How do I know if someone teaching a mindfulness course is appropriately trained?
Integrity of mindfulness classes and the UK listing of mindfulness teachers
How can a member of the general public wanting to take an 8-week mindfulness-based class be reassured that what is being offered has depth and integrity? The UK Network for Mindfulness-Based Teacher Training Organisations recently launched a listing of mindfulness-based teachers. In the emerging professional context for mindfulness in the mainstream, this is an international first. The listing goes beyond current self-report arrangements for teachers to publicise their credentials by requiring independent verification of the application by a referee from the UK Network. So far 150 teachers have been listed. It is likely to become the “go to” place in the UK for anyone wishing to find an appropriately qualified mindfulness-based 8-week course teacher.
Improving access to high quality teachers
There is no one regulatory body overseeing the professional context for mindfulness-based teaching. Many mindfulness-based teachers work within the context of their root profession (i.e. a health professional or a school teacher is bound by their professional regulatory body), and this gives some protection for both teacher and course participant. However, it is also important for a mindfulness course participant to have the confidence that their teacher has done the necessary preparation for the specific nature of this work. It is relatively easy for people who do not have the recommended credentials to set up as a teacher; and it becomes confusing for those wanting to access a well-qualified teacher to know how to judge the quality of their potential teacher. The listing aims to offer an arena for teachers who have invested in their training to connect with the general public looking for a class.
At this time of expanding interest in the relevance and potential of mindfulness in society (Mindfulness All Party Parliamentary Group, 2015) there is a corresponding expansion in the number of teacher training programmes, teachers on the ground, forms of programmes, and societal settings within which mindfulness-based approaches are being offered. There are tensions between the urgency to respond to the demand for greater teaching capacity, and the urge to ensure that developments are sustainable and have integrity. The pace of these developments poses particular challenges for upholding the integrity of the teaching process. Building the skills, knowledge and attitudes which enable a teacher to offer Mindfulness-Based Programmes (MBPs) with integrity takes time and particular training processes. Teaching MBPs engages the teacher and course participants in a relationship dedicated to exploring one of the most sensitive and delicate subjects possible – the nature of one’s own mind, and its relationship to our actions in the world (‘Is mindfulness safe?’ is covered in a recent OMC blog written by Ruth Baer and Willem Kuyken). It is important that this work is conducted by practitioners who are well prepared for navigating the inevitable challenges and demands of the learning process. Yet because much of the training involves developing particular internal qualities, and the teaching process is nuanced and subtle, the results of this training (i.e. the skills of the teacher) are not easy for a layperson to judge. It is important therefore that there are systems which enable those who want courses to easily connect with those who are best equipped to offer them.
The building blocks that led to the teacher listing
So how is this emerging field ensuring that robust foundational building blocks to support integrity are being put in place? How are we stepping up to the challenge of protecting the integrity of MBPs offered in our public service mainstream institutions and in the community by private practitioners and independent organisations, at this time of unprecedented interest and demand?
The new listing is a relatively modest step – it is a list of teachers who meet minimum training levels and who are adhering to recommended ongoing good practice. It does not offer the professional and disciplinary safeguards of an accrediting body or professional organisation. It does not offer governance for the myriad of different programme forms that are emerging – currently the listing covers just the main 8-week programmes on offer in the UK that originate from the original MBP – Mindfulness-Based Stress Reduction. However, it is also a significant and important step, and is the culmination of a UK process of development to create a professional context for mainstream mindfulness over the last 15 years. This has included work from within the UK academic contexts on MBP good practice (Evans, Crane et al. 2014, Crane, Kuyken et al. 2010), and research on what good teaching ‘looks like’ and how can we assess this (Crane, Kuyken et al. 2012, Crane, Eames et al. 2013). It has also included the establishment of the UK Network in 2005 – now a thriving collaboration of twenty teacher training organisations within the UK who are working within agreed good practice boundaries. The UK Network has made a highly significant and impactful contribution to integrity by agreeing and disseminating a joined up view on what good practice looks like for teachers and trainers of MBPs (UK Network, 2015).
The mindfulness-based approaches field holds significant promise. Although there is still much work to do, the evidence base is promising and growing (Dimidjian, Segal 2015). A critical step in the research process of new interventions is implementation. Implementing new evidence is challenging and requires deliberate and active effort, and in and of itself requires careful research. It is critical that any new approach is implemented in ways that are consistent and congruent with the developers’ intentions and with the evidence base (a topic covered in the first OMC blog post). MBPs have particular characteristics which require careful attention in the implementation process. Dimidjian and Segal (2015) speak of the risk of MBPs becoming ‘orphan interventions’ in which effort is invested in the design and initial testing of the intervention but little care is given to implementation; and that MBPs are vulnerable to not being taken up in standard routine practice unless research is conducted, and careful consideration is given to sustainable methods of training teachers. An important research project investigating the process of implementation of Mindfulness-Based Cognitive Therapy in the UK health service will report its results later in 2016 (Rycroft-Malone, Anderson et al. 2014), will hopefully offer insights into this crucial area and will inspire future research attention.
A key part of successful implementation is the development of governance for a new approach. If skilful forms of governance are not developed from within the field there is a risk that integrity is weakened, which in turn could lead to compromised public confidence. What does appropriate governance and professional practice in the context of MBPs look like? What frameworks are needed within which practitioners can optimally operate? What standards are needed to support appropriate ethics, conduct and competence levels? How can the field maintain public confidence and ensure that professionals working with integrity are not undermined by those who are not?
In the midst of this live and emerging process it is not possible to precisely predict how and what governance structures will emerge. The process of ensuring integrity is requiring the generation of new knowledge and the development of fresh insights; it is requiring collaboration on national and international levels to develop consistent and coherent approaches to integrity; and it is a reflexive process of dialogue between the contemplative contexts for mindfulness practice, and the emerging professional context of MBAs in the mainstream. There is a parallel emphasis on developing integrity both from the ‘inside out’ (training teachers so that there are expectations regarding on-going attention to self-integrity), and from the ‘outside in’ (developing anchor points in the form of governance and standards that people from within and without the profession can relate to). At best, governance structures and organisations empower teachers on the ground by giving impetus to best practice, recognising their investment in training, and promoting public confidence.
To do this important work successfully all stakeholders need to collaboratively contribute to dialogue on training, integrity and governance developments. The process requires that everyone working within the field takes on a measure of responsibility for upholding and developing clarity around integrity. Much rests upon the teacher themselves. They are the main vehicle and conduit for the work in the world. As Kabat-Zinn said: ‘It has always felt to me that 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). The key intention of the UK Network good practice guidance is to create the conditions which support teachers to take responsibility and practice this ‘inside out’ work of deep reflection on self-integrity. Engagement in supervision, and the support of periodic sustained practice during guided residential mindfulness meditation retreats are two particular pieces of good practice that stimulate teachers to develop the awareness needed to be reflective responsive practitioners.
Teacher training organisations also have particular responsibilities in this area, and are well placed to collaboratively provide leadership on the ‘outside in’ work of developing a professional context for graduates from training programmes to practice within. This work can range from proactively engaging in networking and relationship building, negotiation with key stakeholders, developing and disseminating good practice, and conducting research on training, competence and ethics. It is important that these developments navigate a line between participatory, inclusive approaches which bring the field towards consensus on good practice, whilst also ensuring clarity in relation to what constitutes a divergence from agreed integrity standards.
In conclusion – the work ahead
In bringing mindfulness into mainstream, contemporary, everyday contexts, we are moving into new territory. This has not been done in this way before and requires the generation of new understandings. Thoughtful multidisciplinary work is needed to develop understanding about how to move the promise of this work forward in ways which enable accessibility to practices and learning which can transform lives. How we navigate the delicate questions that the process raises is critical in how successful this aspiration will be.
It is clear that a lot of ground work has already taken place to support good practice, which offers good foundations for future developments. As is perhaps inevitable for an emerging field, there are some growing pains which include threats and challenges to the integrity of the work. When different disciplines come together (i.e. contemplative traditions with mainstream psychology, education and health care), there are tensions that require careful thought. These tensions include how to ‘hold’ contemplative practices that arose within the context of religious traditions, when delivering in contemporary mainstream contexts; expansion of interest in mindfulness and a subsequent dilution in understanding of the meaning of the term; lack of embedded governance frameworks which make it harder for teachers who have invested in their training to represent themselves clearly to the general public; and implementation taking place ahead of the development of empirical evidence. The issues involved are subtle and far-reaching. They need a proactive and joined up response from all those working within the field going forward.
Ultimately, it needs to be borne in mind that the purpose of developing clear governance is to serve our wider community – the general public who are the recipients of the services that MBP teachers offer. Upholding integrity is in the service of enabling the receivers of mindfulness services – i.e. participants in classes – to have clarity. Clear accurate communication is needed, both of the approach being offered and of the training in which the teacher has engaged in order to be able to offer it. The general public need to know that the teacher adheres to recognised standards, has engaged in appropriate levels of training, and has reached a recognised level of competence. Hopefully the new listing will help in these directions, and will be a foundation for future integrity steps. We need to take the long view – ensuring as a field that we are carefully and systematically putting in place strong foundational structures which support good teaching and research practice.
Dr Rebecca Crane directs the Centre for Mindfulness Research and Practice, Bangor University. She is author of MBCT Distinctive Features, and Mindfulness and the Transformation of Despair and receives royalties from their sales.
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Oxford Mindfulness Centre
The Oxford Mindfulness Centre (OMC) is an internationally recognised centre of excellence at the University of Oxford, and has been at the forefront of research and development in the field of mindfulness. The OMC works to advance the understanding of evidence-based mindfulness through research, publication, training and dissemination. Our world leading research investigates the mechanisms, efficacy, effectiveness, cost effectiveness and implementation of mindfulness. We offer a wide range of training, education, and clinical services, all taught by leading experts and teachers in the field, who are training the next generation of MBCT researchers, teachers and trainers. We actively engage in collaborative partnership to shape the field and influence policy nationally and internationally. Through the charitable work of the OMC, we are improving the accessibility of MBCT for those most in need.
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