EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK by Shawn Joseph Jules Venne B.S.W., University of Northern British Columbia PRACTICUM REPORT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK University of Northern British Columbia December 2024 © Shawn Joseph Jules Venne, 2024 1 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 2 Abstract This report documents and explores the practical, personal, and professional challenges faced, as well as the strengths and insights gained through my clinical practicum with HML Wellness Solutions. It captures the essence of my educational journey, underscoring the growth fostered through mindfulness, resilience, and the enriching experience of working with supportive mentors. It outlines my experiences working with clients in a group setting and oneon-one sessions. These reflections are supported by literature that outlines the benefits of a positive therapeutic relationship and mindfulness-based interventions and the role of supervision in clinical development. It marks the end of my Master of Social Work (MSW) journey and the beginning of my dedicated practice in clinical social work. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 3 Table of Contents Abstract 2 Acknowledgements 5 Introduction 6 Chapter 1 - Overview 7 My Story 7 Working with Clients 7 Pursuing a Master of Social Work Degree 8 Rational for Practicum 11 Goals for Growth 12 My Theory of Change 16 Definition of Terms 17 Writing Style 18 Chapter 2 - Agency 19 HML Wellness Solutions 19 What I Learned Working in an Agency 20 Supervision with Tracy 21 Meetings with Cindy 22 Chapter 3 - Agency Practices Practices with Individual Clients 25 25 The Initial Sessions 25 Introducing Mindfulness 26 Three Minute Breathing Space 27 Documentation 27 Lack of Connection with Support Workers 28 Practice with Groups Chapter 4 - Literature Review 28 30 The Therapeutic Relationship 30 Mindfulness 32 Cognitive Behavioural Therapy 34 Mindfulness Based Interventions 34 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 4 MBCT 35 MiCBT 36 Spirituality and Clinical Social Work 37 Supervision and Clinical Social Work 38 Group Therapy 40 History of Group Therapy 40 Benefits and Challenges of Group Therapy 42 Stages of Group Process 44 Clinical Skills for Group Facilitation 45 Chapter 5 - Working with Groups My Experience with Groups this Practicum Chapter 6 - Working with Individuals Handling Challenges Chapter 7 - Implications for Future Social Work Practice 46 46 51 56 58 Prioritizing the Client’s Voice and Nurturing a Strong Therapeutic Alliance 58 Mindfulness and Social Work 58 Expanding Group Facilitation Skills 59 Conclusion 59 References 61 Appendix A - First Session Assessment 68 Appendix B - MBCT Class Flyer 72 Appendix C - MBCT Interview Template 73 Appendix D - MBCT Session 1 Agenda 74 Appendix E - Last Class Reflection Questions 75 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK Acknowledgements I would like to extend my gratitude to my academic supervisor, Indrani Margolin, who guided and encouraged me throughout the practicum placement process, as well as my whole social work academic journey. My heartfelt appreciation also goes to my practicum supervisor, Tracy Larson, my social work lens consultant, Cindy West and the HML Wellness agency for their support and opportunity to apply and enhance my skills in a real-world counselling environment, as well as all the clients that entrusted their healing journeys with me. And finally, to my wife and family who supported me during all the personal challenges. 5 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 6 Introduction My practicum at HML Wellness Solutions is the cumulation of my six year journey through the Master of Social Work program at the University of Northern British Columbia. My intention during my practicum was to bridge my education gained during my social work program, and my counselling training, with the real world experince of working at a counselling agency. I was very interested to learn about how a counselling agency with multiple practitioners operates and how clientele are served in a supportive and caring manner. This paper outlines my theoretical and personal positioning, literature review, agency overview, and learning goals and outcomes. I was excited to add to my understanding and experience of clinical social work in the safe learning space of HML Wellness Solutions. My goal was to successfully bring the cumulation of my training, education, and lived experience into my time at HML Wellness Solutions and play a part in furthering their mission of supporting those in need. I also deepened my understanding of the therapeutic modality Mindfulness Based Cognitive Therapy (MBCT). (Mindfulness is discussed in depth in Chapter 4 - Literature Review of this paper.) Additionally, and possibly most significantly, it was an opportunity for me to build a deeper understanding of how to serve a diverse population, from a therapeutic perspective, under supportive and experienced supervision. Additionally, this report provides a comprehensive overview of my MSW journey, from the initial decision to pursue an MSW, through the difficulties in finding a practicum placement that would accept me, to the personal impact of my late wife’s illness and passing. Integrating these experiences with my practicum at HML Wellness Solutions, I examine the professional and therapeutic growth that occurred, specifically through the application of mindfulness-based practices. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 7 Chapter 1 - Overview My Story Working with Clients I began working one-on-one with individuals on a part-time basis in 2008. 1 had received training in Emotional Freedom Technique (EFT) and experienced such profound shifts in my own life from it that I wanted to share it with others. I rented a small office, put an ad in the Common Ground, and waited for people to call me. I began seeing a few clients a week. It was my first exposure to having somebody come to me looking for emotional support. From a marketing perspective, it seemed like there was very little awareness of EFT and this was reflected in the number of clients that were contacting me. In 2009 I decided that I needed a more well-known healing modality, so I enrolled in a 2-year hypnotherapy program. This increased my skill set, the number of clients that would come to see me, and my experience working with clients. I also started studying another healing modality at this time, called the Sedona Method. Around this time, I became a member of the Canadian Professional Counsellors Association (CPCA). Near the end of 2011, 1 determined that my venture of starting my own counselling business had cost me too much money. I decided to take a break and go back to accounting work full-time. In 2014, 1 decided to pursue a formal education in a counselling-related field. I enrolled in the Bachelor of Social Work program at UNBC newly offered in Vancouver at Langara College, which my supervisor, Dr. Indrani Margolin led. This pilot program unfortunately ended in 2020. While attending UNBC, I also started training in mindfulness-based interventions. I received training in MBCT and also mindfulness integrated cognitive behavioural therapy (MiCBT). I graduated from the social work program in 20 1 7 and received my undergraduate EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 8 degree in social work. As soon as I had my degree, I took the exam and became a licensed social worker with the BC College of Social Work. As a member of the college, I was now able to purchase liability insurance and see clients as a social worker. Pursuing a Master of Social Work Degree When I graduated from the BSW program at UNBC, it felt pretty clear to me that I wanted to focus my career path in the field of clinical social work. At that time, I noted that my work’s extended health plan covered registered psychologists and registered Master of Social Work practitioners. As I was closer to completing an MSW than a PHD in psychology, I decided I would pursue the MSW route. I was able to finish the bulk of the course work in one semester and then started looking for an agency with which to do a practicum placement. After contacting a few counselling agencies, I realized that my formal education in social work was not enough. They were looking for someone that had formal education in counselling, specifically someone that was pursuing a master’s degree in counselling. This seemed contrary to my findings that many extended health insurance companies will recognize an MSW counsellor and not an MA counsellor. I have since learned that this is because social workers have a governing body, while counsellors that are not PhD psychologists do not have an official governing body (BC Health Regulators, 2024). My approach to life has usually been to take suggestions from life events as they occur and so if I am met with obstructions in one direction then I like to take this as an indicator to look in other directions. The MSW program at UNBC allows a student to pursue either a practicum route to an MSW or a thesis route. As I was not having a lot of doors open for me with the practicum route, I decided to try doing a thesis project. The topic I chose was exploring how shifting our perspective of the self through an eastern spiritual lens could be beneficial in clinical EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 9 social work. This was a topic very close to my heart, as shifting my perspective of the self had made a profound shift in my sense of well-being. Five years ago, I began working on my thesis proposal. There were definitely times of struggle, as I was wrestling with a subject matter that did not seem to fit very well in the area of social work. I did not see any examples of people taking on such material in their social work theses. I also faced many personal changes and challenges during this period. My late wife and I moved from our townhouse in Vancouver to a small house in the community of Hope, BC. We moved there to be closer to our daughter and our three grandchildren. Six months after our move to Hope she was diagnosed with breast cancer. Our whole life changed at that point, with constant visits to doctors and chemotherapy treatments. After a roller coaster ride of changing prognosis from bad to good to bad again, it became apparent that the treatments were not working and that my late wife was not going to survive the cancer. Our focus then shifted to how to spend this remaining time that she had left. The final two weeks were spent caring for her in the hospital and then the hospice. In April 2022, the oncologist told us that my late wife probably had only six to twenty-four months left; she only lasted three and a half months from that day. During all this time it was difficult to keep my focus on my schooling and completing my thesis proposal. My late wife passed away in July 2022. Not long after that I forced myself to refocus on completing my thesis proposal. In October 2022, 1 completed my thesis proposal and sent it to my thesis committee. I received very strong negative feedback from one of my committee members. I could not fault her feedback, as I realized that it was a stretch trying to fit my thesis topic into the field of social work. Perhaps at another time I would have been able to take her feedback and revise my thesis but, at that time I just did not have the capacity for that EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 10 undertaking. In keeping with my approach to adjusting to life occurrences, I considered the door to doing a thesis closed and I looked for other open doors. After taking some time off, I decided that I would change my thesis stream back to doing a practicum placement. Again, I was having a very challenging time finding a placement. I had located a local support agency in Hope that I thought would be a great place to apply my skills and to learn from. I tried to contact the HR person a number of times and received no reply back. I then contacted the person who was running the support programs. She thought I would be a great fit for the organization and forwarded my information onto the HR person from whom I had previously contacted. There was still no response. Around this time my academic supervisor arranged an interview for me with a counselling agency in Vancouver. The agency specializes in working with LGBTQ2S+ individuals. In the interview I was quite thrown off by the questions related to working with LGBTQ2S+ individuals. My approach to working with people has always been very client¬ centered and to meet them where they are at. If what they are presenting is not their sexual orientation or gender identity or race or social/economic status, then I would not bring the subject up. It did not seem like the people who were interviewing me agreed with my approach and I did not go any further in the interview process. Never being one to give up on me, my supervisor found another agency in Prince George that she thought with which I might be a good fit. The agency was called HML Wellness Solutions. The position would be a remote position working with clients via video or telephone. I jumped on the opportunity, contacted the owner of the agency, we set up a time for an interview EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 11 and I was accepted. I started my practicum placement at HML Wellness Solutions in January and completed my practicum in September. During my time at HML Wellness Solutions, I integrated a great deal of my training in MBCT into my work with clients, both in my individual and group work. I chose to study MBCT as mindfulness has played a very significant role in my life for the last 25 years. I believe that my training and practice in mindfulness was a big part of my level of resilience over the last few years of my journey. Mindfulness and other practices I have learned from Eastern Spirituality helped me to be with each experience on a moment-by-moment basis. By being with each moment as it was arising, my mind was not as engaged in going into the future and catastrophizing. Given the experiences that were happening in my life, catastrophizing could have led to a high level of suffering, and my life and my state of mental well-being could be very different than it is today. Because of the effectiveness and the versatile application, these are the skills and tools that I am called to share with others and that I had an opportunity to share with the clients of HML Wellness Solutions. Rational for Practicum Although there was a point that doing a practicum was not the path that I wanted to pursue, now having done a practicum, the value that I have received from taking this path is more than evident. I feel fortunate to have had this opportunity regardless of it being a requirement for my MSW education. The experience of connecting with clients on a regular basis has allowed me to develop the hands-on skills necessary for clinical practice. These skills include how to begin building rapport with a client, how to actively listen without an agenda, and how to document interactions with the client. Another significant experience that I acquired EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 12 during my practicum was leading MBCT groups. Although I had been trained in leading MBCT groups, and had helped with facilitating groups under supervision, I had not previously led a group on my own. Even though the thesis work held personal relevance and I think it would have been a useful resource, the practical application learned through the practicum experience feels more aligned with my career aspirations. This practicum enabled me to build on theoretical knowledge, hone clinical skills, and deepen my understanding of mindfulness as a therapeutic tool. Goals for Growth Outlined below were my goals for growth in clinical social work that I focused on while completing my practicum at HML Wellness Solutions. I. Completing an orientation of HML Wellness Solutions. a) Familiarizing myself with agency structure, mission statement, policies, and staff. II. Continuing to develop my understanding of clinical social work practice and the incorporation of mindfulness and spirituality into clinical social work. a) Reading texts on spirituality in social work practice, including Spirituality and Social Work (Coates et aL, 2007) Integrating Spirituality in Clinical Social Work Practice (Cunningham, 2012), Spiritual Diversity in Social Work Practice: The Heart of Helping (Canda et aL, 2020), Becoming a Spiritual Influencer Through the Heart and Soul of Field Practice (Boynton & Margolin, forthcoming) and Altered Traits: Science Reveals How Meditation Changes Your Mind, Brain and Body" (Goleman & Davidson, 20 1 7) EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 13 b) Learning about incorporating mindfulness and spirituality into clinical social work from listening to my practicum supervisor’s experience and other practitioners at the agency. III. Incorporating alternative methods into my practice when appropriate. One alternative method considered was expressive arts therapy. a) Reading texts on expressive art therapy, including Creative Connection: Expressive Arts as Healing (Rogers N. H., 1993), and Trauma and Expressive Arts Therapy: Brain, Body, and Imagination in the Healing Process (Malchiodi, 2020) IV. Increasing my knowledge of clinical social work practice. a) Deepening my experience of incorporating mindfulness into the therapeutic process, through the use of mindfulness based cognitive therapy (MBCT) and mindfulness integrated cognitive behavioral therapy (MiCBT). b) Gaining experience working with other counselling modalities, particularly expressive art therapy. c) Gaining understanding and experience working with clients experiencing grief and the grieving process. Books include On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss (Kiibler-Ross & Kessler, 2005), Being with Dying-. Cultivating Compassion and Fearlessness in the Presence of Death (Halifax, 2008), and Meetings at the Edge: Dialogues with the Grieving and the Dying, the Healing and the Healed (Levine, 1989) d) Continuing to read textbooks pertaining to clinical social work approaches of interest as I gained experience in my practicum. Textbooks include Clinical Social Work Practice: An Integrated Approach (Cooper & Lesser , 2021), and Counselling Skills for Social Work (Miller, 2014). EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 14 e) Having weekly supervision with my practicum supervisor to support me in the development of my clinical practice skills. V. Continuing to strengthen my clinical skills. a) Further developing my skills in the areas of assessment and treatment planning. b) Carrying my own caseload of individual clients and having the opportunity to co¬ facilitate a group. c) Enhancing my ability to bring empathy and reflective listening into my counselling sessions, by using journalling as a self-reflective tool, and sharing this self-reflection and case examples in my supervision meetings. d) Learning best practices for note taking and record keeping in clinical practice. e) Further developing my tools for creating an inviting space for clients by reading The Art of Holding Space: A Practice of Love, Liberation, and Leadership (Plett, 2020). VI. Staying informed of the structural barriers and experiences faced by the client populations with which I may be working with, in particular, possible issues pertaining to clients with an indigenous background and/or clients coming from a background of poverty. VIL Contributing to my practicum report regularly throughout my practicum. a) Maintaining a journal to document my reflexive process, insights, and areas to research. b) Designating specific times for reading and writing each week. c) Maintaining a schedule that will allow me to produce a first draft of my practicum report upon completion of my practicum hours. VIII. Maintaining a regimented self-care plan to help ensure a healthy and sustainable practice as I move into clinical work. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 15 a) Ensuring that as I work through my practicum, I keep a healthy balance between my time online supporting clients and time offline supporting myself. b) Maintaining a regular sitting meditation practice each morning, to allow my mind and body to rest and practice the art of not-doing, c) Maintaining a regular yoga practice of at least every second day, to give my body an opportunity to move and stretch, and to release any holdings that have been accumulated over the previous days. d) Being open and vulnerable with all of my academic and practicum supervisors, so that I can be truthful about any issues that might arise for me during my practicum. This is essential in order to not hold anything in that might be troubling me, and unnecessarily exacerbating stress or anxiety. Upon completing my practicum and reflecting on the goals that I created almost a year ago, it is interesting to see which goals I was able to hold in focus and accomplish and which goals I was not able to achieve. One challenge to keeping all of my goals in focus was that major changes continued to unfold in life for me. Even as I continued to process the grief of my late wife’s passing, I entered into a new relationship. We moved from my place in Hope and bought a house on Salt Spring Island together and I transitioned from part-time work to full-time work. I feel that I accomplished the learning regarding growing my clinical skills, my experience delivering mindfulness-based interventions with clients, and my self-care goals. Unfortunately, I did not progress in my goal to explore doing art-therapy with clients, nor did I journal to the extent that I had intended. I did not read all of the books that I had listed, however I did read some of them and read other books and journal articles that were not listed but that came to my attention during this time. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 16 My Theory of Change My theory of change is rooted in the belief that all human beings long to be whole and free, and that if that is not our current experience, we all have the capacity to change and move our lives in that direction, given the opportunity and resources to do so. The opportunity might include access to education and learning, mental and emotional support, and physical well-being (Bogin, 2023; Hick, 2010; Maslow, 2011). Two resources that I believe can support such change are mindfulness-based interventions and the client-centered approach, as demonstrated by Carl Rogers (Rogers C. R., 1995). This approach is focused on meeting clients where they are and adapting techniques to fit their journey. This theory is that, in each one of us is the natural tendency towards growth and healing, and that all that is required to release and foster this journey towards wholeness is the appropriate positive relationship (Rogers C. R., 1995). Rogers describes a point in his professional development when his approach to therapy shifted from the question “How can I treat, cure or change this person?” to “How can I provide a relationship which this person may use for his own personal growth?” He theorized that if he could provide a certain type of relationship, the other person would discover within themselves the capacity to use that relationship for growth and change and personal development. Rogers describes the type of relationship he aspired to nurture with his clients as requiring to be authentic and accepting of the individual, holding them with unconditional self¬ worth and compassion - a relationship of warmth and safety. He believed that acceptance could only come with understanding of the person, which required him to be free from morale or diagnostic evaluation. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 17 My training and experience, therefore, is not necessarily to add more and more knowledge and tools, but to remove barriers such as judgment towards others and myself, in order to be as fully present and accepting of any individual with whom I am engaged. I believe self-compassion is a necessity to have for myself before I can hope to nurture it in others. I believe mindfulness can be an important skill for clients to learn as it can support clients in exploring their internal and external experiences with acceptance, curiosity, and openness, as opposed to aversion and judgement. This can create a fertile internal environment where change and healing can happen. Definition of Terms • Mindfulness: Mindfulness is the practice of paying full, non-judgmental attention to the present moment. It involves observing one’s thoughts, feelings, and sensations as they arise, without reacting or becoming absorbed in them. This approach allows a person to experience the present moment, without being influenced by thoughts of the past or future. Mindfulness is often cultivated through meditation but can be practiced in everyday activities to enhance focus, reduce stress, and promote well-being (Segal et aL, 2013). • MBCT (Mindfulness-Based Cognitive Therapy): A therapeutic approach that combines cognitive-behavioral strategies with mindfulness practices to prevent relapse in depression and improve overall mental health (Segal et aL, 2013). • MiCBT (Mindfulness-Integrated Cognitive Behaviour Therapy): An evidence-based therapy approach that integrates mindfulness practices rooted in the Vipassana tradition with fundamental techniques of Cognitive Behavioral Therapy (Cayoun et aL, 2018). EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 18 • Client-Centered Therapy: A therapeutic approach focused on prioritizing the client's perspective, with the idea that they know what is best for their healing journey, emphasizing empathy, unconditional positive regard, and acceptance. Developed by American psychologist Carl Rogers (Rogers C. R., 1995). • Cognitive Behavioral Therapy (CBT) - A widely used therapeutic modality that is based on the theory that our thoughts, emotions and behaviour all effect each other, and if we change our thoughts, we can change our emotions and our behaviours (Beck, 2011). • Congruence - A term emphasized by Carl Rogers, referring to the therapist's authenticity and transparency within themselves and with their clients. It was deemed to be crucial for creating a genuine therapeutic relationship (Rogers C. R., 1995). • Spirituality in Clinical Social Work - The intersection of spiritual practices and therapeutic approaches. The idea is based on the theory that spirituality, in some form, is integral to a human being’s well-being and wholeness. The focus is not on a therapist imposing their spiritual beliefs onto a client but opening the door to bringing spirituality into the therapeutic conversation, and inviting the client to explore what spirituality means to them (Cunningham, 2012; Margolin, 2014). Writing Style This report is written in reflective, first-person narrative to capture my personal and professional growth experienced during my time in my practicum placement. I have attempted to balance an academic style that is required in a graduate level paper such as this, with a casual style that can be accessible to the average reader. My intention is to emphasize my self- awareness and learning process, which I believe are key to clinical social work practice. I use storytelling to provide context for my learning experience and incorporate personal stories (such EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 19 as the challenges faced during my educational journey). I attempt to balance this informal sharing with theoretical concepts and literature reviews to support my reflections. My writing style offers the reader insights into my professional development and personal growth. I hope that it helps the reader to better understand my journey in clinical social work. Chapter 2 - Agency HML Wellness Solutions The following section is an overview of the agency where I completed my final practicum placement, HML Wellness Solutions. It includes a short history of the agency, the common issues with which their clients struggle, and the primary therapeutic approaches used by the practitioners that work there. It also includes a summary of what I learned working in an agency, and my experiences with the supervision that I received during my practicum. HML Wellness Solutions first started in 2008 as a small business, teaching wellness, psychology, and sociology courses online and then evolved into providing therapy in 2014. Their stated mission is “creating happiness one session at a time” (HML Wellness Solutions, 2023). The agency is privately owned by Tracy Larson. Tracy is a registered clinical counsellor, holds an MA in counseling psychology, and is working towards her PsyD in psychology. There are three other therapists working at the agency, one is also a registered clinical counsellor, and the other two are registered social workers with master’s degrees in social work. There is also a practicum student currently working at the agency. HML Wellness Solutions promotes the option of working with practicum students as an affordable option for people to access counselling. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 20 HML Wellness Solutions focuses on several different areas that individuals struggle with in their lives. Those issues are grief and loss, stress, anxiety, chronic pain and illness, depression, self-esteem, sleep issues and post-concussion issues. The agency offers their services to individuals, couples, and youth. Both online counselling as well as in-person counselling, out of their Prince George, BC office, are offered. Practitioners at HML Wellness Solutions specialize in a number of different therapeutic modalities and approaches. Some of the modalities include CBT and Dialectical Behavioural Therapy (“DBT”). Several practitioners have experience in trauma-informed therapy and specialize in supporting clients in working with past traumas. What I Learned Working in an Agency Before doing my practicum, I had never worked at or with a counselling agency. All of my counselling experience had been solo. I was the only person running the business, doing the booking, and doing the marketing. Being part of a team was a new experience. I wish that I could have been there in person, as my only interaction with the agency team was my supervision meetings with Tracy, my meetings with my MSW consultant, Cindy, and my emails with the office administrator, Ruth. I believe this limited my experience of working in a team. Some of my key learnings from working in an agency were the value of supervision and peer support. I also learned the importance of documentation and the proper information to record and share with external agencies. In addition to the supports, one of the benefits of working in an agency was the access to resources, both educational and the variety of client assessment forms. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 21 Supervision with Tracy Tracy, as both owner and head therapist, provided invaluable supervision, sharing insights from her vast experience and training during our bi-weekly meetings. She was always kind and patient with me and my questions. Regular supervision offered me a depth of perspective on my clients and therapy that I might not have otherwise considered. Tracy’s knowledge of the resources in Prince George was always very helpful when I would come to her with the different issues that my clients were having. She also consistently had helpful advice regarding my work with clients. She would offer me questions or topics to explore with my clients, for example “what are the benefits of continuing on with this behaviour?”. Another example was her guidance suggesting that a lot of people struggle in their lives because they see life as black and white, and sometimes our task as therapists is to invite them to see the shades of grey in order to better relate to those shades. She was also very helpful in reminding me to ask clients about their medical support including getting pertinent names. Her knowledge about medications, both prescription and not, was very useful. One example is a client who was drinking alcohol to relax and cope and was also struggling with not sleeping. Tracy offered the likely possibility that their excessive drinking, while helping them fall asleep, was possibly having a negative impact on their sleep when the sedative in the alcohol wore off (Brower, 2001). She was also very helpful and supportive when I was engaged with clients that were working through trauma. One example was a client who was focused on sharing their past traumatic memories as part of their healing process. Tracy wanted me to ensure that the client had a plan in place for after our sessions of what they could do to nurture themselves after sharing these memories after our sessions, as accessing such memories can be a heavy load on the nervous system (Van Der Kolk et al., 1997). EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 22 Another area where Tracy’s supervision was helpful was in introducing me to some helpful forms to use with clients. Some of the forms she introduced me to were: • Brief Mood Survey - to assess a person’s current emotional condition. • Evaluation of Therapy Session - Helps the client and therapist assess the progress of the sessions. • PHQ9 - Patient Health Survey - a general assessment of a client’s health. • GAD7 - General Anxiety Disorder - a client’s level of anxiety. • Insomnia Severity Index - to assess a client's level of sleep disorder. Tracy was also instrumental and very supportive in promoting my MBCT group and supporting me while I was running the groups. We worked together with my academic supervisor, Indrani, to brainstorm agencies and organizations to which to send the class flyer, and she promoted it on the HML Wellness Solution’s website, email newsletters, and social media pages. Throughout the group program, I met with Tracy and debriefed how the classes were going. Although she had no experience running the specific MBCT group, she provided me with very helpful guidance regarding the clientele who I was working with and helped me with making adjustments to the program along the way. Meetings with Cindy Cindy, a fellow therapist with an MSW degree, offered a social work perspective to my time at HML Wellness Solutions. Our conversations explored topics like grief, resilience, and professional challenges, drawing from her previous experiences at Elizabeth Fry, her time as a therapist at HML, and her personal journey. During our bi-weekly meetings, Cindy’s insights EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 23 provided a wealth of lived experience and added dimension to my understanding of how viewing therapy through a social work lens can make a difference in how we work with clients. I always enjoyed my conversations with Cindy. She shared with me her opinion on the difference a background in social work has had on her engagement with her clients in contrast to how she has seen other therapists engage, who do not have a social work background. She spoke about the struggles that some clients would come to her with. An important takeaway for me from our discussions is that she considers it a part of her role to help clients see that the low selfesteem and self-criticism that they are feeling may not be warranted. She explains that there are structural barriers at play in our society - such as gender, social-economic status, and skin colour - that are not in their control and that if they can recognize those barriers, they may change their self-image of themselves and possibly change their sense of well-being and their lives. A therapist with a background in social work may be more attuned to different aspects of a client’s life instead of just focusing on improving the client’s self-esteem. Another topic that Cindy and I looked at in depth was grief and how to work with clients who are dealing with grief. She shared with me the details of the grief counselling training that she received through a training company called Pesi (Pesi, 2024). She explained to me the types of grief and the importance of being able to identify which type of grief your client is experiencing, as it may help in the understanding of their experience and help guide how to best provide support. The types of grief she described to me are: • Normal - This is the natural and expected grief that is experienced when a loss occurs in our life. Typically, if acknowledged and felt, grief will pass through our system over time and will not require clinical intervention. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 24 • Anticipatory - This type of grief occurs before a loss, usually when someone knows that a loved one is nearing death or is going to go through major life changes. • Complicated - Also known as prolonged grief and occurs when the usual grieving process becomes prolonged, intense, and disruptive. People with complicated grief may feel stuck in their mourning and have difficulty moving forward. It can lead to depression and withdrawal. • Disenfranchised - This happens when the grief is not openly acknowledged or supported by others in society, such as in cases of miscarriage, the death of a pet, or when the relationship with the deceased is stigmatized (e.g., the death of someone due to addiction) • Collective - This form of grief is experienced by a group of people, a community, or a nation in response to a shared loss or tragedy. She also shared with me that there are assessment tools to help therapists identify how a client is managing the grief in their life. Some of those assessment tools are: • HAM-D - Hamilton Depression Rating Scale • CDI - Children’s Depression Index • IES-R - Impact of Event Scale - Revised Cindy also shared with me some of her strategies in engaging with clients and assessing their progress in therapy. She said that she uses some of the pre- and post-session tools that Tracy shared with me. Another important takeaway is that sometimes Cindy asks clients near the end of a session “How are you feeling?” and “Did you find the session today helpful?” She EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 25 shared that clients are honest, and I could likely gain some helpful insight, that I might not get without asking. Chapter 3 - Agency Practices This chapter describes the different practices I employed during my practicum at HML Wellness Solutions. Included in this discussion are: • The practices used in my individual sessions with clients. • The system used for documenting the sessions. • The practices used in group sessions. • How group participants were recruited. • Adaptations made as needed to better support clients. Practices with Individual Clients The Initial Sessions Once I was assigned a client and given the details of the initial session, 1 would check the client management platform for any available information on the client. During the session, I would try to balance filling in all of the necessary information on the initial appointment assessment form (see Appendix A) with having a natural-feeling conversation with the client. My intention would also be to build rapport, as it is important during the first session for the client to get a sense of whether I am someone with whom they feel emotionally safe. During my first few sessions my primary approach focused on the counselling micro skills of active listening and responding with empathy (Ivey et al., 2023). EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 26 Introducing Mindfulness If the client expressed an interest in making some shifts in their life, I let them know about my training in two modalities that combine mindfulness and cognitive behavioral therapy, MBCT and MiCBT. If they were interested in the program, I would send them more detailed information and we would begin the program at the next session. Ideally, we started each session with a guided mediation. This is done intentionally, to keep the client’s focus on what is happening in the present moment, instead of thinking about the past or future. The key message of the program is to notice what is happening in the moment (Segal et al., 2013). In order to maintain a client-centered approach, I always checked in to see if they were okay with starting with a guided meditation or if they had something pressing that they wanted to talk about instead. There were sessions that were wholly focused on something they were dealing with. In these cases, I rescheduled the planned session for the following week. Supporting clients through the MBCT program was a good lesson in adaptation. The first lesson was adapting the group program to work with individual clients. Another lesson was how to adapt each session to fit each individual. Often, I shortened the guided meditations and adjusted which guided meditations I did with each client. One client, who felt that a 30 minute meditation was too long, found a nine-minute version of the 30-minute body scan meditation used in the program. This was a great example of resourcefulness by a client. As well as adapting content, I needed to be flexible with the progression of the program. It was rare that even 10% of the home exercises would get completed between sessions. I accepted that the sessions were not based on my agenda, and that anything that the client was able to learn in the session was helpful and likely something they had not heard before. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 27 Three Minute Breathing Space There were some specific fundamental MBCT skills that I taught clients. One skill was called the “three-minute breathing space” (Segal et aL, 2013) which is a short exercise consisting of three separate one-minute activities. The first minute the client is invited to just notice everything that they are experiencing in that minute, all of the information that is coming in their senses, including their thoughts. The instruction is just to notice it, they do not need to do anything with it. The second minute, they are to completely let go of noticing all their experience and just focus their attention on the air coming in and out of their body. The third minute, they are invited to expand their attention to their whole body, and to stay with noticing their whole body, including their breathing. I quite like this technique, as it is short, relatively easy to do, and encompasses a number of the important components of MBCT, namely: being open to our experience without needing to change it or push it away, being able to completely shift our focus from something else and bring it instantly to our breath, and being able to bring our body, and the present moment, into focus. The other specific key skill that I brought up often was noticing their thoughts. A word that is used in MBCT is “auto-pilot”. It refers to how we can be fully functional in life and not be aware of doing it or why we are doing it (Segal et al., 2013). By starting to bring attention to our thoughts in a more intentional way we can reduce our time in autopilot and increase control over our emotional responses and reduce the impact of negative patterns. Documentation I made sure to document anything that the client said regarding their state of well-being, and any issues with which they were dealing. For the clients engaged in a MBCT program, I EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 28 documented what exercises we had done, what theory we had gone over, and what exercises they were assigned for next week. I also noted what their plans were for the upcoming week as this was an indication of whether the client was continuing to engage with supports in their community, or whether they were self-isolating. Engaging in community is a strong positive indicator of good mental health outcomes (French et al., 2011). Lack of Connection with Support Workers One area of working with individuals that I was a little disappointed about was the lack of contact with other supports working with the clients. All of my clients had at least one support worker that they were connected with at CMHA. In one of my meetings with my practicum supervisor, Tracy pointed out that as part of the agreement with CMHA Prince George, we were supposed to be connecting with the client’s CMHA supports on a regular basis. The only interaction that I had with a CMHA support worker was once for my first client. The support worker had referred the client to HML Wellness Solutions, and so I called the support worker before the initial session to gather information regarding the reasons for the referral and any other information they may want to share. I was excited about connecting with other agency support staff, as I have studied a fair amount about the benefit of wrap-around care and had experienced very positive results with some of my other practicum placements (Hess & Draper, 2023); unfortunately, I did not receive a response from any of the other social workers. Practice with Groups Participants in the MBCT groups were recruited by sending flyers to the agencies that HML Wellness Solutions is affiliated with, and also other agencies in the Prince George area (see Appendix B). After a participant signed up, I would do a one-on-one intake interview with EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 29 them. I used a form that I had used during my MBCT teacher training for the intake interviews (see Appendix C). The primary goal of the intake interview is to inform the potential participant of what we will be doing in the program and whether this will work for them, and something they are willing to commit to. Another purpose of the intake interview is to screen for people that may not be suitable for the program at this point in their lives, specifically due to active addictions to substances that might impact their participation and mental health issues that might also impact their participation. Once the participants were all screened and enrolled, I prepared for the first class. The structure of the eight-week program, including the agenda for each session, is clearly laid out in the MBCT handbook (see Appendix D) (Segal et al., 2013). The one part that I needed to plan was how much time I was going to take for each item of the class agenda. Once this was done, I was ready to start the first class. Just as in the individual MBCT sessions, the classes consist of two components that are weaved together throughout the class, they are theory and exercises. Both are essential to the program and making progress in mindfulness and CBT. The classes are usually started with a guided meditation, the only exception is the first class, in which we start introductions and ground rules and then with what is called the “raisin exercise”. This is an exercise in which students are guided through the complete act of eating a raisin mindfully using all of their senses (Segal et al., 2013). After the first class, it was obvious that I was going to have to adjust my schedule to adapt to the group size and the capacity and experience of the participants. I shortened the duration of most of the exercises we were going to be doing in class. Another adaption was EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 30 dropping the “mindful movement” exercises. After doing it once it was clear that the participants were not enjoying it and a number of them had mobility or chronic pain issues. In hindsight, I could have introduced some other form of movement - as the intention of the exercise is not to get exercise, it is to merely bring mindfulness to the movements of the body. I guess I had a lot to manage with doing a group for the first time and it seemed easier to drop the exercises from the agenda. The usual MBCT program has a full-day retreat between session 6 and 7, with the theory being that having a full day immersion in mindfulness exercises give the participants a deeper experience than the two-hour weekly sessions. In consultation with my practicum supervisor, Tracy, we decided to not include the full-day session with the CMHA groups. It was primarily a logistical decision. For the final class I created a slide presentation to show to the group which included additional resources for participants to utilize beyond their time at the group. I also created a slide with reflection questions that the participants could reflect on (see Appendix E). They were invited to share anything that came up for them from the reflection exercise. Chapter 4 - Literature Review This literature review focuses on different factors of my practicum placement, the therapeutic relationship, mindfulness and mindfulness-based interventions, spirituality, and clinical social work and also supervision in social work and counselling. The Therapeutic Relationship What is becoming more apparent in the mental health field is that as long as the modality is evidence-based, which modality is used has little impact on the success or failure of therapy, EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 31 and that the relationship between the client and the therapist is the primary indicator of success (Saxon et al., 2017). Carl Rogers believed that the right therapeutic relationship was all that was necessary for healing and growth (Rogers C. R., 1995). The challenge then is what is the “right” therapeutic relationship? According to Rogers three key factors needed for the right relationship are empathy, unconditional positive regard, and congruence. Empathy can be described as deeply understanding a client’s feelings. This understanding is more encompassing than cognitive understanding, this understanding is also felt viscerally and emotionally. Empathy is the therapist’s ability to “feel with” the client. This helps to foster a safe, supportive environment of openness and trust (Kaluzeviciute, 2020). Expressing true empathy requires three distinct skills. They are the ability to share the other person’s feelings, the ability to cognitively intuit what another person is feeling, and an intention to respond compassionately to that person’s distress (Lamn & Singer, 2009). If the client feels that the therapist understands them and feels with them, they feel seen and heard. Unconditional positive regard is said to be one of the less examined and less well understood of the three factors required for a nourishing positive therapeutic relationship (Wilkins, 2000). Rogers attempts to help us to better understand the concept by stating that “to demonstrate unconditional positive regard, a therapist values the humanity of her client and is not deflected in that valuing by any particular client behaviours” (Wilkins, 2000). Another approach to understanding unconditional positive regard is to contemplate the contrary concepts of the term. The contraries would be: conditional positive regard, where we can have positive regard for another, if certain conditions are met; unconditional negative regard, when no matter what an individual does it will not shift our negative attitude towards them; and unconditional positive disregard, when no matter what another does we will never regard them as a being of EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 32 worth (Vlaicu, 2022). Unfortunately, these contrary perspectives are much more common in our society today. The third factor required for a positive therapeutic relationship according to Rogers is congruence. Congruence is the therapist’s ability or willingness to engage with integrity between their thoughts, feelings and actions, and for this integrity to be transparent to the client (Sutanti, 2020). Unlike the other two factors, empathy and unconditional positive regard, which are directed towards the client, congruence is primarily an internal experience for the therapist and an outward expression. It requires the therapist to hold in their awareness both the client’s emotions and needs, and their own emotions, and thoughts and the reactions that are occurring for them at all times during the therapeutic interactions (Sutanti, 2020). In engaging with a spirit of congruence, the therapist models self-expression and emotional transparency, as best they can, to the client. Through this modelling, it is hoped that it will inspire the client to also explore their inner landscape, greet it with acceptance and be able and willing to express it to others. All three of the factors required to create a positive and nurturing therapeutic alliance need self-awareness in abundance. Mindfulness training and practice can prove an invaluable skill to acquire and nurture self-awareness. Incorporating mindfulness can strengthen a therapist’s ability to be aware of their thoughts, feelings and inner reactions when working with a client (Segal et al., 2013). Mindfulness In the spirit of enhancing emotional wellness for clients, clinical social work has always endeavoured to utilize the best practices from psychology and other health service, as well as EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 33 create their own (Hick, 2010). Over the last few decades, this profession has gradually incorporated more perspectives that are outside the Western European paradigm of wellness and healing. One example of this expansion has been the adoption of perspectives from the Eastern philosophies and psychologies of Buddhism and Hinduism. One of the primary tools adopted and incorporated into Western psychology has been mindfulness. Professionals and researchers in the mental health field began to seriously study and use mindfulness in the late 1970s and it continues to grow in popularity and prominence. During a MBCT group that I participated in recently, I spoke with one participant who had come to mindfulness through a referral from their doctor. This provides an indication that mindfulness has been "legitimized" in the eyes of the Western medical establishment. The prevalence of mindfulness in our society has increased significantly, especially in the last 10 years. Once a fringe activity, considered to be done only by hippies and Buddhist monks, articles about mindfulness can be found in such mainstream publications as the LA Times, the Harvard Gazette, The New York Times, and the Wall Street Journal (CMA, 2019). This popularity is largely due to the use of mindfulness as an intervention tool in modem medicine and mental health treatments. Rather than a medication that is prescribed, it is an invitation to look at the mind and to take an active role in changing how our minds perceives reality and the world around and within us. Mindfulness has reached a level of prominence and legitimization in the West because this concept and practice has improved the lives of a significant number of people suffering with mental health issues, such as anxiety and depression (Davis & Hayes, 2011; Black ,2014; Segal et al., 2013). There is growing research that shows that mindfulness is effective in many different areas of a person’s life (Davis & Hayes, 201 1; Segal et al., 2013; Black , 2014). EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 34 Cognitive Behavioural Therapy Cognitive therapy, or more commonly known as cognitive behavioural therapy (CBT) was primarily developed by psychiatrist Dr. Arron T. Beck in the 1960s (Beck, 2011). Dr. Beck branched away from his training in the psychoanalytic model and took a different approach when he noticed that at the root of a number of psychiatric issues — primarily depression and anxiety — was a disorder in how the person was thinking (Beck, 2011). It was discovered that the issue with some clients’ thinking was that they habitually interpreted situations that they encountered in a manner that reinforced their negative mood. The thoughts were typically about themselves, their world, or their future. The focus of CBT is to point out the habitual patterns of thought to the client. Once the habitual patterns of thought are pointed out, the client is then invited to explore alternative thoughts about a situation and shift their thinking to more neutral or positive thoughts. As the client starts to experience a more balanced thought process, their mood also becomes more balanced. The benefit of the CBT approach is that the client is taught tools to address their thought patterns even when they are not with the therapist. This empowers the clients to maintain the improvements that they have experienced working with the therapist. The basic model of CBT is that we all have core beliefs that create intermediate beliefs (such as rules, attitudes, and assumptions), which in turn, are responsible for creating our automatic thoughts (Beck, 2011). As mentioned above, in CBT therapy, clients are invited to first identify their automatic thoughts that create their unwanted moods and mental states. They are also invited to identify, explore and possibly replace their intermediate and core beliefs. Mindfulness Based Interventions There are two mindfulness-based interventions that incorporate cognitive behavioural therapy into their model of intervention. They are MBCT and MiCBT. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 35 MBCT MBCT was created in 1992, when three psychologists, Dr. Zindel Segal, Dr. Mark Williams and Dr. John Teasdale, were searching for a means to support their clients with depression relapse (Segal et al., 2013). They had become aware of the Mindfulness-Based Stress Reduction (“MBSR”) eight-week program, developed by Jon Kabat-Zinn. MBSR had proven to be quite successful for patients with chronic pain, hypertension, heart disease, cancer, and gastrointestinal disorders (Segal et aL, 2013). MBCT is presented as an eight-week program, that begins with participants practicing the basics of mindfulness meditation and learning how our mind works. The program was created to be used with groups; however, it could be adapted to be used with individual clients. Each week progresses with an increase in the length of meditation and further explorations into how our mind impacts our mood. Each session had a handout that is given to the client at the end of each session. The handout outlines the theme of that week’s session, the exercise introduced at that session, some educational summary, and the home exercise expectations to be done before the start of next week’s session. In the final eighth week, the focus is on bringing all the learnings of the previous weeks together, and on retaining what was learned to help prevent depression relapse. Research has shown that MBCT helped reduce the chances of depression occurring by 50% (Segal et al., 2013). The theoretical foundation of MBCT draws significantly from CBT, in that our thoughts are key in determining our sense of well-being, as our feelings and behaviours are often very intertwined with our thoughts. There is a cognitive education component, related to a basic understanding of how our thoughts, feelings and behaviours influence one another and determine our moment-to-moment experience. There is also a practice component in which we learn the EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 36 mindfulness skills of paying intentional attention to the present moment in a non-judgmental accepting way (Segal et al., 2013). In this “paying intentional attention” to we notice our thoughts, emotions, and sensations as they arise, without needing to control, change or suppress them. Through a combination of understanding how our thought, emotions and behaviour interact and learning skills to notice them without needing to react to them, we can change our moment-to-moment experience. For example, we can notice when we are experiencing a state we label depression, anxiety, overwhelm, guilt, shame, or hopelessness, and do our best to notice it and not do anything about it, including feeding it with more thoughts (Cayoun et al., 2018). If we are able to approach states in this manner, then the states will typically pass in time, and at least not deepen to an unbearable level. In this manner, learning MBCT can contribute positively to a sense of well-being. Another key theory in MBCT is that the average person focuses most of their attention to their thoughts and very little attention to what they are experiencing in their bodies. This imbalance contributes to our being preoccupied with thoughts, such as worries, plans or memories, and not noticing what is happening in the present moment. In MBCT the body is used consistently as an anchor into noticing the present moment, as thoughts are often about the past or the future, but the body is only experiencing what is happening right now (Segal et al., 2013). MiCBT MiCBT was created by Dr. Bruno A. Canyon, a clinical psychologist, based in Australia. Dr. Canyon had been practicing the Buddhist meditation technique of Vipassana and was also EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 37 using CBT with his clients (Cayoun et al., 2018). He experienced profound personal changes from his Vipassana practice, and also saw these changes in others (Cayoun et al., 2018). This led Dr. Canyon to wonder how his clients’ progress might grow from integrating the benefits of Vipassana meditation with the benefits of CBT. MiCBT consists of four stages of progressively integrating mindfulness and CBT into one’s life. The stages start with Intrapersonal Regulation, in which we learn to notice how our mind and nervous system work together to process our interactions with the world. The second stage is Behavioural Regulation. Through the mindful noticing established in the first stage, we can begin to shift our relationship with our mind, our body and the world around us. In the third stage, Interpersonal Regulation, the focus moves to our relationship with others in our lives. The final stage, Transpersonal Regulation, is called the “Empathic Stage”. It teaches relapse¬ prevention skills with a focus on compassion and ethics. The research has shown that “the increased sense of self-worth and empowerment helps prevent relapse into emotional, addictive, and stress-related disorders,” (Cayoun et al., 2018). Spirituality and Clinical Social Work Since beginning my journey in social work, one of my main interests has been in exploring the connection between spirituality and social work. Although mindfulness can be viewed as a secular activity, for thousands of years it has been an integral part of many spiritual practices, including my own spiritual journey. I see mindfulness as contributing to bridging modem mental and emotional therapeutic interventions with ancient spiritual practices. Although social work, for the most part, has its origin in the Christian social movements and charities in the 19th century, incorporation of religion or spirituality into social work has been increasingly frowned upon since that time, with only a renewed interest in this over the past twenty years EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 38 (Cunningham, 2012). This previous shift away from religion and spirituality in social work occurred because efforts to professionalize the field increased and the ethical focus in social work moved to respecting the strengths and beliefs of the individual and away from imposing beliefs and moral judgements onto them. Cunningham also describes how one of the fathers of modem therapy, Albert Ellis, “equated religious or spiritual belief with irrational thought (p.13)”. B.F. Skinner frowned upon religious institutions for, what he considered, their focus on controlling their followers (Cunningham, 2012). Therefore, when those in the helping professions suggest the possibility that a practice, that is used within a religious institution, may have therapeutic value, they are often fighting against the cynicism of the larger therapeutic community. It has benefited service users to have the harmful and narrow judgments that can often come along with organized religion taken out of the practice model; however, spirituality is an integral part of our lives and to try and support people with too sterile an approach, can be too limited and will likely not meet their needs as a whole person (Graham, Coholic, & Coates, 2006: Boynton & Margolin, forthcoming). As our therapeutic models evolve, the line between therapy and spirituality may also evolve and begin to blur, to the benefit of our clients and our society. Supervision and Clinical Social Work Participating in a practicum is an invaluable part of the path to growing and nurturing my clinical social work education. Gaining important experience engaging with clients in one of the key benefits; however, the other, and perhaps more valuable benefit is the opportunity to be under the supervision of an experienced therapist. Clinical supervision offers a structured relationship in which therapists receive support, guidance and valuable feedback (Vallance, 2004). EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 39 Clinical supervision is an opportunity for therapists to refine their therapeutic skills and to learn new skills. Through regular feedback supervisors can help therapists enhance and improve on their current skills and also introduce new skills that the supervisor has found effective. Supervisors can also advise the therapists on approaches that may be helpful with different population of clients. Another area that supervisors can aid with is different ethical approaches to challenging situations and potential ethical dilemmas. Some issues that can be challenging for newer therapists are confidentiality, dual relationships, informed consent, and when mandatory reporting may be required (losim et al., 2022). The experience that supervisors have accumulated can provide important insights and examples which aid in a fuller understanding of this important part of the therapeutic field. Supervision can be very impactful in providing emotional support (losim et al., 2022). This is one area where the supervisor’s years of experience become an immense asset. Having been through so many scenarios they are able to offer the therapist words of encouragement and support that can be invaluable for newer and less experienced therapists. Being new to challenging and complex situations and not having support in dealing with these situations can have a very negative impact on a therapist’s health and well-being. Having a supervisor to share cases with and discuss emotional and physical reactions to those cases can be very beneficial in reducing burnout. Supervision is also an opportunity for self-reflection and personal growth, by giving therapists an opportunity to notice and communicate their biases, reactions, and assumptions, that may interfere with the therapist’s ability to meet their clients with nonjudgmental positive EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 40 regard (losim et al., 2022). It is also an opportunity to recognize their areas of strength, learn how to nurture these strengths, and recognize their areas of growth and how to address these areas. The ultimate benefit of clinical supervision is that it offers a more positive outcome for clients (Vallance, 2004). With all of the benefits that have been outlined, the biggest winner is the client, who benefits from not only the attention and energy of the student therapist, but also the experienced supervising therapist. Group Therapy History of Group Therapy There is not a clear consensus on when group counselling actually started. Some attribute the beginning to Sigmund Freud in 1902 and his famous Wednesday night meetings; however, these were meetings with his students (Barlow et aL, 2012). The first groups that parallel more closely the counselling groups of today can be traced back to 1905, when Dr. John Pratt started facilitating group sessions with his tuberculosis patients. Dr. Pratt called his group sessions “thought control classes”, and it was one of the first examples that group support could improve both physical and emotional well-being (Barlow et al., 2012). Group therapy techniques continued to advance through the first half of the twentieth century. Psychodrama was introduced in 1921 by Jacob Moreno (Riva MA, 2020). The term “group analysis” was brought forward by Trigant Burrow in 1925 (Barlow et al., 2012). Group dynamics theory was developed in 1930 by Kurt Lewin in the 1930s. After World War II, there was a need for treating the large number of soldiers coming back from war with post-traumatic stress disorder (Brabender et al., 2004). The military psychiatrists were overwhelmed with the EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 41 number of patients needing treatment, and looked to group therapy as means to support a larger number of people efficiently and effectively. It was found that the group therapy approach could be just as beneficial as individual therapy for many conditions. Current research continues to support these findings. Recognition of the benefits of group therapy continued to expand over the following decades. It was at this time that the American Group Psychotherapy Association was created to promote the interest in group therapy (AGPA, nd). The world of psychotherapy expanded significantly in the 1960s and 1970s, with the introduction of cognitive behavioral therapy by Aaron Beck and Gestalt therapy by Fritz Peris. The world of group therapy also expanded during this time with the introduction or growth of Psychoanalytic group therapy, Humanistic approaches, Gestalt group therapy, and Behavioral group therapy (Brabender et al., 2004). The group therapy of today has expanded to include a number of new modalities and focuses. Some of the more common contemporary groups are cognitive-behavioral group therapy, dialectical behavior therapy groups, and mindfulness-based stress reduction groups. Other therapy groups have branched off from these groups with specializations in such areas as different forms of addiction, eating disorders, and trauma (Brabender et al., 2004). Some of the key elements that are incorporated into modem groups are: recognition of group dynamics and how to support positive dynamics and reduce negative dynamics, utilizing specific techniques for specific groups and their unique problems, and incorporating different theoretical approaches as needed. Group therapy continues to evolve as our understanding of mental health grows and the needs of society grow. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 42 Benefits and Challenges of Group Therapy There are also a number of benefits to group therapy that may not be available with oneon-one therapy. Some of those benefits are (Corey et al., 2018) • A number of perspectives regarding an issue instead of just the therapist's. • A broader support network in the event that support is needed. • An opportunity to practice new behaviours with the group. • The possibility of the participants realizing that they are not alone in their struggles and instilling a feeling of connection and community. • The possibility of being understood in a way by the other participants, that the therapist may not understand. • Seeing others shared experiences can result in a normalization of their issues and reduced stigma. • Participants can be each others’ role models and leam from each from others' successes and coping strategies. • Seeing other participants’ progress possibly inspiring hope and optimism As much as group therapy has a number of significant benefits, working in groups can come with its challenges (Corey et al., 2018). One of the common difficulties can be vulnerability, with participants feeling too vulnerable to participate due to lack of trust in the group or the process. This can have a negative impact on the effectiveness of the group. Another challenge in groups can be confidentiality, as keeping what is shared in the group confidential and within the group can be difficult. It can keep participants from fully engaging in the group. It can also be quite disastrous for the group if someone’s trust is betrayed. Clashing personalities EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 43 within the group or strong aggressive personalities in the group can dominate the focus of the group’s energy. It can also lead to other participants not having an opportunity to share or censoring their share to conform to the other personalities. Another challenge is that the pace of the group may not meet the needs of all the participants. The group may be moving at too slow a pace for some members and too fast of a pace for others. This may lead to frustration and a desire to leave the group for some participants. Triggering topics of discussion can also be challenging in groups and some issues shared by participants may trigger and cause distress to other members. This could cause the triggered participants to retract from involvement in the group. It could also cause the person who was sharing the issue to also withdraw from sharing more with the group. Although group therapy is proven to be as effective as individual therapy it does not have the same level of one-on-one attention as individual therapy, and some participants may need this level of attention at a certain point in their healing journey. This may lead to these participants dominating the sharing in the group or them feeling quite frustrated that their needs are not being met. Although the challenges mentioned above can be significant and have a negative impact on the success of the group, group facilitators can play an important role in addressing these challenges when they arise and hopefully before they arise. They can do this by setting clear ground rules regarding confidentiality and participant engagement. Fostering an inclusive, non¬ judgemental environment can assist in participants feeling more comfortable in the group. The facilitator may also need to play an engaged role to balance the level of sharing from each participant in the group. Even with these potential pitfalls, research has shown that group therapy has the potential to be a very effective form of therapy for healing and emotional well-being. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 44 Stages of Group Process Groups will typically go through specific stages through the duration of the group (Corey et aL, 2018). Group leaders and members can navigate the therapeutic process effectively if they understand and are aware of these stages. It is helpful to keep in mind that these stages are not always linear, and some stages may repeat may reoccur even after the next stage has occurred. For example, a group that has moved into the “working” stage may reenter the “transition” stage if a new topic of discussion is introduced. These stages are: 1. Formation or Initial Stage - This is the stage when the groundwork and ground rules of the group are established, and the trust is developed between the participants and with the facilitator. The group leader’s role is to explicitly create a safe and structured environment. 2. Transition Stage - In this stage participants are working through any resistance they may have to being in the group. This is done through exploring their feelings and determining how much trust they have within the group and how safe they feel. This is also the stage when group members may begin to confront each other and work through conflicts and is therefore often referred to as the “storming” stage. The group leader’s role in this stage is to help the group through any resistance and to encourage engagement and honesty. 3. Working Stage (Productivity and Exploration) - As the name implies, this the stage when the group focus on goals and progress is at its height. This occurs as the group members are feeling more comfortable in the group, leading to an increased level of self-disclosure and willingness to take risks. At this stage the leader can take a less EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 45 directive role and allow the members to take a more engaged role in the process and flow of the group. 4. Consolidation and Termination Stage -The ending stage is when the focus of the group is on summarizing and integrating the learnings achieved in the group going forward. There is also a focus on the feelings of the group about the group ending and what future supports might look like to replace the support of the group. The leader’s role is acknowledging any feelings related to endings and supporting members in planning for the future beyond the group. Clinical Skills for Group Facilitation As group therapy is still therapy, all the clinical skills required of an individual therapist are still required in a group setting. There are, however, skills required and specific to working with groups that are not necessarily needed in individual sessions (Corey et al., 2018). Some of the clinical skills needed in both forms of therapy are: active listening, authenticity, empathy, and non-judgmental positive regard. Some clinical skills that are specific to working with groups can be considered leadership and management skills, such as being able to set boundaries for the group to follow and also being able to firmly, but gently maintain those boundaries. This group of skills also revolves around resolving conflict among participants and encouraging members to participate. Another group of skills could be grouped into awareness of process, which includes being educated in the stages of group development, to better understand how to approach each stage with the group, and also being aware of the interpersonal relations between members. This awareness also extends to the content and ensuring that the focus of the group stays on the group topic. Another EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 46 important skill is that of flexibility and adaptability, as working with multiple participants requires an ability to adapt that can be more challenging than working with only one individual. Chapter 5 - Working with Groups In this chapter I share my experiences facilitating groups during my practicum at HML Wellness Solutions. My Experience with Groups this Practicum Over the course of my practicum with HML Wellness Solutions, I facilitated two MBCT groups. This was my first experience facilitating a group on my own. It was a rewarding experience with unique challenges and learning opportunities. The format of the group was quite unique as I was located remotely, either in Hope or on Salt Spring Island. One participant was logging in remotely from their home in Prince George, and the remainder of the group were together at the CMHA clubhouse in downtown Prince George. With the bulk of the participants attending the group in one of the common rooms at the clubhouse, a laptop was set up at the front of the room to serve as the camera so we online could see that group. A large screen was also set up so that they could see me and the other participant, and a microphone was placed on a table in the middle of the room. I facilitated two MBCT groups for 1 6 weeks. There were five participants in the first group and four in the second group. Before the group started, I met with each of the participants over the phone, as is prescribed in the MBCT program. This preliminary meeting with participants originated from the mindfulness-based stress reduction (MBSR) program created by Jon Kabat-Zin (MCCR, 2024). Research has shown that meeting participants individually prior to the start of the program can enhance the benefits from their involvement (Kocovski et al., 2013) EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 47 All the groups sessions that I had trained with had been in person. I had no experience with how to facilitate such a group online. Prior to the first class, I created my agenda for the two-hour session, allocating a specific time for each activity. I learned quite quickly that I was going to have to make adjustments to the agenda. I needed to reduce the time allocated for sharing due to the number of participants in the group being only five, as the groups I was trained in had all been full, with twelve participants. I also needed to adjust the time allocated for meditation exercises, as it was clear, not all of the participants in this group had the capacity to endure a 3O-minute body-scan meditation. It also became clear quite soon into the first group that it was going to be challenging to monitor each of the participants and assess how they are doing with the meditations. My only portal into the large group at the clubhouse was a small four inch by four-inch screen on my laptop screen, and in that screen the participants were about ten feet from the camera. I was used to sitting in a circle of chairs with the twelve participants and my supervisor. I realized that this was going to be an adjustment. In hindsight, I do not think I was able to monitor each of the participants as well I would have been able to in person, sitting in a circle. I do not know the impact that this had on the overall experience of each of the participants. This would have been a good question for a survey at the end of the session or end of the program. I was very nervous at the beginning of the first session. This was my first solo group session, and I was afraid that it would not go well and that the participants would not like it. I did my best to just meet those thoughts with mindfulness and equanimity and carry on with my agenda. After the first session I adjusted my agenda. It went from a two-hour class to closer to an hour and a half. I assessed that the participants were struggling to do a meditation for longer than 15 minutes, and I also found that because there were half as many participants as I was used to it EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 48 took much less time for discussions. There was definitely a range of engagement from the participants. Even the concept of just watching or noticing our thoughts, without engaging with them was quite foreign to some of the participants. I am not sure if some of the participants were actually ever able to grasp the possibility of it during the program. As is usual with all the groups that I have been a part of, the completion of the weekly home exercises was quite sporadic. I can completely understand the challenge to introducing a new daily habit and especially one as abstract as meditation. It is unfortunate however that it is so challenging to do the home exercises between class sessions, as research has shown that it significantly increases the benefits that can be gained from the program (Crane et al., 2014). There were some interesting moments during the sessions that were like waves that I felt like I just needed to ride out, along with the participants. One of these situations was when a student, who was doing a placement at the Connections clubhouse, sat in on the class. We had just finished an exercise and I invited feedback from the participants. The student shared their thoughts about depression and what they thought an individual should do if they were experiencing depression. One of the participants disagreed with them and thought that what they shared was one-dimensional and too simplistic. The student then turned to me and asked me what I thought. I sat with her question for a moment and then I told her that I had never experienced deep depression, and that I would defer the question to anyone in the group that had experienced it. The participant that disagreed with her previously put up her hand and wanted to answer her question. I think it was a wonderful teaching moment in which one person was sharing with another person their lived experience of a situation, to contradict the other person’s idea that was probably something that they had heard or read about. This was a real-world EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 49 example for me of one of the benefits of group therapy, the group members educating and supporting each other, and me just getting out of the way. There were moments during the sessions that were challenging for my ego and my sense of being a good teacher or guide. The hardest times were when people would let me know they were not coming or just did not show up at all. My thoughts would quickly go to doubts about the program and wondering if I had been better at facilitating the group and had better content, or been more engaging, people would have continued coming to the class. Doubtful thoughts about my skills would also arise when I would invite participants to talk about their experiences after an exercise. When there was very little feedback, I would notice thoughts about my facilitation skills. Thoughts such as, they did not have anything to share about the exercise because they did not enjoy it and it was not very helpful. It was not lost on me that to stay focused on the task of teaching, I needed to use the very mindfulness skills I was teaching the participants. It is a very interesting experience to be teaching a skill to others and using that skill personally at the same time. I would often share this experience with the class when I wanted an example of the benefits of mindfulness. I also found it useful to share this experience in order to illustrate to the participants that after many years of practice I still have negative thoughts, and that there is not some point when negative thoughts just stop coming. This is a very common misconception about mindfulness -that if negative thoughts are still arising, I must be doing something wrong (Segal et al., 2013). I find that any opportunity that I have to dispel common misconceptions can be very helpful for students. Preconceived ideas about what mindfulness is about and how they should be progressing in their practice can be powerful barriers to a student's progress. Whenever those incorrect unsupportive ideas can be let go, it is very helpful. Group work can be especially helpful for dispelling these misconceptions, because if one person in the group questions the EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 50 misconception and sees through it and then shares it with the group, it is more easily accepted than if I point it out to the group. As much as there were challenges, there were also a number of moments when it felt like it was all worth the time and energy, such as when the participants would share some wonderful insights. One example was when one of the participants shared with me how profound the idea that “thoughts are not facts” was to them. This is the theme of one of the weekly sessions. It is based on the misconception that so many of us have that if we have a thought, it must be true. An example of this is if a student has the thought “I am horrible at this mindfulness stuff, I’ll never get it, I am just wasting my time”. If this thought is taken as a fact, it can create anxiety regarding a person’s capabilities and their choice of spending their time trying to learn something that they will never learn. In addition, believing this thought can reinforce previous thoughts and reinforce old patterns of self-criticism and negative self-talk. The participant shared that this idea was a game-changer for them. They said that they were very surprised that they had lived 50 years and had never heard this idea, that thoughts were not facts. I also received positive feedback from the participants at times. One example was an email from a participant who had to withdraw from the program: “Sorry, but for personal reasons I won’t be returning, it’s a shame I was getting so much out of this program, if you plan on teaching this class again through Connections, I would love to give it another go!! Thank you for everything you’ve been great.” This was very nice to hear as at times it is difficult to assess whether a person is experiencing benefits from the program. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 51 In these group sessions, I experienced the challenge of balancing individual needs with the collective needs of the group. I learned the importance of pacing and adjusting to the group dynamic. I tried to offer an inclusive and supportive environment. It was a wonderful learning experience, and I am grateful to the participants who were courageous enough to join me on the eight week journey and to the staff at the CMHA connections centre who were also courageous in allowing me to facilitate the group with their clientele. Chapter 6 - Working with Individuals In this chapter, I reflect on my time working with clients one-on-one. I will give examples of specific client interactions, challenges, and personal learning experiences that shaped my practicum. It includes case studies illustrating the therapeutic process, as well as the challenges and rewards of teaching MBCT to some of the clients. I will also reflect on the support and feedback that I received from my practicum supervisor Tracy, and how it supported me in some specific cases. During my time at HML Wellness Solutions, I primarily was assigned clients through the partnership that HML had with the local CMHA organization in Prince George. As I did not have an MSW degree, clients who see me cannot claim their visit with their insurance company. Therefore, clients that were wanting to have their fees paid by insurance companies did not want to work with me. It was also quite common that clients did not want to work with a practicum student, or wanted to work with someone in person and did not want to work virtually. The partnership between HML and CMHA was a contract arrangement in which therapists from HML would work with clients of CMHA up to a prearranged number of billable hours per month. The maximum number of clients I ever had in one week was three. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 52 I found that working with clients during my practicum at HML Wellness Solutions was different from any other experience that I have had working with clients. In all of my past experiences working with clients, they have had a pretty good idea of what my approach with clients was, specifically mindfulness. With the clients from CMHA, they were not connecting with me with the intention of learning how to incorporate mindfulness into their lives, they were coming for a number of different reasons. This difference required me to change my approach with clients. I had to let go of any agenda I might have and just be completely open to where each client was at. With some clients, after a few sessions, it was clear that they wanted to make some changes in their life, and I introduced the possibility of learning MBCT. However, some clients did not state that they wanted to change anything, and it took me some time to realize that they just wanted someone to talk to. With one client that I connected with weekly for months, we would literally just talk about their week, their relationship, and their work. This really challenged my self-assessment of how I was doing as a counsellor. It felt like I was falling short in my role as a counsellor with so passive an involvement with a client. This shifted for me during one session. This client had lost their daughter a few years ago and regularly attended a support group for parents of children who have died of drug overdose. The client would often go to this group on the same day of our weekly call. During one session I asked him if he had gone to the support group the previous week. He shared with me that after our call that week he did not feel like he needed to go to the meeting. This surprised me. It did not seem like we were doing anything in our sessions; however, there must have been something going on if our session replaced their need to go to a support group. When I shared this experience with my practicum committee at our mid-practicum meeting, my academic supervisor, Dr. Indrani Margolin, commented that I was “supporting people through relationship”. I have considered this EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 53 description since I heard it in July. Carl Rogers speaks a lot about supporting people through relationship. The realization he came to was that he did not have to do anything with a client. All he had to do was to provide a loving, supporting relationship and the person would discover within themselves the capacity to use that relationship to grow and heal (Rogers C. R., 1995). As I have pointed out earlier, I definitely resonate with Carl Roger’s perspective and aspire to support people as he did. There was another client that 1 worked with quite consistently, and they were my first client. We worked regularly on a weekly basis for most of my time at my practicum. They came to me through a referral from their support worker at CMHA. It was not their idea, so they had no agenda and no idea what they wanted to do. One thing was clear was that they were not very happy with their life, and so I presented MBCT to them as an option. As they had no agenda, they were open to giving it a try. We started the eight-week program together the next week. This was my first time doing the MBCT one-on-one with a client. I had to revise a two-hour group session into a 50-minute individual session. As is quite common, the client struggled with doing the weekly, at-home exercises between sessions. We worked on adapting the exercises to make his mind less averse to doing them. This was not very successful. I felt okay about the session, as I thought we were covering some good mindfulness and CBT theory and they were being introduced to some new and potentially life changing ideas. We were also doing guided meditations at each session. I was not bothered that they were not completing the home exercises, but the client was. They were concerned that they were wasting my time, as they were not living up to their commitments. When they would express this in the sessions, I would use it as a lesson to practice mindfulness. At one point we were exploring how the sessions were going for them. They commented that they were practicing during the guided meditations in the EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 54 sessions, and so they requested that we meet twice a week instead of once a week. I agreed and we did this for a few weeks, and for some reason this did not last. We had stopped doing the program at one point and the client requested that we start it again. This surprised me as they continued to have very little agenda throughout our time together. We had started the program as they requested and then before one of our usual sessions, they called the office and said they would no longer be attending our sessions. They had not been keeping up with the weekly exercises, and my assumption was that the feeling of wasting my time had overcome his desire to keep meeting. I feel like I learned a great deal from working with this client. Of course, as with all clients, I learned to let go of focusing on outcomes. I learned how to do a one-on-one MBCT session, and how to adapt the material continuously to meet the client’s needs. I learned about listening and noticing where the client was at, as there were times that we spent most of the session just talking about the client’s week and did very little of the MBCT program. Every session was a mystery as to what we would be doing, based on what the client was needing. I also learned how to allow the client to have their own experience. By this I mean there were times when I wanted so much for the client to see their self-worth and their potential, and to shift out of their sadness and self-criticism, but when I noticed this arising, I would allow it to be there and instead meet the client where they were at. I gained a deeper understanding and appreciation for Carl Rogers’ client-centered approach, particularly its core principles. The first principle is genuineness and authenticity. An example of this occurred with a client who shared their struggles with completing the weekly exercises. I related to them by EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 55 sharing my own difficulties when I first learned the program. This seemed to shift their perspective, reducing their negative self-judgments and lifting their mood. The client expressed appreciation for knowing that I, too, faced challenges. This experience helped highlight for me the importance of authenticity in building rapport and fostering trust. The impact of the second principle, unconditional positive regard, became apparent during a session with a client who began the session confessing that they had treated someone harshly and with anger. I just responded by saying, “It sounds like you were really angry. Sometimes that kind of energy just comes up and it seems like if you had your choice, you would not have treated them that way.” I immediately noticed a change in their body language; they seemed to relax, and their demeanor became more open. This was a meaningful moment for me and strengthened my resolve to always hold clients in the best light. The third principle, empathy, was something I practiced regularly in sessions. The more I practiced empathy, the more I realized how healing it can be for a client to feel truly understood, and in some cases, that alone was enough to shift their experience. Although I occasionally felt tempted to offer guidance, I reminded myself to just notice this impulse and not act on it. Carl Rogers’ client-centered approach really resonates with me, and I appreciate the emphasis on the relationship with the client and allowing healing and change to happen naturally instead of trying to make it happen through doing. By focusing on being real, showing acceptance without judgement, and practicing empathy, I have seen how powerful it can be to create a space where clients feel safe, supported and understood. These experiences have reinforced how important it is to build genuine connections and let clients find their own way EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 56 toward growth. As I keep learning, I’m excited to keep developing these skills and using them to foster a supportive and impactful space for others. Handling Challenges There were some challenges I encountered working with clients during my practicum. One was managing a client load during my practicum and continuing to work at my full-time occupation while trying to fit in clients. There was a time when I was managing three different calendars: my personal calendar, my work calendar, and my client calendar. There were definitely a couple of times when I got my dates confused, and I had to contact the administrator at the HML office and apologize and have them reschedule. Another challenge was that clients that did not answer their phones when it was time for our appointment. As all of my clients were from CMHA, some had difficulty remembering that we had a session, or just did not have access to their phones at that time. With one of the clients, my practicum supervisor Tracy would tell me to just call them at random times to check in and see how they were doing. She said this was not standard procedure, but she had worked with this client previously and she would make an exception for them. This was a real challenge for me as I really do not like bothering people, and I felt that this would be a bother. However, I needed the hours and trusted Tracy and so would rein in my resistance and call them. During one session with this client, I realized how far off my assumptions and fears were. The client shared that they appreciated how we did not give up on them. What I was sure was a bother to the client, was actually quite supportive as a demonstration of care and consistency. This was very heartwarming for me, as I knew some of this client’s history and I knew that many people and organizations had given up on them in their life. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 57 I ran into another area of resistance during my time working with clients. My practicum supervisor Tracy had introduced me to a method called TEAM-CBT. TEAM-CBT is a new framework for using CBT with clients. TEAM is an acronym for Testing, Empathy, AgendaSetting, and Methods (Feeling Good Institute, 2023). The key part of TEAM-CBT that Tracy introduced me to was the testing piece. The idea is that traditionally therapists have relied on their assumptions about how a session went and would allow those assumptions to influence future sessions. Research has shown that these assumptions are not always correct, and that we owe it to our clients to have them assess each session so that we are not relying on our assumptions. By scoring each session we get a much more accurate idea of how the session went for the client and what we might need to adjust with our sessions in order to better meet the needs of our clients. The challenge for me was not that I disagreed with having clients do the assessments. It actually made a great deal of sense to me. My challenge was that I had an aversion to asking the clients to do the assessments. I did give the assessment to one client once and that was the one and only time. Again, I feel that this aversion is related to my not wanting to bother people. I do not want to bother the client with constant paperwork. This is one area in which I would like to make progress going forward. I would like to be more comfortable with asking my clients to assess their sessions on a regular basis as assessments are a very valuable and informative tool. Each client needed a different form of support, from supportive guidance to simply having someone to talk with. Some clients needed support around managing their lives, processing emotions, or simply having a meaningful conversation. The experience during my practicum taught me to adjust my responses according to the client’s needs in each session, and to be aware of when they needed empathy, structure, or connection. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 58 Chapter 7 - Implications for Future Social Work Practice Prioritizing the Client’s Voice and Nurturing a Strong Therapeutic Alliance Whether my future rests in clinical social work or in doing social work in the field, respecting my clients’ autonomy and individuality needs to remain paramount in my approach. Working with clients both individually and in groups during my practicum, it was clear how much we as citizens rely on the supports of our social programs. It was also clear how supported the clients felt when those social programs respected their individuality and how unheard and unserved, they felt when it was not respected. As I continue in my social work practice, I plan to continually assess and adapt to each client’s unique needs, striving for them to feel empowered and heard throughout the therapeutic process with me. One of the tools for doing so could be using the session assessment tool from TEAM CBT, that was introduced to me during my practicum. This would be one tool to help me incorporate client feedback and help me refine my interventions and our sessions together. I hope that this more active and collaborative client engagement will help to nurture a stronger therapeutic alliance with the people I work with. Working with clients at HML Wellness Solutions affirmed for me how critical trust and rapport are in building such an alliance and I plan to continue to focus on creating safe, empathetic spaces where clients feel comfortable exploring their challenges and strengths. Mindfulness and Social Work Beyond using MBCT and MiCBT as mindfulness-based interventions, I plan to explore the broader benefits of mindfulness within social work practice. The principles of mindfulness, such as being present in the moment, being non-judgmental and accepting, and fostering compassion, patience, trust and gratitude are core to the practice of social work (Segal et al., EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 59 2013). Some of the ways that I would like to bring mindfulness into social work, are through psychoeducational workshops with clients and social workers. I would also like to explore culturally sensitive ways to tailor mindfulness to diverse populations with different cultural backgrounds, beliefs, or experiences. Expanding Group Facilitation Skills Facilitating groups during my practicum highlighted the transformative power of shared experiences in a therapeutic setting. I would like to continue facilitating groups and also further my education in group facilitation skills. I hope that the continued experience and education will support me in creating environments that foster connection, mutual support, and shared learning. Conclusion As I reflect on my journey through my practicum placement at HML Wellness Solutions it is clear that it was not just about applying the knowledge I had gained in my MSW program, it was also about bringing together my life experiences, my therapeutic studies outside of UNBC, and my passion for mindfulness and clinical social work. Adapting to each client’s unique needs, building rapport through remote sessions, and leading mindfulness-based cognitive therapy (MBCT) groups were all opportunities to grow. The guidance and support I received from my practicum supervisors were invaluable. Tracy taught me a great deal about the nuances of working with clients and her insights helped shape my practice and my approach with those clients. Our regular conversations in which she shared her experience with me helped me to trust in the process and our work with others. My EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 60 conversations with Tracy and Cindy reminded me of the value of connecting with guides and peers and not working in isolation. This experience has also deepened my commitment to mindfulness as a therapeutic tool. In addition to being a very effective modality, it is also a way of helping me be present with my clients and able to offer them a space of acceptance and nonjudgmental support. I continue to be amazed by how something that has been a passion of mine and so instrumental in my well-being is also a resource that I can pass onto others in my clinical practice. Although the journey has been a wonderful learning experience, it was also marked by challenges that required flexibility and a willingness to adapt. Some of those challenges included the need to revise my approach during group sessions, navigating the complex interactions with clients, and balancing the demands of my own life outside of the practicum. This experience has left me with new skills and knowledge and a deeper understanding of what it means to support others on their path to healing. It has affirmed my belief in the power of just being present with a person with empathy and the potential for growth in every human being. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 61 References AGPA. (nd). Fifty Years of AGPA 1942-1992: An Overview. 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Annals of the New York Academy of Sciences, 821(1), 99-113. Vlaicu, A. (2022). The philosophical counsellor and unconditional positive regard. International Journal of Philosophical Practice 8:1, 65-79. Wilkins, P. (2000). Unconditional positive regard reconsidered. British Journal of Guidance & Counselling, 28:1, 23-36. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 68 Appendix A - First Session Assessment HML wellness solutions 1652 Ogihne Street S., Prince George. DC VZM 1W9 phone 236-423-0077 Far ’50-277-4857 First Session Assessment Presenting Problem(s), precipitating event(s), history of current problems(s), exceptions to problem(s): Current Functioning: Other Stressors: Coping and Resources: Psychosocial and Family Situation: Employee Situation & Work Related:) i 69 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK HML wellness solutions U32 Opiww Pnraa Gaoqp, K V2M 1W9 rhone ?W-<2 1-0077 f«x 250 277 Ml? Is the employee 'plan member) on any form of disability'1 Previous Counselling Therapy: Mental and Physical Status: Sleep Patterns Appetite Current Mood (Administer Bnef Mood Survey): Memory- Concentration Suicide Ideation Attempts (previous current1 Medical problems Concerns Substance Use: - akobol (did you administer AUDIT?) 2 70 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK HML wellness solutions IMlOphMMrvvt^PnnccCaorp, K V2M 1WV Pbo«w 2J«-*2S 0077 1*1 250 277 *«37 - marijuana - prescription medication - illicit drugs Have you ever tried to cut dcivn on any of your alcohol drug use? Has anyone ever expressed concern over your alcohol drug use'1 Have you ever felt bad or guilts- about your alcohol drug use? Have you ever used to get over hangover aftereffects of use? If any substance use concerns are identified, please use the screening tool ASSIST to do further evaluation Current Risks Identified: 0 Nonappbcable 0 Abuse Neglect 0 Aggressive Behaviour [] Job Loss 0 Substance Use 0 Suicidal Ideation Level of Risk: 0 Not applicable 0 Low [] Moderate 0 Moderate-High 0 High 0 Imminent Relevant Details: 3 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 71 HML wellness solutions MS2 Ortv» Strwt V, Prine. phone zM-azs-aon f «■ '** Safety Plan (if necessary): Clinical Impressions and Notes: Goals for Counselling: Treatment Plan: Homework: 4 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 72 Appendix B - MBCT Class Flyer Mindfulness Based Cognitive Therapy (MBCT) 8 Week Course • Stress Reduction - practice stress reduction techniques to mitigate impact of daily stressors and improve resilience • Improved emotional regulation - develop emotional awareness and ways to respond • Prevention in relapse of depression - recognize and respond to early signs of depression to interrupt patterns • Enhanced focus and concentration - stay present and engaged with the task at hand Through the practice of mindful awareness, participants develop the capacity to relate differently to distressing moods and negative thoughts by strengthening an orientation to the present moment. 8 Week Online Course Our instructor. Shawn Venne, BSW. RSW. has over 30 years Pay What You Can experience in mindfulness and self-exploration. Shawn has a 16 hours of instruction unique ability' to help others face their challenges, and to Tuesday evenings. Mar 5 - Apr 23 provide guidance and insight that can be life changing. 6pm to 8pm EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK Appendix C - MBCT Interview Template MBCT Individual Interview Template Name Date • Welcome • Confidentiality • What brought you to be interested in this program? o Previous experience with mindfulness? o Previous experience with CBT’ • History of MBCT O o MBSR & Jon Kabat-Zinn Early 90's & Depression relapse • Group Process/lntention O Shinning a light on our habitual pattern of mind o Continual theme of shifting from ’doing" to "being" Gradual process - Planting the seed 1 session per week x 8 weeks (2 hrs per session) (possibly one full day] Practice each day (approximately 1 hour per day) A place to practice meditation at home? O o o o o o Access to recordings’ Questions? • Exclusion Criteria o Suicidal thoughts/ideations? o Substance use that might interfere with the participating in the program? o History of Trauma? Someone to work with regarding trauma if it arises? • Conclusion o • Go over handouts Next Steps o Payment to hold a spot Final Questions? 73 EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK 74 Appendix D - MBCT Session 1 Agenda SESSION 1 - Agenda THEME On automatic pilot, it is easy to drift unawares into "doing" mode and the ruminative thought patterns that can tip us back into depression. Habitual doing mode also robs us of our potential for living life more fully. We can transform our experience by intentionally paying attention to it in particular ways. We begin to practice stepping out of automatic pilot by paying attention intentionally, mindfully, to eating, to the sensations of the body, and to aspects of everyday experience. AGENDA • Establish the orientation of the class. • Set ground rules regarding confidentiality and privacy. • Ask participants to pair up and introduce themselves to each other, then to the group as a whole, giving their first names and, if they wish, saying what they hope to get out of the program. • The raisin exercise. • Feedback and discussion of the raisin exercise. • Body scan practice-starting with a short breath focus. • Feedback and discussion of body scan. • Home practice assignment: O Body scan for 6 out of 7 days. O Mindfulness of a routine activity. • Distribute audio files (via CD, flash drive, or URL) and Session 1 participant handouts (including the Home Practice Record form). • Discuss in pairs: O Timing for home practice. O What obstacles may arise. O How to deal with them. End the class with a short, 2- to 3-minute focus on the breath. EXPLORING MINDFULNESS IN CLINICAL SOCIAL WORK Appendix E - Last Class Reflection Questions REFLECTION EXERCISE • Why did you come originally to the class? • What were your expectations? • What did you want/hope for? • What did you get out of coming, if anything? • What did you learn? • What is most important to me in my life (what do I most value) that this practice might help with? • What are your biggest blocks/obstacles to continuing? • What strategies might help you not get stuck? 75