counselor education programs leave much cognitive skill development to chance (Etringer & Hillerbrand. 1995; Fong. Borders, Ethington. & Pitts. 1997) and that this inattention to the cultivation of internal skills may result in decreased counseling self-efficacy, increased anxiety, decreased counseling performance, and decreased ability to learn new skills (Bandura. 1986: Larson & Daniels. 1998). it has been theorized that mindfulness practice may help in the cultivation of key counseling skills, but researchers have done little to explore these relationships. Therefore, an investigation is warranted of mindfulness and the counselor skills and attributes of counseling self-efficacy, attention, and empathy. Counseling Self-Efficacy Counseling self-efficacy is defined as "one's beliefs or judgments about his or her capabilities to effectively counsel a client in the near future" (Larson & Daniels, 1998, p. 180). According to theory, counseling selfefficacy is a primary mechanism between simply knowing how to help in a counseling situation and actually executing effective counseling actions. Although self-efficacy is not equivalent to competence (e.g., someone may think that he or she has the skills to counsel effectively but. in fact, may lack those skills), higher counseling self-efficacy is related to higher performance attainment because it increases motivation to complete a task (Bandura, f 986) . In their review of the counseling self-efficacy literature, Larson and Daniels found that higher counseling self-efficacy is related to perseverance in the face of challenging counseling tasks and an increased ability to receive and incorporate evaluative feedback. They also found that counselors with strong counseling self-efficacy report less anxiety and interpret the anxiety they do have as challenging rather than as overwhelming or hindering. Many authors have asserted that cultivating self-efficacy in counselors is an important component of counselor development (Bischoff, 1997: Duryee, Brymer, & Gold, 1996: Leach, Stoltenberg, McNeill, & Eichenfield, 1997; Skovholt & Ronnestad, 1992; Stoltenberg & Delworth, 1987). Increasing self-efficacy is theorized to occur through four primary sources: (a) mastery experiences, (b) vicarious learning, (c) verbal persuasion, and (d) changes in emotional arousal (Bandura, 1986). Mastery experiences, in which individuals have personal experience with learning a skill, are considered to be the most powerful means of developing a sense of efficacy. For counselor educators, this means that offering students mastery experiences in the core counseling skills is crucial to developing counseling self-efficacy. Outcome research reveals that two essential skills for successful counseling are the capacity to maintain attentive presence and the ability to empathize with the client (Lambert & Barley, 2001; Orlinsky et al., 1994; Wampold, 2001; Watson, 2001). Etringer and Hillerbrand (1995) pointed out that counseling experts can both direct their attention more efficiently and monitor their own cognitions more than can counseling novices. Similarly, O'Byrne, Clark, and Malakuti (1997) stated that advanced counselors are skilled in focusing their attention strategically. When the counselor is unable to sustain attention, the session may be characterized by a lack of intimacy, remoteness, and detachment (Truax & Carkhuff, 1967). Accordingly, 98% of surveyed counselor educators at programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) expected that, by the end of their practicum experience, students should be proficient in attending and empathy skills (Bradley & Fiorini, 1999). Attention Because it is related to a variety of cognitive processes (e.g., perception, memory. planning, speech), attention is a difficult construct to define. Neuropsychologists consider attention to be a system of cognitive subprocesses rather than a single function, yet a full understanding of how these subprocesses operate is still unknown (Gopher. 1993; Leclercq, 2002; Zimmerman & Leclercq, 2002). It is suggested that the process of paying attention includes four primary mental capacities: selective attention (i.e.. the ability to attend to some aspect of experience while ignoring others), divided attention (i.e., the ability to simultaneously hold attention on two different objects or tasks), sustained attention (i.e., the ability to hold attention over some period of time), and attention switching (i.e., the ability to change focus from one object to another). The literature further suggests that the four capacities are interrelated. The ability to divide attention seems to be regulated by the ability to switch attention from one object to another (attention switching), and the ability to sustain attention may be regulated by the ability to avoid distractions (selective attention). For the purposes of this study, the ability to strategically control attention in the counseling session is defined as the ability to sustain and divide attention. Although everyone has the capacity for attention, individuals differ in their ability and propensity to sustain attention and control its focus. In a counseling session, for instance, a counselor may become easily distracted by internal dialogue or, conversely, may focus almost exclusively on the content of the client's narrative, overlooking the process. With practice, however, these skills can be improved (Brown & Ryan, 2003; KabatZinn, 2003: Leclercq, 2002). Because strategically controlling attention is essential to the counseling process, counseling students need mastery experiences in attention skills to hone this important mental skill. Although other professions (e.g., medicine, sports) are beginning to recognize the value of attention training (R. M. Epstein. 2003; Gill. 2000), actual training in cultivating core attention capacities seems to be missing from counselor education. Empathy Models for empathy development in counselor education emphasize training in the external, observable communication of empathy (e.g., Ivey & Ivey, 2003) rather than the internal mental processes that lead to empathic communication. Literature on empathy defines it as a multidimensional process that first involves an affective response (e.g., a gut feeling of anxiety) that leads to a cognitive response (e.g., reflecting feeling: Bohart & Greenberg, f997: Duan & Hill. 1996: Feshbach, 1975: Hoffman. 1975). Being able to be empathic also requires an ability to suspend judgment and bias to walk in the other's shoes. To suspend judgment and understand the client's world, the counselor must be able to tolerate a client's difficult feelings and the difficult feelings that may arise in the counselor—rather than avoiding them or overidentifying with them (e.g., crying in the session). This ability is often referred to as having affect tolerance (Fulton, 2005; Goldstein & Michaels, 1985 Morgan & Morgan, 2005). Although current training models in counselor education may help students to identify feelings, to communicate those feelings specifically and concretely, and to act as if they are empathic, they may not necessarily offer students the affective experience of empathy considered necessary for the development of genuine empathy. Furthermore, although counselor education research and literature encourage exploration of personal values and biases, specific instruction on how to suspend the human tendency to judge and evaluate experience is lacking. The expectation seems to be that the ability to engage empathically with clients will naturally develop from accurately identifying and communicating client feelings. The focus on external, observable counseling skills rather than on the internal processes of attention and empathy results in a gap between theory and practice in counselor education that may have a profound impact on counselor development and counseling outcomes. A number of theorists have suggested that mindfulness training may be an important tool to bridge this gap (Bien, 2006; Block-Lerner, Adair, Plumb, Rhatigan, & Orsillo. 2007; Fulton, 2005; Germer. 2005; Martin, 1997; Morgan & Morgan, 2005; Schure, Christopher. & Christopher, 2008; Walsh & Shapiro. 2006). Mindfulness The seminal definition of mindfulness is "paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" (Kabat-Zinn, 1994, p. 4). Shapiro, Carlson, Astin, and Freedman (2006) identified three interconnected "building blocks" (p. 375) of mindfulness: intention, attention, and attitude. Mindfulness is thus a state of being attentive to experience that is characterized by an attitude of openness and acceptance of experience (Brown & Ryan, 2003; Kabat-Zinn, 2003; Martin. 1997). In many ways, it mirrors Freud's (as cited in M, Epstein, 1995) concept of "evenly suspended attention" (p. 114: i.e.. attending to the client without having preconceived ideas or biases), which Freud considered a central component of therapy. For thousands of years, spiritual seekers have used mindfulness techniques to help train the mind to concentrate and remain non-judgmentally focused on the present moment and to increase affect tolerance (i.e., the ability to tolerate difficult feelings in the self or others)—all skills that are important for counselors. Several reviews of the mindfulness literature reveal that researchers and clinicians are effectively applying the techniques of mindfulness to the treatment of a variety of physical and mental health issues with significant results (Baer, 2003: Bishop, 2002; Grossman, Niemann. Schmidt, & Walach, 2004: Lazar, 2005), Moreover, research findings support the proposed relationship between mindfulness and the ability to strategically control attention (Bögels. Sijbers, & Voncken, 2006; Shapiro, Brown, & Biegel, 2007: Valentine & Sweet, 1999) as well as the relationship between mindfulness and empathy (Bead, Ferrer, & Cecero. 2004: Schure et al., 2008: Shapiro, Schwartz, & Bonner, 1998). Valentine and Sweet (1999) found that practitioners of mindfulness meditation scored significantly higher on a test of sustained attention compared with a control group. Bagels et al. (2006) found that mindfulness training helped individuals with social phobia reduce self-focused attention and increase task-focused attention. in their study with master's-level counseling psychology students, Shapiro et al. (2007) found that mindfulness-based stress reduction training resulted in a reduction in ruminative attention. Beitel et al. (2004) found that mindfulness was significantly correlated with empathic concern (i.e., the ability to have an affective response to the experiences of another) and perspective taking in undergraduate students. Similarly, Shapiro et al. (1998) found significant increases in empathy in a treatment group of medical students when compared with a control group. Furthermore, in their qualitative study of counseling students, Schure et al. (2008) found that participants in a 15-week course in mindfulness reported substantial effects on their counseling skills, including enhanced listening skills and empathy. A review of the literature, however, reveals a lack of quantitative studies about mindfulness in counselor preparation. Purpose of the Study The purpose of this exploratory study was to address an important gap in the counselor education literature by investigating the relationships between mindfulness, attention, empathy, and counseling self-efficacy in counselors-in-training. We examined a path model that hypothesized a predictive relationship between mindfulness and counseling self-efficacy mediated by attention and empathy. Per path analysis protocol, we also hypothesized a relationship between mindfulness and the two mediator variables (i.e., attention and empathy), as well as a relationship between the two mediator variables and counseling self-efficacy. The following research questions were addressed in our sample of counselors-in-training: Research Question 1: What are the relationships between mean scores of mindfulness, attention, empathy, and counseling self-efficacy? Research Question 2: What are the relationships between mindfulness, attention, empathy, and counseling selfefficacy within a path model that specifies a relationship between mindfulness skills and counseling selfefficacy mediated by attention and empathy? Method Participants Master's-level counseling interns who had completed at least one semester of internship at CACREP-accredited programs that required at least a two-semester internship participated in the study. Doctoral students from CACREP-accredited programs were also recruited as participants to obtain a greater range of counseling experience (it was assumed that all participating doctoral students had completed a master's-level internship). Participants were recruited by contacting counselor educators who work with master's-level interns and doctoral students and obtaining their agreement to distribute instrument packets at the end of class or supervision. A total of 421 instrument packets were sent by postal mail to 15 schools, of which 8 had both a master's-degree program and a doctoral program. A total of 187 packets were returned from 10 schools for a return rate of 44%. Five of the 10 schools offered both master's and doctoral degrees. Eight surveys were removed from the data set because they were incomplete, leaving a total of 179 participants. Of the 179 participants, 129 (72.10101 were master's interns and 50 (27.9%) were doctoral students. The master's-level students reported having earned an average of 45.13 graduate credit hours in counseling-related courses: doctoral students reported having earned an average of 84.90 hours. In addition, 153 (85.5%) participants were female, and 26 (14.5%) were male. The average age was 29.86 years (SD = 6.94). The majority of participants identified as Caucasian (n = 142, 79.3%). A small percentage indicated ethnic minority status, primarily African American (r = 20. 11.2%). Other identified races/ethnicities were Asian (n = 4. 2.2%). Asian American (n = 2, 1.1%), Hispanic/Latino (n = 4. 2.2%). and multiracial (n 7. 3.9%). (Percentages do not equal 100% because of rounding.) Instruments Five Factor Mindfulness Questionnaire (FFMQ: Baer; Smith. Hopkins. Krietemeyer & Toney, 2006). The FFMQ is a synthesis of several recently developed mindfulness questionnaires, including the Mindful Attention Awareness Scale (Brown & Ryan. 2003), the Freiburg Mindfulness Inventory (Buchheld, Grossman, & Walach, 2001), and the Kentucky Inventory of Mindfulness Skills (Baer, Smith, & Allen, 2004). Consequently, the FFMQ represents the collective understanding among scholars of what mindfulness is and how it should be operationalized. Baer et at. (2006) found that the five mindfulness questionnaires that informed the FFMQ all demonstrated good internal consistency (.81-.87) and were correlated with one another and with meditation experience as expected. With one exception, convergent and discriminant correlations were in the expected directions. Baer et al. (2006) also conducted exploratory and confirmatory factor analyses with a combined item pool from all live questionnaires, yielding a clear five-factor model. The 39-item FFMQ measures five factors of mindfulness: Observing, Describing. Acting With Awareness, and Nonjudging. The five factors form a total mindfulness score, which reflects a global measure of mindfulness. The total score was used as the unit of analysis in this study. The FFMQ uses a 5-point Likert-type scale ranging from 1 (never or very rarely true) to 5 (very often or always true). Internal consistency factor coefficients range from .75 to .91, and Baer et al. (2006) reported an estimate of reliability of .96 for the total instrument, with interfactor correlations ranging from .15 to .34. In the current study, the total reliability was