TEACHING SELF-CARE THROUGH

MINDFULNESS PRACTICES:
THE APPLICATION OF YOGA,
MEDITATION, AND QIGONG TO
COUNSELOR TRAINING

JOHN CHAMBERS CHRISTOPHER is a professor

of counseling psychology in the Department of
Health & Human Development at Montana State
University and a senior staff psychologist at MSU’s
Counseling Center. He is the recipient of the 2003
Sigmund Koch Early Career Award by the Society
of Theoretical and Philosophical Psychology of the
American Psychological Association. He specializes
in cultural psychology and theoretical and philosophical psychology. He
has written on the cultural, moral, and ontological underpinnings of the-
ories of psychological well-being, moral development, and psychotherapy.
He also maintains a private psychotherapy and consultation practice,
Habits of the Heart.

SUZANNE E. CHRISTOPHER is an associate professor of community

health in the Department of Health and Human Development at
Montana State University. She received her doctorate in the Department
of Health Behavior and Health Education from the University of North
Carolina School of Public Health. Her primary work is conducting
community-based participatory research, and she is currently funded by
the American Cancer Society for a multiyear women’s health project
with the Apsáalooke (Crow) nation.

TIM DUNNAGAN is an associate professor within the Department of

Health and Human Development at Montana State University. During

AUTHORS’ NOTE: Correspondence concerning this article should be addressed to

John Christopher, Montana State University, 221 Herrick Hall, Bozeman, MT
59717; e-mail: jcc@montana.edu.
Journal of Humanistic Psychology, Vol. 46 No. 4, October 2006 494-509
DOI: 10.1177/0022167806290215
© 2006 Sage Publications

494
 John Chambers Christopher et al. 495

the past 18 years, he has been involved in a variety of health interven-

tions within worksites and communities as a practitioner, director, and
evaluator/researcher on topics such as welfare reform, fetal alcohol syn-
drome, obesity, fall prevention, diabetes prevention, employee job satis-
faction, college student health enhancement, health care costs containment,
underaged drinking, and impaired driving. During the past 12 years, he has
focused his efforts in the areas of worksite- and community-based health
theory and program intervention development, implementation, and
evaluation.

MARC SCHURE is a public health promotion specialist at the Gallatin

City–County Health Department in Bozeman, Montana. He recently
received a master’s degree in health education and promotion from
Montana State University, where he worked on a multistate research
and education project promoting healthy eating, physical activity, and
positive body image. He also holds a bachelor’s in cultural anthropol-
ogy and a master’s in continuing and adult education from the
University of Wisconsin–Madison. Currently, he is working on local
and state public health promotion issues and systems improvement.

Summary

Faculty in counseling training programs often give voice to the

importance of self-care for students during the training period
and into practice after training is completed. However, few
programs specifically address this issue in their curricula. To
address this perceived need, a course was developed to provide
students with (a) personal growth opportunities through self-
care practices and (b) professional growth through mindfulness
practices in counseling that can help prevent burnout. A focus
group assessed course impact on students who reported signifi-
cant changes in their personal lives, stress levels, and clinical
training.

Keywords: mindfulness-based stress reduction; MBSR; self-care;

meditation; yoga; qigong, stress prevention and con-
trol; therapist training

The notion of burnout is broadly applied within American society

but was originally coined to refer to the physical and emotional
exhaustion that can occur for human service providers. Consequences
of burnout are serious for individuals experiencing burnout, their
496 Teaching Mindfulness Practices

coworkers, and their clients (Jackson & Maslach, 1982; Jackson,

Schwab, & Schuler, 1986). Workers in the health care sector are
particularly vulnerable to stress overload and burnout (Harris,
2001; Moore & Cooper, 1996; Sharkey & Sharples, 2003; Wall
et al., 1997). According to Moore and Cooper (1996) mental health
professionals, in particular, are subject to severe levels of stress
because of working in an emotionally exhaustive environment.
Consequently, learning to deal with stress and burnout is a criti-
cal dimension of professional development.
Self-care practices are self-initiated behaviors that promote
good health and well-being (Bickley, 1998). Although main-
stream, accredited counseling training programs often emphasize
the need for self-care strategies to prevent burnout, the demands
of the curricula and clinical training often leave little room for
directly teaching these strategies. Self-care is typically presented
to the student as an individual responsibility and is not taught
directly through the curricula. We believe that the quality of
training programs is compromised if the rhetoric of practitioner
growth, development, and self-care is not matched by specific
means for trainees to learn and practice methods of self-care.
Learning self-care techniques can assist counseling students
in the long term and can affect their educational and training
experiences (Baker, 2003; Weiss, 2004). More so than in other dis-
ciplines, counseling students experience moments of strong per-
sonal emotions that accompany “human suffering and mortality”
(Rosenzweig, Reibel, Greeson, Brainard, & Hojat, 2003). Students
preparing to go into counseling have additional demands com-
pared to most graduate students as they face the stress and chal-
lenge of self-development for clinical work. These demands and
stressors may have harmful effects on students’ effectiveness and
success by reducing their capacity for attention, concentration,
and decision making, all critical skills to becoming an effective
counselor (Shapiro, Shapiro, & Schwartz, 2000).
A perceived need in counselor training led the first author
to develop a graduate course entitled Mind/Body Medicine and the
Art of Self-Care. The goals of the course were to familiarize students
in an accredited counseling program with mindfulness practices
and their relevance for counseling and to provide students with
methods for self-care and the prevention of burnout. The underlying
philosophy behind the course is that of Buddhist mindfulness as
interpreted through the Mindfulness-Based Stress Reduction
 John Chambers Christopher et al. 497

(MBSR) Program developed by Jon Kabat-Zinn (1990) and

implemented at the University of Massachusetts Medical Center
in 1979. Mindfulness is based on cultivating awareness “with the
aim of helping people live each moment of their lives—even the
painful ones—as fully as possible” (Kabat-Zinn, 1993, p. 260).
Although mindfulness is an ancient concept that has a rich tex-
tual background (e.g., Bhiku Soma, 1949; Buddhaghosa, 1976;
Goleman, 1977; Govinda, 1969; Gunaratana, 1992), MBSR
attempts to communicate the essence of contemplative practice in
a nonsectarian, generic form that can appeal to a broader American
audience not inclined toward Eastern religious-philosophical
traditions.
Although mindfulness can often lead to states of relaxation, the
ultimate goal of mindfulness differs from relaxation training. The
intent of relaxation exercises is to replace a less desirable mental and
physical state such as stress, anxiety, fear, or pain with a more desir-
able state such as calm, peace, or relaxation. In mindfulness prac-
tices, the goal is instead to be present to whatever our experience
is at the moment. As Kabat-Zinn (1993) puts it, “Acknowledging
present-moment reality as it actually is, whether it is pleasant or
unpleasant, is the first step towards transforming that reality and
your relationship to it” (p. 261). The extensively researched MBSR
program has been used with more than 10,000 medical patients and
has been found to be beneficial for a variety of medical conditions
including chronic pain, heart disease, gastrointestinal disorders,
anxiety, depression, and extreme skin conditions (Kabat-Zinn, 1982;
Kabat-Zinn & Chapman-Waldrop, 1988; Kabat-Zinn et al., 1992,
1998; Kabat-Zinn, Lipworth, & Burney, 1985).
Mindfulness practice has the potential to transform counseling
trainees in a number of ways including becoming less reactive to
stress-related or anxiety-provoking events such as when clients
are in crisis or are discussing painful emotions. Counseling students
can also conceivably gain new ways of relating to their emotional
life that include awareness and tolerance. Instead of responding
with defensiveness and reactivity, contemplative and mindful-
ness disciplines can assist counselors to become more present and
connect more intimately with themselves, their clients, and their
supervisors (Epstein, 1995; Lesh, 1970; Magid, 2002; Rubin, 1996;
Safran, 2003).
Unlike some researched mind/body practices, such as Benson’s
generic form of meditation known as the Relaxation Response,
498 Teaching Mindfulness Practices

Kabat-Zinn’s 8-week MBSR program was based on a variety of

different practices. Research bears out the importance of provid-
ing people with multiple practices. For instance, Kabat-Zinn,
Chapman, and Salmon (1997) found that individuals who experi-
ence anxiety somatically (e.g., physical symptoms such as gastro-
intestinal distress) prefer meditation, whereas those who
experience anxiety cognitively (e.g., racing thoughts) prefer yoga.
Therefore, different practices are available in MBSR to best meet
the physical, affective, and cognitive needs of the individual.

RESEARCH ON MINDFULNESS
PRACTICES IN TEACHING

Given that counseling programs focus on personal growth and

development, we were surprised to find no published studies that
looked at the application of mindfulness practice to counseling
curricula or students. Studies, however, have been conducted that
evaluate MBSR as a tool for helping undergraduate college
students and nursing and medical students cope with stress.
Results from a controlled study of undergraduate students
showed that MBSR participants had statistically significant
decreases in levels of depression and anxiety and had a greater
sense of control and adaptability skills (Astin, 1997). Shapiro,
Schwartz, and Bonner (1998) examined the impact of an 8-week
MBSR program on medical and premedical students and found
similar reductions in state and trait anxiety and overall psycho-
logical distress, including depression. They also found an
increase in scores on a measure of spiritual experiences and an
increase in scores on an empathy measure. Another controlled
study of medical students found a significant decrease in total
mood disturbance among participants as compared to the control
group (Rosenzweig et al., 2003). Using quantitative and quali-
tative methods, Bruce, Young, Turner, Vander Wal, and Linden
(2002) found that an 8-week MBSR program for nursing
students decreased psychological symptoms and, to a lesser
degree, physical symptoms and increased health-related quality
of life and sense of coherence. The nursing students also reported
enhanced awareness of their physical, emotional, and mental
responses to stress, new abilities to let go of stress, and
decreased feelings of being rushed, confused, and disoriented.
 John Chambers Christopher et al. 499

DESCRIPTION OF THE COURSE

Unlike the above studies, the course we developed and describe in

this article is not a supplemental 8-week program but a semester-
long elective course integrated into the curriculum that not only
teaches techniques for stress reduction but also directly addresses
the issue of how mindfulness practice and transformation can be
integrated into the students’ clinical work. The two primary goals of
personal and professional growth were operationalized through
six course objectives: (a) to provide students with techniques and
skills for self-care, (b) to foster students’ understanding of indige-
nous traditions of contemplative practice from both Eastern and
Western cultures, (c) to foster students’ awareness of mind/body
medicine and contemporary attempts to adapt contemplative prac-
tice to health care, (d) to foster students’ awareness of mind/body
research regarding the effectiveness of contemplative practice in
behavioral medicine, (e) to begin to foster students’ awareness of
ethical considerations in the application of mind/body medicine,
and (f) to foster students’ awareness of the impact of culture and
cultural understandings of well-being on the counseling process.
Consequently, the course is interdisciplinary in nature, drawing
on source materials from religious studies, psychological and med-
ical anthropology, behavioral medicine, cross-cultural psychology,
and psychiatry. The course entails both academic and experiential
learning.
The experiential component of the class was loosely based on
Kabat-Zinn’s (1990) MBSR program. During the first 75 minutes of
a 2 hour and 15 minute class taught twice a week, students were
taught and practiced hatha yoga, meditation, and the body scan
(a type of conscious relaxation exercise that stresses the goal of
awareness instead of relaxation). In addition, the students were
taught qigong, an ancient Chinese practice for cultivating health.
Students chose a practice, such as meditation, yoga, qigong, or
tai chi, and engaged in practice sessions for a minimum of 45
minutes a day, 4 days of the week, outside of class. Students were
paired up and met once a week to process their practice activity
during the semester.
The academic aspect of the course included an introduction
to readings about the mindfulness practices (including authors
indigenous to the specific traditions and contemporary Western
interpreters), recent applications to psychotherapy and behavioral
medicine, and current research. Students presented four 15-minute
500 Teaching Mindfulness Practices

overviews of self-selected empirical research on aspects of mind/

body medicine (e.g., contemplative practice, meditation, yoga, the
relaxation response, tai chi chaun). Twice during the semester
each student was responsible for cofacilitating the discussion of
the readings for that day. A major component of the course was
an intellectual and experiential journal, providing students with
the opportunity to process and discuss both their reaction to the
ideas and concepts in the readings and discussions and also their
reactions to the contemplative practices. Journal writing had to
total a minimum of 60 typed pages during the semester.

PARTICIPANTS

Participants in this study were first and second year master’s-

level graduate students in mental health counseling, school coun-
seling, and marriage and family counseling enrolled in an elective
graduate course entitled Mind/Body Medicine and the Art of Self-
Care. Focus group data were collected from 11 participants. The
age of the participants ranged from the early 20s to mid-50s.
Eight participants were female and three were male.

METHOD

To assess the impact of this course, one of the coauthors who is

not the course instructor conducted a focus group near the end of
the semester. Focus group research is a qualitative data-gathering
method that allows researchers to gain a variety of perspectives
(Patton, 2002) and has been shown to be a useful tool in gather-
ing evaluative data from students (Christopher, 2000). Focus
groups allow participants to hear each others’ comments and
either disagree or build on what has previously been said. As
Morgan (1988) aptly describes, “The hallmark of focus groups is
the explicit use of the group interaction to produce data and
insights that would be less accessible without the interaction
found in a group” (p. 12). The interactive framework allows par-
ticipants to use each other’s thoughts to generate new ideas and
insights and the group moderator can probe for clarification and
depth. In addition, these groups give students the opportunity to
have an open forum for discussion and give them a sense of having
an impact on their education. Focus groups allow researchers to
 John Chambers Christopher et al. 501

gather data on multiple individuals at one time, in a relatively

quick and inexpensive manner.
A moderator’s guide was developed by the moderator largely
based on the descriptions provided through a six-volume focus
group instructional series (Morgan & Krueger, 1998). The guide
listed the purpose of the focus group, probing ideas, group control
and facilitation techniques, and questions for discussion. For this
project, ground rules were developed by the students after the
moderator asked, “What rules would you like to have in place so
that we can have a productive discussion?” Ground rules such as
listening to others’ opinions and ideas, being open to the fact that
there are no right or wrong answers, and agreeing to keeping the
discussion confidential were examples of the students’ ground
rules. These rules are similar to the suggested ground rules pre-
sented by researchers who engage in focus group research (Morgan,
1998; Templeton, 1994). The questions were open ended and
included, “Why did you take this course?” “What is the first thing
that comes to mind when you consider the course?” “What do you
like most about the class?” “What do you like least about the class?”
“Discuss the strengths and weaknesses associated with the class
organization.” “Would you like to make any other comments?”

ANALYSIS

The focus group was tape-recorded, and field notes were taken
during and immediately after the session was completed. The
tape was transcribed verbatim by a trained graduate assistant.
Inductive content analysis was used to identify the primary
themes in the data (Patton, 2002; Strauss & Corbin, 1990). The
researchers used the transcribed sentences as the unit of analy-
sis. The level of analysis was across cases that allowed the the-
matic grouping of the responses to be similar for all the students.
All authors read the transcript and developed and discussed
themes until agreement on all themes was reached. After com-
pleting the analysis, the researchers cowrote the results section.

RESULTS

It was evident that students found the class to be of high-

quality and a valuable experience that helped them to grow
502 Teaching Mindfulness Practices

personally and professionally. Suggestions were made about how

the course could be improved; however, none of the themes
demonstrated any problems of substance associated with the
class. Results are presented by question asked.

Why Did You Take This Course?

Students responded that they wanted to learn more about the

mind-body connection, that they wanted to learn how to manage
their stress, and that they wanted to learn how to use relaxation
techniques with clients. Students mentioned that they had heard
about mind-body practices or that they had tried some practices
(e.g., yoga) but wanted a more in-depth experience. Several students
mentioned that they took the class for themselves because they
had heard that they would practice self-care techniques in the
class. One student stated that he initially took the course because
he thought it would be easy and was surprised that he experi-
enced significant growth through his efforts:

I was hoping it would be something to breeze by and the reality is

it was probably my most difficult course and not so on a require-
ment level but I think on an internal level, because as I learned to
have to slow down and pay attention to my body and through med-
itation and awareness, all of this stuff came to my consciousness
that maybe through busyness and activity and attending to others
that I wasn’t intending to. It forced me to kind of take a deep
breath, an internal look at some things that I might have avoided.

He laughed and said, “It kind of backfired on me.”

What is the First Thing That Comes to

Mind When You Consider the Course?

The students described different types of changes that they

experienced as a result of taking the course. Specifically, physical,
emotional, mental, and spiritual changes were mentioned. They
indicated that it was refreshing to have a class that was taught
in a nontraditional format. Students also described being more
patient, aware, conscious, and able to focus. One student
described what she meant by being able to focus:

Well, just basically what I was saying about being able to recenter
myself and just taking a couple minutes to do that. Focusing on
 John Chambers Christopher et al. 503

things that, you know, are in the present, and not necessarily stressing
out about things that are in the future or things that have already
happened, um, just focusing on what’s real instead of letting the
stress overwhelm me.

The students talked about significant changes that they experi-

enced as a result of the class, leading the moderator to probe fur-
ther into that area. Several students gave direct examples of how
this class facilitated personal changes and how these changes
influenced their therapy with clients.

I feel like . . . really being able to be present with myself . . .

truly present with myself and then being able to take that into the
therapeutic environment where I can really be with the client. You
know, I really don’t know how to put words around it, but I do think
there’s some spiritual component to the therapeutic process, and
I’m not going to attempt to try to tell you about my understanding
of it, but I do think that that component of presence allows that to
be possible.

Another student noted:

I really became aware of how disconnected I can be from myself, espe-

cially, all of these extrinsic motivations, until I’m here and I start
breathing, um, I suddenly realize the difference, and the difference
being that I’m in this completely defensive, like get out of my way
type of mode, I’m closed up. I’m not greeting the world at all, I’m more
looking at, I’m like, are you in my way, and I get around them and
hurry to class. I still do that, I still catch myself doing that, but after
practice, um, I can greet the whole world a lot more openly than to
see it as an obstacle and to bring that with my clients is amazing.

What Do You Like Most About the Class?

There were several comments about the instructor. Students

enjoyed his manner, the fact that he was emotionally present and
available, that he walks the talk, and that he was willing to devi-
ate from the syllabus to teach areas the students were interested
in learning about. One student commented,

I really value, he really walks his talk and that’s, when I think about
the people that have really influenced me over my life, it’s those
people, you know, that, because, you pick that up and carry it with you.

The students also brought up that they enjoyed the readings.

504 Teaching Mindfulness Practices

What Did You Like Least About the Class?

Students differed on their preference for the number of prac-

tices that should be reviewed during the semester. Some
students would have preferred trying out more types of prac-
tices, whereas others liked learning fewer practices in more
depth and detail.
Another area where students had differing opinions was in the
journal writing assignment. As mentioned above, students were
required to journal 60 typed pages during the semester about
reactions to course readings and about their personal practice.
Some students did not like journal writing, most did not like hav-
ing a certain number of pages that they had to write, and some
did not like having to type their journals on the computer. Others
disagreed on these topics, receiving a lot of benefit from journal-
ing. One of the students who had trouble with the journal assign-
ment stated:

I felt that what I was writing was very real and I got really angry
and resentful and actually I almost went to go and talk to [the
instructor] and say this is real stuff and so what’s important, do
you want quality or do you want quantity? Because these are my
real experiences and I can’t put it into, maybe this isn’t going to
take four pages, but I will certainly write what I experience and
maybe it takes two.

The students also had differing opinions about having to give

presentations on four scientific articles during the semester.
Some thought it was too many presentations, some did not like
that they had to be scientifically based, and some had trouble
finding research-based articles on topics covered in this course.
Others disagreed. One student explained the potential future
benefit of this part of class:

I think that if we are looking to integrate this into the practice

with the public, it will be met with skepticism, and given that this
is an academic course, first of all, I think it has an important place
in this course. But furthermore, in convincing perhaps the clinic
that we work for, that hey, I want to bring this mindfulness medi-
tation to working with people with depression, you’re going to need
to back it up besides just kind of the hippy-dippy ‘cause it feels
good type of mentality. So to actually have that empirical approach
and say, look at these articles, this is what’s it’s proven to be, why
are we not trying this? I think that’s, that’s a lot [of] money in the
bank.
 John Chambers Christopher et al. 505

Discuss the Strengths and Weaknesses

Associated With the Class Organization

Students responded that the course was not tightly organized.

This was good for some and not good for others. For one student,
this structure impeded the student’s ability to feel properly pre-
pared for class. For others, the structure seemed to fit into the
course objectives and seemed well matched with the goal of stay-
ing present. One student commented, “I think it kind of extended
the practice of being present in the moment and by not cutting
things off, if there was a good conversation, there was depth
there, we stuck with it.”

Would You Like to Make Any Other Comments?

Lastly, students were given the opportunity to provide any

other feedback or comments. The first comment was based on the
fact that this class might not be taught every year. Students
thought that would be “a big error.” There was considerable agree-
ment concerning this topic. There was also much agreement with
the idea of making this course, which is an elective, a require-
ment for all of the counseling students. One student summed up
her feelings:

In a lot of ways, I feel like this was the most important class I’ve
taken, just learning to be present in a different way. It has huge
implications in the counseling area. I’ve taken a lot of different
yoga classes in the past and you focusing on the poses and I’ve
never been given a base of how to breathe. And I’ve noticed that
when I’m in session and it’s a new thing and it’s kind of nerve
wracking, I have this new control over my body where I can like,
take a breath, and it’s a different kind of breath than I’ve ever
knew how to take, and feel like, oh, I feel calmer now, and I feel cen-
tered, and in control of my body and I can be present to this person
instead of being anxious inside. It’s just huge.

DISCUSSION

Students reported that Mind-Body Medicine and the Art of

Self-Care was a high-quality, rigorous, relevant course that had a
significant impact on their personal and professional lives. Students
overwhelmingly gave praise for this course and the instructor.
They indicated that they took this course to learn about the
506 Teaching Mindfulness Practices

mind-body connection, self-care techniques, and ways of applying

these techniques with clients. The reasons given by students
closely match the curricular goals of the course.
We found that student feedback reflected the intended benefits
of the course. Students expressed that the course positively influ-
enced them in a variety of personal and professional ways. A
number of students indicated having a greater awareness or con-
sciousness of themselves and/or their clients as a result of the
course. Students also expressed an ability to focus more and stay
more in the present than before taking the class. Such acquired
abilities are desired effects of MBSR programs (Kabat-Zinn,
1990). Many students also reported feeling better equipped, both
emotionally and mentally, to deal with daily stress in their lives.
These positive impacts support similar results from related stud-
ies with university students (Astin, 1997; Bruce et al., 2002;
Shapiro et al., 1998).
Students also talked about significant changes experienced as
a result of taking the class, particularly around working with
clients. Concepts covered in this course and contemplative expe-
rience through course practices changed how students conceptu-
alize and pursue the therapeutic process. The fact that students
have had such experiences within the context of a university
course confers relevance for the role of these practices in coun-
seling curricula and other higher education based endeavors
(Tisdell, 2003).
Our findings most strongly support the value of these types of
courses on students training to be caregivers (i.e., therapists and
other health professionals). In most university courses, it is
uncommon to hear students talk about significant and substantial
changes within and across a variety of life domains because of tak-
ing a course. It is also worth mentioning that students valued this
course enough to commit to four additional sessions of practice
each week outside of class time. Taking this course resulted in pos-
itive outcomes with personal functioning and also influenced
students’ capacities and abilities within clinical environments.
The perceived weaknesses of the course were not consistent
across students and were primarily related to preferences in
teaching style and course assignments such as journal writing
and presentations. Such variability in student preferences within
the classroom setting can be associated with preferred learning
styles and degrees of comfort in performing certain tasks or
assignments. Yet given the fact that students needed to regularly
 John Chambers Christopher et al. 507

schedule extra time outside class for practice, perhaps such

negative reactions were more indicative of feeling generally over-
loaded. Additional research could elucidate the deeper meaning
of these reactions.
Given the summary of this course’s evaluation and results
from related studies, we feel that college programs would benefit
from incorporating similarly structured courses into counseling
curricula. The first author is willing to share the course syllabus
with interested parties.

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