Tending the Field of Mindfulness-Based Programs: The Development of International Integrity Guidelines for Teachers and Teacher Training.

Since Jon Kabat-Zinn first introduced a contemporary, secularized application of mindfulness for the relief of pain and stress in physical health-care settings, there has been a significant and rapid expansion of the range of mindfulness-based programs (MBPs) designed for various health care, education, workplace, and other settings. As is common with developing programs, these often run ahead of carefully considered and researched effectiveness evaluations. This raises questions of how to best train mindfulness teachers to skillfully facilitate such interventions while minimizing the potential for harm. In this article, we describe the work of an international group of senior teacher trainers who met to develop guidelines on the ethics and standards for teacher trainers and their training pathways. In this article, we will define MBPs; describe the process by which these international guidelines were developed; and share details of the collaborative team who made up the international network that worked on them. We offer these guidelines as "living documents" that specifically set out: (1) ethical standards for mindfulness teachers and trainers; (2) criteria and standards for teacher trainers; and (3) criteria and standards for training pathways. As "living documents," these will continue to be commented on and refined over time. Given that MBPs offered within secular settings in most countries currently have limited oversight or accreditation processes, we hope these guidelines will provide support and clarity to the teachers of all established and emerging MBPs, and their trainers and supervisors.

Introduction

We are at a critical moment in the development of mindfulness-based programs (MBPs)[1] and indeed the role of mindfulness in wider society. Since the first Western applications of mindfulness in medicine and health care offered in the format of Mindfulness-Based Stress Reduction,[2] there has been an exponential rise in the number of trainings, programs, and adaptations in what was once a rather sparse field. This is very good news: providing more innovative and evidenced-based programs by trained teachers that contribute to a deeper understanding of mindfulness in the public domain. However, we are also seeing the influence of the marketplace on this field, giving rise to a proliferation of quick-fix courses and techniques offered by often minimally trained teachers. Furthermore, recent research findings are demonstrating that there can be unwanted effects from meditation practice that require both skillful handling[3],[4] and further investigation.[5]

At this critical juncture in the teaching and training of MBPs, we are faced with the need for careful and caring scrutiny of the quality of all existing and newer mindfulness-based programs, the training and preparation of the teachers, and the impact of the many and varied mindfulness courses being offered. The intention of these guidelines is to ensure that teachers are consistent across all MBPs in offering their participants mindfully embodied presence along with appropriate skills and frameworks that support human growth and flourishing with the potential for healing and transformation. We also wish to guide the ways in which teachers advertise, offer, and fund their programs to ensure they are grounded in ethical considerations that are committed to integrity, transparency, openness, relational responsibility, and clarity around limitations, while recognizing the needs we have for viable livelihoods. The thoroughness and robustness of mindfulness-based program teacher training demand a unique commitment and cost. Like other professions, there are skills and competencies that are taught and evaluated. However, one of the central requirements of teacher training integrity is having a personal meditation practice, which is a much more difficult element to assess. It is especially hard to assess how this practice translates into an individual’s embodied expression within the teaching, although much work has been done to develop tools that can evaluate this for the purposes of training and research fidelity.[6-8]

There is now a range of published articles on mindfulness teacher training pathways[9-14] as well as preliminary attempts to correlate teacher training pathways with MBP outcomes.[15],[16] This body of literature needs to be widened to include evolving mindfulness-based courses and will be usefully informed by articles which lay out principles for assessing intervention integrity such as those by Crane and Hecht,[7] and Crane.[10]

Therefore, with this rush of emergent programs and training pathways, it is timely to formally articulate and disseminate the training standards and criteria that have been developed over the past forty years for the most researched programs, namely, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT). These standards and criteria will be articulated in this article to provide a foundation for ongoing dialogue and to offer a potential framework for all trainings in all MBPs. We will also describe what we mean by mindfulness-based programs; the process by which these international guidelines were developed; and who made up the international network of senior international teacher trainers who worked on them. We offer the guidelines as “living documents” that specifically set out (1) ethical standards for MBP teachers and trainers, (2) criteria and standards for teacher trainers, and (3) criteria and standards for training pathways.

As the MBPs currently offered in secular settings in most countries have limited oversight and/or accreditation, we hope these guidelines will provide guidance and clarity for all current and emergent programs and teachers. Aspiring to best practices, and committing to a sense of integrity and quality, will assist a cooperative effort toward disciplined growth and healthy maturation of this nascent field.

Defining Our Terms: Mindfulness and Mindfulness-Based Programs

For the definition of mindfulness, the authors refer to Kabat-Zinn’s operational definition[1] of mindfulness as “… the awareness arising through paying attention on purpose in the present moment ...non-judgmentally … in the service … of self-understanding, wisdom, and compassion.”[17]

We see the evidenced-based MBPs, specifically MBSR and MBCT, as the application and recontexualization of the concept of mindfulness found in the teachings and practices from Buddhist traditions as a “lived universal dharma”[18] within a secular framework of experiential education which involves and also goes beyond the meditative practices, both in and out of the classroom. This secular application of mindfulness is interwoven with theoretical rationales drawn from such fields as science, medicine, psychology, and education and attempts to address the causal and maintaining factors of human distress and suffering as they manifest in a range of modern-day contexts. It includes a significant immersion in daily formal and informal mindfulness meditation practice supported by inquiry and class discussion led by the teacher; it is a lively investigation of what occurs when we change our relationship to the present moment, and to that of our physical, cognitive, and affective processes with an attitude of curiosity, interest, kindness, and acceptance. The content, process, and teacher requirements for MBPs have been laid out in a seminal article by Crane et al.[19]

The following table lays out the essential and flexible elements of MBPs, which will greatly inform our capacity to evaluate various offerings and their related training pathways.

How These Guidelines Were Developed and by Whom

The intention to create guidelines for teachers and teacher training pathways that would support the ongoing integrity of MBP teacher training was formed following 5 separate international meetings held in the United States and Europe, attended by recognized leaders and teachers in the field, all engaged in the teaching and training of teachers in evidence-based 8-week MBPs, most typically, MBSR and MBCT.

Such representation from various established Mindfulness-Based Teacher Training Organizations (MTTOs) and/or regional Teachers’ Associations around the globe allowed a compelling inquiry into creating coherence in this field, especially given the various practical, contextual, and logistical realities faced in different countries and regions. This inquiry was informed by the attendees’ long and rich experiences of teaching, training, and supervising others in MBSR and MBCT, as well as their long-term personal meditation and retreat experiences, and provided much of the groundwork for developing the guidelines described later in this article.

This led to a multinational meeting in 2015 in the United Kingdom, now also including the Asia Pacific and South African networks, that reached a clear consensus that the development of a collaborative international network was needed by grassroots teacher and trainers alike to ensure the ongoing integrity of MBP teacher training.

From this 2015 international meeting, the vision and mission for this initiative was developed. These were preliminarily agreed to, as described as follows:From this meeting, 2 groups emerged. The first was a Steering Group of well-respected senior teacher trainers in the field, referred to as the Midwives, who would support the ‘birthing’ of this new collaborative network. This group consisted of Tim Burnett (Director, Mindfulness NW, USA), Rebecca Crane (Director, Centre for Mindfulness Research and Practice, UK), Linda Lehrhaupt (Director, Institute for Mindfulness-Based Approaches, Germany), Dawn McDonald (Senior Teacher, Institute for Mindful Leadership, Canada), Florence Meleo-Meyer (Director of Training, Center for Mindfulness in Medicine, Healthcare and Society, UMass Medical School, USA), and Camilla Skjöld (Founder, Centre for Mindfulness, Sweden).

Vision

Our vision is to support teachers and trainers in maintaining the integrity of mindfulness-based programs that are grounded in awareness, compassion and wisdom upheld by an interconnected, diverse and global network dedicated to promoting health, well-being and ease for the benefit of all beings.

Mission

An international collaborative network of mindfulness-based teacher training organizations committed to maintaining integrity and upholding training standards of mindfulness-based programs supporting transformative inner work that allows all beings to flourish in our diverse world through the practice of mindfulness.

The Steering Group then established a second group, the Transitional Working Party (TWP), to begin the work of (1) collating, articulating, and disseminating the guidelines for ethical standards and criteria for MBP teachers, teacher trainers, and training pathways; and (2) considering guidelines on structure and governance for such an international grouping.

The TWP members were nominated by the Steering Group based on the criteria below and were drawn from representatives of MTTOs and regional Teachers’ Associations from around the world representing most, but not all, geographical regions. It comprised 2 co-chairs, Günter Hudasch (Germany) and Maura Kenny (Asia Pacific), plus Allan Goldstein (USA, West Coast), Lot Heijke (Holland), Lynn Koerbel (USA, East Coast), Patricia Lück (South Africa), Catherine Phillips (Canada), and Taravajra (UK).

Eligibility Criteria for the TWP

Despite the recognition and acknowledgement that there were still many regions underrepresented at this time, the geographical spread of the teacher training organizations was felt to be broad enough to begin the work.

Seniority of at least 5 years’ experience as a teacher trainer within an established MTTO or other closely related MBP teacher training organization.

Representation of both their own training organization and the region within which they worked and were well respected, well networked, and well trusted within their wider community.

Knowledge of local and regional training organizations—to ensure geographical, cultural, and organizational considerations were covered.

The Work Completed to Date

Beginning in February 2016, the TWP met regularly, producing 4 sets of guidelines on:

Ethical Standards for Mindfulness Teachers and Teacher Trainers.

Criteria and Minimum Standards for Teacher Trainers.

Criteria and Minimum Standards for Teacher Training Pathways and Guidelines for Levels of MBP Teacher Experience.

Structure and Governance for an International Integrity Network for the MBPs.

The resulting documents were sent to the Steering Group in December 2016 for further review. These were then disseminated through the regional networks represented in the TWP and an overview of the work was presented at the Centre for Mindfulness, Research and Practice Mindfulness Conference in Chester, UK, in 2017.

Summaries of these guidelines and standards are presented in the following tables, and full copies can be obtained from the authors or any of the named TWP members until such time that a dedicated website is established.

Ethical Standards for Mindfulness Teachers and Trainers

Criteria and Standards for Teacher Trainers

Criteria and Standards for Teacher Training Pathways

Guidelines for Levels of MBP Teacher Experience

As work on the structure and governance document is still in progress, it was felt that these initial documents would be released as a more immediate and relevant contribution to the field. These “living documents” are offered as best practice guidelines to be utilized by MTTOs as they develop and review their teacher training pathways and by MBP teachers as they reflect on the ethical principles that guide their work. We fully appreciate these guidelines may remain aspirational for some time as the length and cost of MBP teacher training may create unrealistic barriers for some communities, or where geographically isolated teachers are trying to establish evidence-based MBPs. Ethically balancing practical and economic realities while holding true to the integrity of the work is a mindfulness practice in itself. To be both rigorous and flexible requires spaciousness and careful consideration.

The TWP acknowledged early on in its work that a priority was to remain true to the vision described above, which highlights both integrity and inclusivity. To wisely progress this work within the many and varied communities we work and live in, relationships need to be tended to with mutual respect, healthy inquiry, and a nuanced understanding of global realities.

Future Directions

As we go forward, ongoing challenges are inevitable and will require a mixture of patience, care, wisdom, and steadiness as we meet them.

These challenges include the following:

Maintaining MBP teacher and training program integrity while working on increasing the accessibility and dissemination of evidence-based courses. Particular attention is needed where there are regional, cultural, and population differences.

Finding ways to initiate or maintain ongoing accessible and affordable training, supervision, mentoring, and course outcome evaluation.

Preventing fidelity drift which refers to the often-observed phenomenon where teachers (or therapists) tend to drift away from offering the original model they were trained in, introducing their own ideas without always realizing they have done so, leaving out core components or not evaluating the outcomes for their participants/clients even if they have made any changes carefully.

Clarifying which new programs fit the current definitions of MBPs, identifying the standards of evidence needed to justify their inclusion, and evaluating the particular training pathways developed to prepare the teachers. This requires ongoing research (especially more effectiveness trials in different settings), judicious use of research funding to fine tune existing MBPs for some populations, and collaborations between scientists, trainers and teachers that would assist with this more targeted endeavor, rather than trying to meaningfully scope and evaluate the iterations of MBPs that are now appearing.

Developing a standardized certification process of both MBPs and MTTOs while paying attention to the implications for different professions, cultures, academic, and nonacademic settings. This would go some way toward safeguarding the offerings so that the public had some way of assessing the integrity of courses on offer.

Transitioning from the international group involved in developing these guidelines to the growing generation of leaders who will support the next steps of this work. Some plans for this are coming into focus and involve website creation, biannual meetings for further discussion, and publication of relevant articles. The structure and governance of such a leadership group needs more reflection, especially as the complexities involved in creating a global body that has a meaningful role are not insignificant. For example, the need for support of both participants and teachers in settings where there is systematized discrimination and abuse, and/or increasing social ecology threats is a pressing challenge for the mindfulness community.

Conclusions

By June 2018, these ethical standard and teacher training guidelines had been presented and circulated with the MBP teacher training networks and organizations, but wider dissemination is still needed along with wider ranging discussions, panels, conversations, and investigations. Over time, the TWP has transitioned with some members stepping back after the initial work was completed and as new representatives joined the group. A series of biannual meetings are being planned to further clarify and discuss components of the documents and the direction of the field, with the possibility of a collaborative website being developed with an international reach for all teachers and trainers.

In the meantime, we hope that the summary tables of the documents become a valuable and practical resource to the MBP teacher trainer community that will guide best practices through minimum standards for teacher development and training that can be appropriately adapted to local contexts. The relevance and value of this work and its related documents is now for the community of MBP teachers and trainers to explore, study, and debate as we collectively and individually offer mindfulness-based programs to those who may benefit, and as we train the next generation of teachers. This is all the more crucial as MBPs move into populations, regions, cultures, and domains where classes look nothing like the generally white, relatively wealthy, heteronormative, gender-conforming populations found in the original programs. In fact, this progress is seen as timely and critical in the development of MBPs and is a welcome movement in the field, speaking deeply to the roots of contemplative practice and ethical frameworks of inclusion and equity.

Creating an environment that cultivates deep listening, openness, and respect for what is possible in diverse and underrepresented regions is critical to realizing the full potential of human flourishing through mindfulness practices. We have endeavored to do so in the development of these guidelines.

Adapted with permission from Crane et al.[19]

Domains of Ethics	Areas in Each Domain
Transparency and openness	Participants are informed of all responsibilities and guidelinesParticipants’ needs and expectations are attended to Well-being of participants prevails over economic interests
Integrity	Personal integrity of teacher ConfidentialityAdherence to MBP principles, eg, patience, trust, acceptanceRespecting copyright laws and intellectual propertyFidelity to MBP curricula
On-going learning	Ongoing professional learning and developmentSupervision or peer supervision Open discussion of competenceDevelopments in field of MBP teaching/training and research
Own practice	Personal daily mindfulness practiceOngoing retreat engagement Remaining in contact with foundational traditions Desisting from conversion or evangelism in relation to Buddhist teachings
Clarity around limitations	MBPs are not a substitute for medically indicated treatments Abide by limitations of personal competency and experienceAdherence to ethical framework of teacher's professional training
Responsibility for relationships	Honoring boundaries in relation to participants/traineesSkillful relationships with competitors in the MBP field
Grievance process	Commitment to existing grievance processes and codes

Domains of Standards	Description/Areas of Domain	Range of Criteria
Trainer readiness	Readiness to train	• Readiness to train mindfulness teachers should be assessed individually• Trainers should be certified level 3/senior teachers or equivalent as described in the training criteria
Trainer prerequisites	Meditation experience	• Minimum of 7 years’ experience in meditation and mindful movement• Minimum of 5 silent retreats of at least 5 days in length
	Teaching experience	• Teaching responsibility for at least 15 mindfulness-based courses over a minimum of 5 years. • Keeps up with continued professional development (CPD) postcertification
	Training to be a trainer	• Trained to be a trainer via an appropriate apprenticeship • Demonstrated competency in training others • Continues to teach mindfulness-based courses to people with varying levels of experience as a teacher, alongside training teachers
Teaching proficiency criteria	Leading groups	• Skill in creating and maintaining a safe container for learning and exploration in the face of stress, pain, illness, and suffering • Skill in large and small group dialogue and process of inquiring together as group process
	Supervision/mentoring	• Qualified and experienced in providing mindfulness supervision and/or mentoring
	Supporting new teachers	• Skillful at giving feedback that identifies strengths and learning needs
Understanding mindfulness	Complexity of mindfulness	• Exhibits experiential understanding of complexity of mindfulness as an approach and its transformative potential
	Aims and intentions	• Thorough comprehension of aims and intentions of all curriculum components within a particular MBP
	Theoretical principles	• Thorough comprehension of underlying theoretical principles of the MBP they are training others in• Thorough understanding of relevant current scientific and/or clinical understanding and relevant spiritual, philosophical and Buddhist traditions
MBP in different contexts	Differences between MBPs and the different settings, cultural contexts and fields of application	• Equipped with capacity to train others in the principles underpinning adaptations of MBPs to different contexts and populations • Working experience in the field of application
Embodiment	Committed to continuous work to embody mindfulness	• Capacity for deep listening, regard and compassion for all participants• Sensitivity to the use of language in relation to guiding meditation practices and navigating class dynamics • A compassionate and strong team player in the context of a training team and in connection with others who are training teachers
Ongoing learning	Personal mindfulness practice	• Ongoing participation in silent, teacher-led meditation retreats • Sustained and ongoing personal mindfulness practice, including sitting practice, inquiry and mindful movement, reinforced by ongoing study with teachers
	Professional training	• Tracks current and developing evidence base for mindfulness-based interventions, with a particular emphasis on the training organization’s area of expertise
	Self-awareness /personal process	• Continued exploration and examination of one’s own personal patterns through supervision, coaching, counseling, psychotherapy or other self-development work

Domain of Standards	Description of Domain	Range of Domain
Prerequisites (to enter the training program)	Meditation and mindful movement practice	• Minimum of 1 year of personal mindfulness meditation practice and study in mindfulness (wisdom traditions, Buddhism, and universal dharma, and a minimum of 1 year of mindful movement practice (eg, Mindful Hatha Yoga, Chi Gong, Tai Chi)
	Professional background	• Professional graduate degree or equivalent working experience in the field (typically health sciences, psychology, medicine, nursing or education, but other fields may also be accepted) • Experience of group work is recommended
	MBSR or MBCT 8-week course as a participant	• Completion of one 8-week MBSR/MBCT course (or equivalent MBP)
	Retreat Experience	• Minimum of 1 silent teacher-led retreat (Residential Meditation Practice Intensives) of 5 to 7 days (which may be comprised of 2 × 2½ day retreats if, eg, people have young children or if no longer retreats locally available) • Geographical and cultural implications may require adaptations to these requirements
	Commitment	• A commitment to ongoing personal practice and study
Teaching pathways	The different parts of a training pathway fit together and form a comprehensive program. Training can be followed through 1 pathway, modular, and/or in different institutes.	• Any training program should offer the theory, rationale and intentions underpinning the MBP being taught with significant amounts of experiential learning, along with ample time to reflect, give and receive feedback from self, peers, and instructors• A training program includes supervision and mentoring, either through the trainers themselves or through external qualified supervisors and mentors. Co-teaching could be part of the pathway, though never replacing supervision and mentoring or a full training program• Participation in an MBP teacher training pathway does not indicate “readiness to teach or supervise or train other teachers” • Teacher/trainer readiness has to be assessed in the process of learning by the processes outlined in level 2 Criteria for certification

Domain of Standards	Description of Domain	Range of Domain
LEVEL 1 Beginner MBP teacher	Contact hours to attain basic qualification	• A basic qualification for a teacher before starting teaching can be low under certain circumstances (eg, 120–200 h), but this can only be a starting point for the professional development. An example would be—the 8 week course (16 h), teacher training intensive (100 h), reading and preparation (6 h), and so on. This precise breakdown will vary from pathway to pathway but a minimum of 120 hours is required•  A silent retreat (Residential Meditation Practice Intensive) of 5 to 7 days should be part of the training trajectory and mandatory before one starts to teach
LEVEL 2Qualified MBP teacher	Further training and maturing of teaching expertise	• Having taught 8 courses• Having undertaken further training of another 120 hours including supervision
	Content of training	Crucial components of the program: • familiarization with and analysis of curriculum elements (themes, practices, presentational elements, learning activities, and group process) weekly and as a whole• embodiment of mindfulness• the skill and art to guide formal and informal practice• the theory and skill practice of delivery of psychoeducational elements of MBPs• the theory and practice of facilitating inquiry• theoretical underpinnings of the program• holding a safe group learning environment• self-reflection (which may include writing, video, audio, and other media or means of expression) • giving and receiving feedback from self, peers, and instructors• supervision (may be outsourced if not provided by the training organization)
	Requirements for completion of level 2 teacher training program	• Teaching: having taught 8 of the MBPs in which one is training (see supervision below) • Personal self-reflection on the teaching process and skills• Supervision: having completed at least 8 to 10 hours with a qualified supervisor covering at least 2 courses• Residential Meditation Practice Intensives: at least 2 retreats of 5 to 7 days each or (the minimum length of 5 days can be comprised of 2 × 2½ day retreats/year if have young children or if no longer retreats locally available). These retreats should be silent, teacher-led, and can be in mindfulness or Buddhist tradition
	Ongoing Continuing Personal and Professional Development	• 2 to 3 days of professional training per year, including supervision, workshops, personal study, webinars, or professional conferences on Mindfulness• Regular silent teacher-led Residential Meditation Practice Intensives as described in the Ethics for trainers and teachers (at least 5 days per 2 years)
	Possible forms of assessment: Ongoing assessment during all phases of trainingFormative feedback on teaching practice and development from more experienced teachersAssessment based on short version of MBI TAC or equivalent criteria.	• Postsupervision reflection: written reflection on personal journey through mindfulness and mindful movement practice, and on one’s own courses• Preparation of all teaching materials (Handbook, Audio files, etc) • Recommendations—by students, colleagues, supervisor, and/or (co-)teachers• Recordings of teaching practice and accompanying written reflection reviewed and certified by teacher training organization. May be outsourced to another MTTO if certification is not possible within the providing MTTO• Audio files of guided formal practices• Students should be seen while teaching either in person or via video
LEVEL 3: Senior teacher	Development process toward senior teacher	• Minimum 5 years of teaching, certified by Centers for Mindfulness that are affiliated with and recognized by the wider MBP community, and with adequate qualification to enable rigorous assessment of teaching competence• Regular teaching experience• Minimum 7 years of personal mindfulness and mindful movement practice• Minimum 5 years of Continuing Personal and Professional Development—including awareness of research and practice developments in the field nationally and internationally • Having taught at least 15 courses• 5 or more silent retreats of at least 5 days each• Personal guidance/mentorship by a teacher/trainer • Ongoing individual mindfulness supervision—ideally monthly but a minimum of 3 to 4 sessions per year; and/or ongoing group supervision with peers with a minimum of 4 sessions per year