Mindful and Resilient Therapists have Better Patient Outcomes
By John M. de Castro, Ph.D.
“Current studies suggest that in successful treatment alliances, therapists are perceived as warm, understanding, and accepting, approaching their patients with an open, collaborative attitude. Mindfulness can help us develop these qualities.” – Susal Pollak
Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance. The personality and characteristics of the therapist are essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.
It would seem that mindfulness would be an important contributor to therapist effectiveness. Communications involve not only talking but listening, a mindfulness skill. Being able to look at things as they are without judgement, another mindfulness skill, would appear to be essential to this relationship. The mindfulness component of being in the present moment would also seem essential to focusing on and being responsive to the client’s immediate experience and reactions.
Resilience is a personal characteristic that “enable one to thrive in the face of adversity.” The therapeutic process is not a linear progression from psychological problems to mental health. It contains many setbacks, resistances, and reversals that must be weathered in order to progress. The ability to withstand this adversity, resilience, is an essential characteristic of an effective therapist. So, it would be reasonable to suspect that the mindfulness and resilience of the therapist would be related to the successful outcome of the therapy.
In today’s Research News article “The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550533/, Pereira and colleagues recruited psychotherapy practitioners and measured them for resilience and mindfulness. In addition, they recorded data of the therapists’ depressed patients from a database of patient outcomes. In particular, they recorded improvements in depression and work and social adjustment.
They separated therapists into two groups based upon their success in treating depression, less or more effective therapists. They found that the more effective therapists had significantly higher scores for mindfulness and resilience. In addition, the more mindful and the more resilient the therapist the greater the therapist’s effectiveness. Hence, therapist mindfulness and resilience were significant contributors to effective treatment for depression.
It should be kept in mind that this study was correlational and care must be taken in interpreting causation. But, the results are suggestive that therapist mindfulness and resilience are important for effective treatment of depression. It is interesting that mindfulness training has been shown to improve resilience. So, mindfulness may be the key. This suggests that therapist training should incorporate training in mindfulness to improve their resilience and effectiveness as mindful and resilient therapists have better patient outcomes.
“Doing psychotherapy is an opportunity to practice mindfulness in everyday life. The therapy office can be like a meditation room in which we invite our moment-to-moment experience to become known to us, openly and wholeheartedly. As the therapist learns to identify and disentangle from his or her own conditioned patterns of thought and feeling that arise in the therapy relationship, the patient may discover the same emotional freedom.” – Christopher Germer
CMCS – Center for Mindfulness and Contemplative Studies
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Pereira, J.-A., Barkham, M., Kellett, S., & Saxon, D. (2017). The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study. Administration and Policy in Mental Health, 44(5), 691–704. http://doi.org/10.1007/s10488-016-0747-0
A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed.