Mindfulness and Clinical Practice: Learning to “Be Present” for Better Outcomes in Therapy

What Does Mindfulness Mean for Clinical Practice?

Mindfulness, described in one text, is “the state of having one’s whole self in the encounter with a client by being completely in the moment on a multiplicity of levels – physically, emotionally, cognitively, and spiritually” (Geller & Greenberg, p. 7, 2012). Author Geller had previously written about how therapists can become more empathic, better in tune with clients, more genuine, and more in touch with themselves and their own experiences to benefit themselves and their clients (2009). Dr. Geller proceeds to describe how presence, while it cannot be guaranteed within any session with a client, can be fostered by taking steps to reduce stress, excessive thinking, difficult emotions, unresolved issues, and lack of self-care to increase the probability that a practitioner can be fully present with clients. She further states that such training should be part of initial and ongoing professional training. Techniques clinicians can use to increase mindfulness include drumming, meditation, and other mindfulness practices (Geller, 2009). Therapeutic presence benefits the client, the therapeutic relationship, and is also good for the therapist in self-care, a decrease in stress and burnout, increased vitality, and decreased anxiety (Geller & Greenberg, 2012, p. 9).

How Does Mindfulness Work and How Well Does it Work?

Geller’s description of the relationship between mindfulness and presence offers one perspective about “how” mindfulness contributes to presence for clinicians: “Mindfulness with ourselves and our experience is equivalent to Person-Centered approaches of being with the client’s pain. It is a way of being with experience, with full acceptance and without judgment. Hence, therapists’ practice of mindfulness with themselves, helps them to cultivate qualities of acceptance, empathy, compassion and presence not only within, but ultimately with the client (Geller, 2009).

Effectiveness of mindfulness practices to increase therapeutic presence is supported by one thesis study where interviews with 11 clinical social workers who practiced mindfulness meditation daily were used to examine how client/therapist sessions were impacted (Galus, 2015). Findings showed that almost all participants were able to be and remain present therapeutically in sessions with strong client transference and countertransference. All participants agreed that due to daily mindfulness meditation practices they were able to:

• “become absorbed, attentive, and engaged in the therapeutic encounter,”
• “manage distractions and anxiety, facilitated their ability to attend and respond to the client, and encouraged them to be more self-aware and flexible in their thinking”
• “experience the intersection of the client, the self, and the therapeutic relationship, with an expansion of awareness” (Galus, 2015).

As for how well mindfulness works in therapy, the ability to measure mindfulness provides one way of measuring and applying scientific study to the concept. Geller and colleagues developed two measures to measure in-session presence, the Therapeutic Presence Inventory-therapist (TPI-T) and client (TPI-C) versions and studied both as a method of self-reporting the process and experience of therapeutic presence for both the therapist and client perspective. They also analyzed the reliability and validity for both measures and the concurrent and predictive validity. The findings supported an association between clients’ perception of therapist presence and development of a positive therapeutic relationship and a therapeutic alliance. The study also supported that empathy, congruence, and positive regard were higher in Process-experiential therapy (PE) and Client-centered therapy (CC) than in Cognitive-behavioral therapy (CBT), which was not surprising due to the theoretical basis for each of those therapies. How well increased presence worked to improve effectiveness of therapy was indicated by the finding of a predictive relationship between how clients rated therapist presence, the feeling by clients that a therapeutic alliance had been established, and the achievement of positive change as a result of the therapy session(Geller et al., 2010).

Learning More

Learn more about the benefits, and more importantly, hands on approaches about how to practice mindfulness in the upcoming CASAT Learning Live Webinar: The Art of Mindfulness and Clinical Practice, to be held on October 22, 2021 @ 9:00 am – 4:30 pm at: Moana Nursery Landscape & Design Center, 1190 W Moana Ln, Reno NV 89509.

While this brief introduction to the research supports the efficacy of mindfulness in improving outcomes in clinical practice, it has only scratched the surface of the content that will be available for behavioral health practitioners in Nevada. The two-section training will be presented by:

Tom Lavin, Psychotherapist, Clinical Faculty, University of Nevada School of Medicine, Psychiatry and Behavioral Science; Recipient, Impact Award, Association for Contextual Behavioral Science

Kathy Schwerin, Marriage and Family Therapist, Dharma Zephyr Insight Meditation Community Leader

The first section will be informational and includes material base on the wisdom of Dr. Steven C. Hayes (Acceptance and Commitment Therapy), Dr. Viktor Frankl (Logotherapy), Dr. Jon Kabat-Zinn (Mindfulness Based Stress Reduction), Dr. Charles L. Figley (Treating Compassion Fatigue), David Lencioni (Overcoming the Five Dysfunctions of a Team), Stephen Batchelor (Secular Dharma), Dr. Howard Gardner (Good Work: When Excellence Meets Ethics), Dr. William James (Pragmatism), Dr. Antonio DaMassio (The Strange Order of Things) and Drs. Gremer, Siegel, Fulton (Mindfulness and Psychotherapy).

The second section will be more experiential and participants will learn a variety of in-class mindfulness practices, learn how to access and use an assortment of mindfulness approaches, practice being present with others, and learn mindfulness techniques to share with clients. For more information, contact CASAT Learning online or at  775-784-6265 or Email or the Event website

For more information about mindfulness and therapy, check out the CASAT OnDemand Resources & Downloads page. To explore more behavioral health topics through podcasts, visit CASAT Conversations. Visit the Catalyst Blog for more articles and for more posts about Mindfulness.

References and Other Resources

Bourgault, M., Dionne, F. Therapeutic Presence and Mindfulness: Mediating Role of Self-Compassion and Psychological Distress among Psychologists. Mindfulness 10, 650–656 (2019). https://doi.org/10.1007/s12671-018-1015-z

Galus, M. (2015). Cultivating presence: effects of therapist’s mindfulness meditation on therapeutic presence.

Gehart D.R. (2012) Therapeutic Presence and Mindfulness. In: Mindfulness and Acceptance in Couple and Family Therapy. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-3033-9_4

Geller, S. (2009). Cultivation of Therapeutic Presence: Therapeutic Drumming and Mindfulness Practices. Dutch Tijdschrift Clientgerichte Psychotherapie (Journal for Client-Centered Psychotherapy), 47 (4), 273‐287. Journal for Client-Centered Psychotherapy, 47(4), 273-287.

Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. In Therapeutic presence: A mindful approach to effective therapy. American Psychological Association. https://doi.org/10.1037/13485-000

Geller, S. M., Greenberg, L. S., & Watson, J. C. (2010). Therapist and client perceptions of therapeutic presence: The development of a measure. Psychotherapy Research, 20(5), 599–610. https://doi.org/10.1080/10503307.2010.495957

This article was developed by Stephanie Asteriadis Pyle, PhD at CASAT, feel free to use, link to, or distribute this information. A link to our site and attribution would be much appreciated. Suggested citation:

Asteriadis Pyle, S. (2021, September 23). Mindfulness and Clinical Practice: Learning to “be present” for better outcomes in therapy. CASAT OnDemand. Retrieved September 23, 2021, from https://casatondemand.org/2021/09/23/mindfulness-and-clinical-practice-learning-to-be-present-for-better-outcomes-in-therapy/.

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