Mindful awareness and compassion, and empathy and anxiety in counselor trainees

291 Pages·2012·2.03 MB·English

FULTON, CHERYL L., Ph.D. Mindful Awareness and Compassion, and Empathy and
Anxiety in Counselor Trainees. (2012)
Directed by Dr. Craig S. Cashwell. 277 pp.

This study explored the relationships between two aspect of mindfulness,
awareness and compassion, and empathy and anxiety in counselor trainees. Empathy and
anxiety are two training variables that have strong associations with counseling
performance. Empathy is widely regarded as important for the effective development of a
therapeutic relationship and positive counseling outcomes while a higher level of anxiety
in trainees can impede the cultivation of empathy and the development of counselor self-
efficacy. Currently, there is little to guide educators in how to cultivate genuine empathy
and also mitigate unproductive levels of anxiety in trainees. Mindfulness has been
proposed as a potential method for addressing both empathy and anxiety, however,
empirical evidence for these associations with counselors is limited. Additionally, the
relative contribution of the compassion wing of mindfulness has been relatively
unstudied.
In this study, the relationships between mindful awareness and compassion and
empathy and anxiety were examined. A total of 131 master’s level counseling interns
were surveyed to determine their levels of mindful awareness, mindful compassion,
empathy, and anxiety using the Five-Factor Mindfulness Questionnaire, the Self Other
Four Immeasurables, the Interpersonal Reactivity Index, and the Trimodal Anxiety
Questionnaire.
Pearson Product Moment Coefficients revealed significant pairwise relationships
between mindful awareness and compassion and anxiety in the expected directions.
Mindful awareness and compassion for others had a significant relationship with
cognitive empathy in the expected directions. Compassion for others had a significant
relationship with affective empathy in the expected direction.
In a linear regression model, awareness and compassion explained a modest
amount of variance in affective empathy with compassion for others contributing
significantly. Linear regression also revealed that awareness and compassion explained a
moderate amount of variance in cognitive empathy with nonjudge, nonreact, and
compassion for others emerging as significant predictors. A substantial amount of the
variance in anxiety was explained by awareness, with describe, act with awareness, and
nonjudge facets emerging as significant predictors. A hierarchal regression indicated that
mindful compassion increased the variance explained in affective empathy, cognitive
empathy, and anxiety, beyond that explained by mindful awareness alone, and offered the
greatest increase for affective empathy.
MINDFUL AWARENESS AND COMPASSION, AND EMPATHY

AND ANXIETY IN COUNSELOR TRAINEES

by

Cheryl L. Fulton

A Dissertation Submitted to
the Faculty of The Graduate School at
The University of North Carolina at Greensboro
in Partial Fulfillment
of the Requirements for the Degree
Doctor of Philosophy

Greensboro
2012

Approved by

Committee Chair
© 2012 Cheryl L. Fulton
APPROVAL PAGE

This dissertation has been approved by the following committee of the Faculty of
The Graduate School at The University of North Carolina at Greensboro.

Committee Chair

Committee Members

Date of Acceptance by Committee

Date of Final Oral Examination

ii
ACKNOWLEDGMENTS

This dissertation is not only a research project but also a very personal endeavor
representing many aspects of my life journey. It serves as a landmark to an important
career shift, a stake in my own future as well as my family’s, a reminder of the complex
coexistence of maternal and career desires, and, most importantly, a symbol of the
overwhelming support of family, friends, and faculty.
In particular, I want to thank Dr. Craig Cashwell, my dissertation chair, for his
endless generosity. He offered patience, clarity, gentle guidance, independence, and
grounded support. I am grateful for his compassionate presence and hope to extend these
gifts to others during my career. I would also like to thank Dr. Wester, Dr. Gill, and Dr.
Ackerman for their time, energy, help, and support through this process. This gratitude
also extends to the many faculty and supervisors who offered guidance and support along
the way. I also want to thank my cohort and fellow students who offered solidarity. We
laughed, we cried, we wrote, we swore, and we wrote some more. You will always hold a
special place in my heart.
Lastly, and most importantly, I want to thank my husband Jeff, and my lovely
daughters Sydney and Samantha for their patience, sacrifice, and support. Like an
astronaut needs a rocket to reach the moon, I could not have completed this dissertation
without Jeff’s countless hours of listening to me think out loud, walks in the park to
center me, hours of editing my work, and herculean effort caring for our girls. I am
grateful for your love, support, and endless belief in me. Sydney and Samantha, you
iii
brought me the joy I needed to persevere and I only hope that I have been a model for
what women can do . . . at any age!

iv
TABLE OF CONTENTS

Page

LIST OF TABLES ...............................................................................................................x

CHAPTER

I. INTRODUCTION ................................................................................................1

Empathy .......................................................................................................4
Anxiety .........................................................................................................5
Mindfulness..................................................................................................6
Statement of the Problem ...........................................................................12
Purpose of the Study ..................................................................................13
Research Questions ....................................................................................13
Need for the Study .....................................................................................14
Definition of Key Terms ............................................................................15
Organization of the Study ..........................................................................17

II. REVIEW OF THE LITERATURE ....................................................................18

Empathy .....................................................................................................18
Defining Empathy ..........................................................................20
Nature of empathy..............................................................20
Cognitive empathy defined ....................................21
Affective empathy defined .....................................23
Cognitive-affective empathy ..................................28
Neurological empathy ............................................29
Empathy constructs ............................................................31
Personality trait ......................................................31
Situation-specific ...................................................33
Observable skill .....................................................34
Interpersonal process .............................................36
Empathy in Counseling ..................................................................37
Empathy and counseling outcomes ....................................38
Limitations of research on empathy ...................................40
Models of Empathy Development .................................................41
Hoffman’s Model ...............................................................41
Feshbach’s Three-Factor Model ........................................42
Buddhist psychology and Mindfulness Model ..................43
Methods for Developing Counselor Empathy ...............................44
Self-exploration..................................................................44
v
Microskills training ............................................................45
Alternative methods ...........................................................47
Mindfulness training ..........................................................48
Summary of Empathy ....................................................................49
Anxiety .......................................................................................................50
Defining Anxiety ...........................................................................53
Components of anxiety ......................................................54
Cognitive ................................................................55
Somatic ..................................................................55
Affective ................................................................56
Behavioral ..............................................................57
Trait and state anxiety ........................................................57
Counselor Trainee Anxiety ............................................................58
Origins of counselor trainee anxiety ..................................59
Supervision and evaluation ....................................60
Counseling .............................................................62
Self-awareness .......................................................63
Other sources of trainee anxiety ............................66
Effects of Counselor Trainee Anxiety ...........................................68
Cognitive functioning and abilities ....................................68
Self-efficacy .......................................................................70
Empathy .............................................................................71
Supervision ........................................................................72
Other effects of trainee anxiety ..........................................73
Reducing Trainee Anxiety .............................................................74
Summary of Anxiety ......................................................................78
Mindfulness................................................................................................78
Defining Mindfulness ....................................................................80
Buddhist roots of mindfulness ...........................................82
Westernization of mindfulness ..........................................83
Two Wings of Mindfulness: Awareness and
Compassion ...............................................................................86
Defining mindful awareness ..............................................89
Conceptual definition .............................................89
Operational definition ............................................90
Defining mindful compassion ............................................92
Conceptual definition .............................................92
Operational definition ............................................94
Mechanisms of Change ..................................................................95
Exposure ............................................................................96
Self-regulation and self-management ................................97
Acceptance .........................................................................98
Intention .............................................................................98
vi
Reperceiving ......................................................................99
Relaxation ........................................................................100
Social neurophysiology ....................................................101
Benefits of Counselor Mindfulness .............................................102
Client outcomes ...............................................................103
Therapeutic relationship...................................................104
Empathy ...............................................................104
Attunement ...........................................................107
Affect tolerance/experiential
avoidance ........................................................107
Self and other compassion ...................................108
Therapeutic presence ...........................................110
Emotion regulation...............................................111
Unconditional positive regard ..............................113
Counseling skills ..................................................114
Anxiety .............................................................................115
Self-efficacy .....................................................................117
Wellness ...........................................................................117
Mindfulness Practice and Training ..............................................119
Informal and formal practice ...........................................119
Mindfulness programs .....................................................121
Mindfulness Based Stress Reduction
(MBSR) ...........................................................121
Mindfulness Based Cognitive Therapy
(MBCT)...........................................................121
Mindfulness Based Role Play (MBRP) ...............122
Mindful Therapy program (MT) ..........................123
Meditation Enhanced Empathy
Training (MEET) ............................................124
Summary of Mindfulness .........................................................................124

III. METHODOLOGY ...........................................................................................126

Research Questions and Hypotheses .......................................................126
Participants ...............................................................................................128
Instrumentation ........................................................................................129
Awareness—The Five Facet Mindfulness
Questionnaire (FFMQ) ..........................................................129
Compassion—The Self-Other Four Immeasurables
(SOFI) .....................................................................................134
Empathy—The Interpersonal Reactivity Index (IRI) ..................139
Anxiety—The Trimodal Anxiety Questionnaire
(TAQ) ......................................................................................142
vii