Embodied Self-Care: Enhancing Awareness and Acceptance Through Mindfulness-Oriented Expressive Writing Self-Disclosure

Running head: MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 1 Embodied Self-Care: Enhancing Awareness and Acceptance Through Mindfulness-Oriented Expressive Writing Self-Disclosure Nevine Sultan University of St. Thomas, Houston, Texas Author Note: Nevine Sultan, PhD, NCC, LPC, Clinical Mental Health Counseling, School of Education and Human Services, University of St. Thomas, Houston, Texas. Correspondence concerning this article should be addressed to Nevine Sultan, PhD, NCC, LPC, Clinical Mental Health Counseling, University of St. Thomas, 3800 Montrose Boulevard, Houston, TX 77006. Email: nevine.sultan@gmail.com This is an Accepted Manuscript of an article published in Journal of Creativity in Mental Health on 04/03/2017, available online at: http://www.tandfonline.com/doi/full/10.1080/15401383.2017.1286277 MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE Abstract Self-care is fundamental to mental health practitioner training and professional efficacy. Expressive writing about stressful events has been researched and shown to have positive physical and psychological effects. Mindfulness, an embodied approach to clinical practice and education, has also been studied and documented as an effective self-care approach. Embodied education integrates experiential history with current learning, which may influence future practitioner performance and client outcomes. This self-care exercise is designed to promote awareness and acceptance among counselors and counselors-in-training, as well as among clients, through use of a mindfulness-oriented written self-disclosure task that may facilitate meaning-making, and may enhance psychological well-being and therapeutic efficacy. It aligns with CACREP and ACA Code of Ethics standards addressing counselor self-care as a necessary facet of ethical practice. Keywords: Expressive Writing; Mindfulness; Counselor Education/Training; Counselor Self-Care; Therapeutic Relationship; Embodied Education; Creativity in Counseling 2 MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 3 Embodied Self-Care: Enhancing Awareness and Acceptance Through Mindfulness-Oriented Expressive Writing Self-Disclosure Significant life events serve a central role in the growth and development of every human. Many individuals wish to disclose details of their experiences with trusted others shortly following the event. It is believed that disclosure helps free people of unwanted thoughts about the event, make sense of the event, increase their ability to regulate their emotions, and improve their social connections (Frattaroli, 2006). This may be especially true for counselors and psychotherapists, who are often exposed through their work to highly traumatizing descriptions of negative experiences (Sultan & Fox, 2013). Disclosure about significant events can be done in various ways, including verbally and in written form (Harrist, Carlozzi, McGovern, & Harrist, 2007; Lyubomirski, Sousa, & Dickerhoof, 2006; Niederhoffer & Pennebaker, 2009). Almost three decades of research in this domain suggest that disclosing one’s thoughts and feelings about stressful life events through writing has beneficial effects on health (Graf, Gaudiano, & Geller, 2008; Greenberg & Stone, 1992; King, 2001; Lu, 2010; Pennebaker, Kiecolt-Glaser, & Glaser, 1988; Poon & Danoff-Burg, 2011). In 1986, Pennebaker and Beall studied the effects of disclosure through a written task. Participants were randomly assigned to one of four writing groups: a) a group writing facts surrounding their trauma; b) a group writing emotions surrounding their trauma; c) a group writing both facts and emotions surrounding their trauma; and d) a group writing nonemotionally about a neutral event. These writing sessions continued for four consecutive days with results indicating that several weeks following the writing intervention, the group writing both facts and emotions demonstrated a reduction in illness-related doctor’s visits (Pennebaker & Beall, 1986). These findings were intriguing, as they suggested that disclosing one’s experience MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 4 about a stressful event may lead to empirically-measured health improvements. A tradition of research examining a broad range of effects of narrative disclosure followed (Frattaroli, 2006). Written self-disclosure may be especially beneficial for both licensed counselors and counselors-in-training, both of whom are susceptible to vicarious trauma—a transformation in the therapist’s inner experience that results from empathic reaction to a client’s traumatic experience—and stress (Adams & Riggs, 2008; Sultan & Fox, 2013) due to the unique challenges of their professional responsibilities (Sultan & Fox, 2013). This does not include trauma and stress suffered through personal non-vicarious experiences. Traumatic and/or stressful experiences can harm professional efficacy as they may negatively impact concentration, attention (Skosnik, Chatterton, & Swisher, 2000), and self-perception (Hemenover, 2003), with implications for the therapeutic alliance and therapeutic efficacy. There is psychological value in constructing a coherent narrative linking who we were at the time of an event with who we are now and who we hope to become in the future (McAdams, 1996). Due to their very nature, stressful events can provide new information that is inconsistent with our life narrative (Horowitz, 2011), resulting in ruminative searches for meaning and obsessive efforts to incorporate the inconsistent information into already existing self-narratives (Gortner, Rude, & Pennabaker, 2006; Pennebaker, Zech, & Rimé, 2001). Theorists and researchers have suggested that written self-disclosure about trauma or stress can enhance positive self-perception, which may result in higher self-concept (King, 2001; O’Connor et al., 2011; Pennebaker & Keough, 1999). Through the facilitation of insight into and comprehension of the personal meaning of a stressful event, disclosure can give rise to a more resilient self- MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 5 concept (Pennebaker, Mayne, & Francis, 1997; Hemenover, 2003). Resilience is a psychological concept predicting positive outcomes despite threats to adaptation (Masten, 2001). Some theorists (Greenberg, Wortman, & Stone, 1996; King, 2001) have suggested that emotional self-disclosure nurtures positive self-perception because it improves self-regulation, self-empathy, and a sense of control. One’s ability to gain insight into a personally stressful event may enhance feelings of efficacy resulting from an increase in positive self-regard and optimism (O’Connor et al., 2011; Pennebaker & Keough, 1999). Additionally, finding positive meaning in an otherwise negative event can enhance one’s sense that life is meaningful and may encourage engagement in active living (Ryff & Singer, 1998). Consequently, coming to terms with negative events may bolster personal growth through understanding that change is a fundamental part of healthy living (King & Miner, 2000). This meaning-making process can take place within a mindfulness-oriented expressive writing self-disclosure paradigm. Theoretical Rationale A number of explanations for the benefits of written self-disclosure exist, drawing from various theoretical orientations, including the psychoanalytic concepts of inhibition and catharsis (Lepore & Smyth, 2002); the cognitive-processing concepts of causation, insight, and integration (Pennebaker, 1993; Pennebaker & Chung, 2014; Tausczik & Pennebaker, 2010); the social integration concept of how people interact with their social world (Pennebaker & Graybeal, 2001; Slatcher & Pennebaker, 2007); the self-regulation concepts of exploration of emotions, clarification of goals, and affective feedback (King, 2002); and the exposure concepts of describing, confronting, reliving, and extinguishing negative experiences (Klein & Boals, 2001). The psychoanalytic idea of catharsis versus inhibition suggests that withholding thoughts and emotions about stressful events may be harmful, while expression of inhibited thoughts and MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 6 emotions may lead to stress reduction and improvement of physical and psychological outcomes (Lepore & Smyth, 2002). Although psychoanalytic inhibition studies suggested a connection between narrative self-disclosure and psychological well-being, researchers arrived at mixed results (Frattaroli, 2006). Greenberg and Stone (1992) conducted a study with results indicating no difference between writing about previously disclosed versus previously undisclosed events. A similar study (Greenberg et al., 1996) examined the difference between writing about real-life versus imaginary stressful events, with results showing no difference between groups. These studies challenged the notion of writing being beneficial exclusively through an inhibition vs. release mechanism (Frattaroli, 2006). Cognitive-processing theorists propose the concept of changing existing belief systems and schemas by reconstructing the conceptual framework of a stressful event into a set of assumptions (Janoff-Bulman, 1992). This suggests that expressive writing facilitates the integration of the stressful event into one’s psyche. Research studies (Pennebaker, 1993; Tausczik & Pennebaker, 2010) were conducted investigating the use of causation words (e.g., because, effect) and insight words (e.g., consider, know) within a writing exercise. Participants who benefitted from the self-disclosure task demonstrated increased use of such words. This indicates that integrating an event into one’s self-schema may be an underlying mechanism rendering expressive writing beneficial. Writing about a stressful event also promotes a decrease in intrusive thoughts, which is related to an increase in working memory (Klein & Boals, 2001). Sloan and Marx (2004) found no consistent support for the cognitive-processing model, identifying elements that may account for this such as the difficulty of measuring cognitive change. MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 7 Self-regulation theorists argue that experiencing emotion is contingent on the status of one’s goals. King (2002) states that well-regulated individuals are those who experience emotion as a feedback system informing them whether or not they are on the right path to goal attainment. Narrative self-disclosure allows participants to make sense of events, explore sources of emotion, clarify goals, and reroute the self-regulation feedback system (Niederhoffer & Pennebaker, 2009). King (2001) also reported that writing as if all of one’s goals have been met may enhance psychological well-being. Finally, exposure theorists posit that the expression of thoughts and emotions regarding a stressful event is akin to exposure therapy, used to treat posttraumatic stress disorder and various phobias. Repeatedly confronting, describing, and reliving the experience of a stressful event may result in extinction (Frattaroli, 2006). Support for exposure theory is mixed, with some research (e.g., Klein & Boals, 2001) suggesting that disclosure may reduce intrusive thoughts and other studies (e.g., de Moor et al., 2002; Lepore, 1997) failing to report such reduction. The proposed exercise is most closely aligned with the theories of self-regulation and exposure as mindfulness is a self-regulation exercise, while written self-disclosure is both a self-regulation and an exposure practice. Benefits of Mindfulness and Other Embodied Approaches to Education There is rising interest in the integration of mindfulness with traditional counseling and psychotherapy for treating a wide range of psychological issues (Moore & Brody, 2009) based primarily on a growing body of research demonstrating the benefits of mindfulness on psychological well-being. Results of a study by Poon and Danoff-Burg (2011) suggested that more mindful individuals gain more benefits through expressive writing. Jon Kabat-Zinn (2003) offered the following operational definition for mindfulness: “An awareness that emerges MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 8 through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” (p. 145). The Impact of Higher Mindfulness on Clinical Efficacy Mindfulness has been shown to be effective in clinical applications with psychotherapy clients and as a self-care practice for mental health therapists and therapists-in-training (Christopher & Maris, 2010; Maris, 2009; Shapiro, Brown, & Biegel, 2007). Brown and Ryan (2003) found that individuals with higher mindfulness demonstrated greater congruence between implicit and explicit affect, suggesting higher self-knowledge and attunement to implicit experience, both of which are critical to the nurturance of the therapeutic relationship and therapeutic efficacy, and are therefore critical to therapist training and practice. Lum (2002) proposed that therapists cannot fully connect with clients unless they are aware of and accepting of their own personal experience. Francesconi and Tarozzi (2012) stressed the importance of including bodily experience in educational settings through somatic or meditative practices, especially mindfulness, to enhance presence and awareness. In their support, they cited the work of Maurice Merleau-Ponty (1945/2013), the French phenomenological philosopher. Merleau-Ponty’s writings on perception, self, and embodiment, especially in his seminal work, Phenomenology of Perception (1945/2013), have greatly inspired the current interest in the connection between cognition and phenomenology, i.e., between learning and personal experience, and the corresponding suggestion that cognition is, itself, deeply embodied (Gallagher & Zahavi, 2012; Röhricht, Gallagher, Geuter, & Hutto, 2014). Francesconi and Tarozzi (2012) added that an embodied approach to education, unlike a purely cognitivist approach, re-evaluates the role of subjective MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 9 experience in the creation and expression of knowledge within a first-person ontological framework. Thus, they extended the idea that education is a lived experience. Francesconi and Tarozzi (2012) go into considerable detail about the role of mindfulness in education, asserting that mindfulness teaches us how to use awareness to expand and deepen groundedness, presence, and connection with others and the world in the present moment. Dixon and Senior (2011), and Lane (2012), echoed this assertion. Similarly, Mensinga (2011) emphasized, specifically within the context of mental health practitioner training, the role of embodied learning and meditative practices as vehicles for enhancing the reflexive capacity of future practitioners, promoting better outcomes for clients. Mindfulness can contribute towards an embodied education paradigm for counselors-in-training, facilitating the integration of experiential history with educational experience into an existential whole. Mindfulness as a Potential Moderator Additionally, mindfulness has been significantly negatively correlated with rumination, depression, and anxiety (Brown & Ryan, 2003). Brody and Park (2004) suggested that written self-disclosure about stressful events while focusing on thoughts and emotions requires the selfregulated attention practiced through mindfulness. Additionally, the written narrative task may be manipulated by instructing individuals to practice intentional introspection of their experiences, which may improve awareness and evaluation of such experiences without judgment and enhance clarification of goals. The Importance of Self-Care It is important to note that there are instances in which the written self-disclosure task may result in negative outcomes beyond the normal increase in sadness typically occurring during or shortly after the writing exercise, including an increase in physiological symptoms and MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 10 psychological distress (Poon & Danoff-Burg, 2011). This has been especially evident among participants with a history of severe trauma (Batten, Follette, Hall, & Palm, 2002). Additionally, some self-disclosure studies have found no significant differences between pre- and post-writing observations (Austenfeld, Paolo, & Stanton, 2006). Nevertheless, professional counselors and counselors-in-training are especially disposed to vicarious trauma and stress due to the challenges of their profession (Sultan & Fox, 2013). As such, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) has established a standard addressing counselor self-care as a necessary component of professional counseling orientation and ethical practice (CACREP, 2016). Likewise, the American Counseling Association (ACA), in its Code of Ethics (2014), has stressed the importance of self-care in promoting ethical clinical practice. An exercise integrating mindfulness with written self-disclosure may be used by counselor educators, licensed professionals, and counselors-in-training as a self-care prevention method to assuage the effects of vicarious trauma, compassion fatigue, and burnout (Richards et al., 2010), enhancing the likelihood of maintaining professional efficacy. Compassion fatigue is a condition similar to vicarious trauma (Sultan & Fox, 2013) in that it is caused by preoccupation with client concerns. Among the symptoms of compassion fatigue are feelings of apathy, repressed emotions, and isolation (Figley, 2002). Burnout is “a combination of multiple emotional and physical ailments manifesting cognitively or within the workplace, [which] could ensue and jeopardize both the counselor’s well-being and treatment efficacy” (Lee, Cho, Kissinger, & Ogle, 2010, p. 131). The Exercise Purpose and Setting MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 11 Mindfulness is an evidence-based therapeutic intervention shown to facilitate awareness and acceptance of thoughts and emotions in a non-judgmental way (Frattaroli, 2006; Richards et al., 2010). Awareness and acceptance are key constituents of mindfulness (Cardaciotto, Herbert, Forman, Moitra, & Farrow, 2008). Awareness has been defined as a continuous monitoring of one’s experience, with an emphasis on present moment experience versus past or future events. It has been characterized as what one is doing when one is practicing mindfulness (Cardaciotto et al., 2008). Acceptance has been defined as one’s ability to experience events just as they are, without avoidance, judgment, interpretation, or elaboration. It refers to how mindfulness is practiced (Cardaciotto et al., 2008). Mindfulness has been shown to enhance one’s ability to make sense of an event and gain insight about it through exploration of emotions and thoughts, clarification of goals, and organization and integration of the stressful experience into one’s selfschema (Frattaroli, 2006; Poon & Danoff-Burg, 2011). Additionally, written self-disclosure about stressful life events has beneficial effects on health and clinical practice (Graf et al., 2008; Lu, 2010; Pennebaker, Kiecolt-Glaser, & Glaser, 1988; Poon & Danoff-Burg, 2011). The purpose of this exercise is to promote awareness and acceptance among counselors and counselors-in-training through use of a mindfulness-oriented written self-disclosure task designed to facilitate meaning-making and enhance psychological well-being. Practice Setting The following mindfulness-oriented written self-disclosure exercise may be used in a variety of settings and contexts, including counselor education and supervision programs, counselor training and continuing education, mental health agencies, and private practice. It is suitable for use with students and supervisees, between colleagues, and with clients, as well as for oneself. MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 12 Counselor education and supervision. Practicum and Internship courses can be psychologically taxing for students who are just learning how to navigate the ropes of clinical practice. This exercise may be used as a self-awareness practice, as well as a preventive measure for self-care as students/supervisees prepare to engage in clinical work with clients. It can also be used, due to the awareness and acceptance dimensions, when supervisees are struggling with questions about self-efficacy. Additionally, it may be helpful for supervisees experiencing similar events to those of their clients, as well as supervisees in the throes of vicarious trauma, those on the edge of compassion fatigue, or those experiencing burnout. Finally, this exercise may be beneficial to students/supervisees exploring the parameters of multicultural and diversity competence and the impact of their values, beliefs, biases, and attitudes on their clinical efficacy. As a counselor educator, I have used and continue to use mindfulness-oriented written self-disclosure to help students successfully process personal and professional challenges they face in their clinical work, as well as to process any dissonances they experience as they interact with clients and colleagues of differing cultural backgrounds. Students have expressed their enthusiasm for the exercise, and many have reported adopting it as a regular practice towards enhancing self-awareness and self-acceptance, as well as multicultural competence and tolerance. Counselor training and continuing education. Counselor training and continuing education programs provide content-focused sessions and workshops designed to ensure subject mastery. While the importance of content cannot be argued, it is often the case that content is mastered through practice. Thus, in addition to explaining the importance of self-care and backing this up with evidence, allowing trainees and attendees of workshops to explore their personal experience of self-care and the enhancement of wellness creates a learning environment MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 13 that honors content as well as practice. As a frequent presenter at various professional venues, I regularly include a brief mindfulness-oriented expressive self-disclosure task as an experiential facet of workshops and trainings focused on self-care. Attendees almost invariably applaud the inclusion of this activity, share the almost instant calming and stilling effect it has produced within them, state that they feel more “clear-headed” and able to engage in active perspective-taking about personal and professional issues, and pledge that they will continue to use the exercise as a preventive and/or self-care method. Mental health agencies. Working in community mental health agencies can be stressful due to the high volume of clients and the formidable demands placed on mental health practitioners within those settings. This exercise can be used both as a preventive activity between colleagues, or as a self-intervention for early signs of vicarious trauma, compassion fatigue, or burnout. Additionally, this exercise may be used with clients at community agencies. Formerly, as a clinician at various mental health agencies offering specialized clinical services in such areas as domestic violence, grief, and sexual trauma, I used this exercise with colleagues who exhibited signs of compromised clinical efficacy due to job-related stress. I also personally used the exercise to process some of the overwhelming thoughts, emotions, and somatic sensations I experienced while working with abused and grieving clients. Because domestic violence, grief, and trauma are often difficult issues to discuss verbally, I invited clients to use the exercise. Many of those clients expressed gratitude for the ability to process their difficult experiences within a safe and “quiet” container, and self-reported higher levels of selfawareness and ability to self-regulate. Private practice. Private practice is a mixed bag. While it can be highly individually MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 14 affirming, validating, and rewarding, it also tends to be quite isolating and disconnecting. Sometimes, the only avenues for social connections in private practice come through the brief interactions that happen during consultation. As a result, private practitioners without immediate access to colleagues (and, depending on the issues with which their clients present) may be especially vulnerable to vicarious trauma, compassion fatigue, and burnout, before they are aware of what is taking place. As a private practitioner, I share an office with a few colleagues that I rarely see. I specialize in grief, dissociative disorders, and complex trauma. Moreover, I work from a bodycentered perspective that places physical and psychological demands on my body, which I use as a tool for presence, attunement, empathy, and relationship. As a result, vicarious trauma is an experience with which I am profoundly familiar. Yet, I feel extremely competent to handle vicarious trauma and attend to it before it compromises my clinical efficacy. This is due to the high level of self-awareness I have. My regular mindfulness-oriented expressive self-disclosure practice has, I feel, contributed a great deal towards my self-awareness and self-acceptance. Over the years, I have used this deeply self-exploratory exercise almost daily as I prepare to encounter the challenging verbal and nonverbal narratives my clients bring into the therapy room. Materials The following materials are needed for this exercise: • Mindfulness-oriented written self-disclosure task instructions (provided in the following section) • Stopwatch/timer • Blank paper MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE • 15 Pens/pencils Procedures The following set of instructions may be used as a guide to facilitate a mindfulnessoriented expressive writing self-disclosure exercise. Depending on the setting (counselor education or clinical training program, mental health agency, private practice) and the population with which it is used (students, colleagues, clients, self), minor modifications may be made to the exercise. 1. Pass out two or three sheets of blank paper and a pen to each participant. 2. Set the stopwatch/timer to 20 minutes. 3. Read the following mindfulness-oriented expressive writing self-disclosure task instructions, adapted from Pennebaker et al. (1988) and Pennebaker (2000), aloud to participants: Write about a real (and, if possible, recent), event that you experienced as stressful, and that you have never disclosed to anyone, or that you have only minimally disclosed. Some examples of what to write about include the breaking of a relationship, an account you heard from a client, and so on. As you write, try to make sense of this event by exploring your deepest thoughts and feelings about it. How did this event affect your life? What role does this event play in your life in the present time? How may this event impact your future? Open yourself up to experiencing your thoughts and feelings as they occur in the present moment. Describe what you are feeling in your body as you write (i.e., tension, tightness, heat, tingling), and where you feel it (i.e., hands, legs, stomach, feet, neck). It is important that you not judge your thoughts or your feelings, and that you allow them space. It is also important that you allow your words to relay your thoughts and feelings without judgment. If you find yourself feeling judgmental, notice this feeling, and then gently let it MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 16 go. Simply accept whatever arises, observe it, and let it pass. Acknowledge your thoughts and feelings without evaluating them as positive or negative; accept them with openness, as they are. If you find your thoughts wandering, consciously bring your attention back to your body, and to the present moment. Please write without stopping until the facilitator tells you the time is up. Don’t worry about spelling, grammar, punctuation, or sentence structure. If you find yourself running out of things to write, repeat the last thing you wrote until you think of something new to write. 4. End the writing session after 20 minutes (more or less, depending on your modifications). 5. Process and debrief. Questions for Processing Depending on the context in which the exercise is being used, supervisor-supervisee, instructor-student, colleague-colleague, or counselor-client, discuss the experience using the following suggested questions. Working teams may use some or all of the questions, depending on the needs of the participant(s). When I use the exercise for myself, I select questions that are most aligned with my present-moment needs following the exercise. I am especially attuned to questions for which I have an adverse reaction and often choose to process those questions at a later time. 1. What was it like to write about a stressful and previously undisclosed event? 2. What was it like to open up to your experience without judgment? 3. What was it like to attend to your bodily sensations, your thoughts, and your emotions? 4. What was it like to be in the present moment? 5. What meanings emerged for you through this experience? MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 17 6. How might this practice facilitate your meaning-making of professional and personal experiences and enhance your psychological well-being? Implications, Applications, and Limitations Use of this exercise has several implications for counselor educators, counselors, and counselors-in-training as it provides a vehicle for self-exploration, promoting self-awareness and higher attunement to implicit communication within the therapeutic relationship. This supports the maintenance of a powerful connection between therapist and client. This exercise offers an invitation for participants to cultivate awareness and acceptance through a double-edged activity that allows them to creatively express perceptions of personal experience while maintaining an attitude of openness, curiosity, and non-judgment, as aligned with some of Carl Rogers’s (1961) core conditions for therapy. Additionally, Fulton and Cashwell (2015) stated that activities that enhance trainees’ ability to demonstrate awareness and non-judgment of their own internal processes may reduce anxiety in the trainee. As a counselor educator, I have incorporated this mindfulness-oriented written selfdisclosure exercise into class time to help students process personal experiences and understand the potential impact on their therapeutic work. I have also encouraged students suffering painful life events or vicarious trauma to use this exercise to facilitate meaning-making of their experience while bringing to it awareness and acceptance. Likewise, as a counselor-in-training in the past, I used this exercise to process many of my own personal and clinical experiences and bring awareness and acceptance to them. Having acceptance for my own experiences enhanced my ability to be accepting and non-judgmental of my clients. Although this exercise has the potential to enhance personal well-being and therapeutic efficacy, it is important to note some of its limitations. One limitation is that writing about MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 18 traumatic events may increase feelings of sadness and distress. This is especially true for those with a history of severe trauma. It is thus necessary to inform participants in advance of this possibility, and to allot time and space for process questions and debriefing. Another limitation is that some participants may experience more improvements in physical versus mental health. Nevertheless, it possible that physical wellness may support mental wellness. Discussion Counselors and other mental health practitioners are exposed to vicarious trauma, compassion fatigue, and burnout due to our work with traumatized clients. It is essential to our well-being as therapists and as persons that we have established evidence-based protocols for self-care as we navigate our profession, per CACREP (2016) standards and the ACA Code of Ethics (ACA, 2014). Taking care of ourselves engenders higher levels of therapeutic efficacy, which supports a strong therapeutic alliance and leads to potentially better outcomes for our clients. This exercise is an avenue for counselor educators, licensed practitioners, and counselors-in-training to attend to their wellness with the understanding that it directly impacts their ability to connect with clients and practice efficaciously. Self-care and embodied awareness begin at the level of the training and education programs that prepare counselors and therapists for professional practice and the potential psychological hazards associated with it. MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 19 References Adams, S. A., & Riggs, S. A. (2008). An exploratory study of vicarious trauma among therapist trainees. Training and Education in Professional Psychology, 2, 26-34. doi: 10.1037/1931-3918.2.1.26 American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA: Author. Austenfeld, J. L., Paolo, A. M., & Stanton, A. L. (2006). Effects of writing about emotions versus goals on psychological and physical health among third-year medical students. Journal of Personality, 74(1), 267-286. doi: 10.1111/j.1467-6494.2005.00375.x Batten, S. V., Follette, V. M., & Palm, K. M. (2002). Physical and psychological effects of written disclosure among sexual abuse survivors. Behavior Therapy, 33, 107-122. doi: 10.1016/S0005-7894(02)80008-9 Brody, L. R., & Park, S. H. (2004). Narratives, mindfulness, and the implicit audience. Clinical Psychology: Science and Practice, 11, 147-154. doi: 0.1093/clipsy.bph065 Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848. doi: 10.1037/0022-3514.84.4.822 Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance: The Philadelphia Mindfulness Scale. Assessment, 15, 204-223. doi: 10.1177/1073191107311467 Christopher, J. C., & Maris, J. A. (2010). Integrating mindfulness as self-care into counselling and psychotherapy training. Counselling and Psychotherapy Research, 10, 114-125. doi: 10.1080/14733141003750285 Council for the Accreditation of Counseling and Related Educational Programs. (2016). 2016 MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 20 standards. de Moor, C., Sterner, J., Hall, M., Warneke, C., Gilani, Z., Amato, R., & Cohen, L. (2002). A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a Phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychology, 21, 615-619. doi: 10.1037//0278-6133.21.6.615 Dixon, M., & Senior, K. (2011). Appearing pedagogy: From embodied learning and teaching to embodied pedagogy. Pedagogy, Culture and Society, 19, 473-484. doi: 10.1080/14681366.2011.632514 Figley, C. R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Psychotherapy in Practice, 58, 1433-1441. doi: 10.1002/jclp.10090 Francesconi, D., & Tarozzi, M. (2012). Embodied education: A convergence of phenomenological pedagogy and embodiment. Studia Phaenomenologica, XII, 263-288. doi: 10.7761/SP.12.263 Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132, 823-865. Retrieved from http://www.apa.org/pubs/journals/bul/ Fulton, C. L., & Cashwell, C. S. (2015). Mindfulness-based awareness and compassion: Predictors of counselor empathy and anxiety. Counselor Education & Supervision, 54(2), 122-133. doi: 10.1002/ceas.12009 Gallagher, S., & Zahavi, D. (2012). The phenomenological mind: An introduction to philosophy of mind and cognitive science (2nd ed.). New York, NY: Routledge. Gortner, E. M., Rude, S. S., & Pennebaker, J. W. (2006). Benefits of expressive writing in lowering rumination and depressive symptoms. Behavior Therapy, 37, 292-303. doi: 10.1016/j.beth.2006.01.004 MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 21 Graf, M. C., Gaudiano, B. A., & Geller, P. A. (2008). Written emotional disclosure: A controlled study of the benefits of expressive writing homework in outpatient psychotherapy. Psychotherapy Research, 18, 389-399. doi: 10.1080/10503300701691664 Greenberg, M. A., & Stone, A. A. (1992). Emotional disclosure about trauma and its relation to health: Effects of previous disclosure and trauma severity. Journal of Personality and Social Psychology, 63, 75-84. Retrieved from http://www.apa.org/pubs/journals/psp/ Greenberg, M. A., Wortman, C. B., & Stone, A. A. (1996). Emotional expression and physical health: Revisiting traumatic memories or fostering self-regulation. Journal of Personality and Social Psychology, 71, 588-602. Retrieved from http://www.apa.org/pubs/journals/psp/ Harrist, S., Carlozzi, B. L., McGovern, A. R., & Harrist, A. W. (2007). Benefits of expressive writing and expressive talking about life goals. Journal of Research in Personality, 41, 923-930. doi: 10.1016/j.jrp.2006.09.002 Hemenover, S. H. (2003). The good, the bad, and the healthy: Impacts of emotional disclosure of trauma on resilient self-concept and psychological distress. Personality and Social Psychology Bulletin, 29, 1236-1244. doi: 10.1177/0146167203255228 Horowitz, M. J. (2011). Stress response syndromes: PTSD, grief, adjustment, and dissociative disorders (2nd ed.). Plymouth, UK: Jason Aronson. Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York, NY: Free Press. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10, 144-156. doi: 10.1093/clipsy.bpg016 King, L. A. (2001). The health benefits of writing about life goals. Personality and Social MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 22 Psychology Bulletin, 27, 798-807. doi: 10.1177/0146167201277003 King, L. A. (2002). Gain without pain? Expressive writing and self-regulation. In S. J. Lepore & J. M. Smyth (Eds.), The writing cure: How expressive writing promotes health and emotional well-being (pp. 119-134). Washington, DC: American Psychological Association. King, L. A., & Miner, K. N. (2000). Writing about the perceived benefits of traumatic events: Implications for physical health. Personality and Social Psychology Bulletin, 26, 220230. doi: 10.1177/0146167200264008 Klein, K., & Boals, A. (2001). Expressive writing can increase working memory capacity. Journal of Experimental Psychology: General, 130, 520-533. Retrieved from http://www.apa.org/pubs/journals/xge/ Lane, J. (2012). Toward a model of embodied environmental education: Perspectives from theatre and indigenous knowledges. Journal of Experiential Education, 35, 395-411. doi: 10.1177/105382591203500302 Lee, S. M., Cho, S. H., Kissinger, D., & Ogle, N. T. (2010). A typology of burnout in professional counselors. Journal of Counseling & Development, 88, 131-138. doi: 10.1002/j.1556-6678.2010.tb00001.x Lepore, S. J. (1997). Expressive writing moderates the relation between intrusive thoughts and depressive symptoms. Journal of Personality and Social Psychology, 73, 1030-1037. Retrieved from http://www.apa.org/pubs/journals/psp/ Lepore, S. J., & Smyth, J. M. (Eds.). (2002). The writing cure: How expressive writing promotes health and emotional well-being. Washington, DC: American Psychological Association. Lu, Q. (2010). How benefits of expressive writing vary as a function of writing instructions, MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 23 ethnicity and ambivalence over emotional expression. Psychology & Health, 25, 669-684. doi: 10.1080/08870440902883196 Lum, W. (2002). The use of self of the therapist. Contemporary Family Therapy, 24, 181-197. doi: 10.1023/A:1014385908625 Lyubomirski, S., Sousa, L., & Dickerhoof, R. M. (2006). The costs and benefits of writing, talking, and thinking about life’s triumphs and defeats. Journal of Personality and Social Psychology, 90, 692-708. doi: 10.1037/0022-3514.90.4.692 Maris, J. A. (2009). The impact of a mind/body medicine class on counselor training: A personal journey. Journal of Humanistic Psychology, 49, 229-235. doi: 10.1177/0022167809331859 Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227-238. Retrieved from http://www.apa.org/pubs/journals/amp/ McAdams, D. P. (1996). Personality, modernity, and the storied self: A contemporary framework for studying persons. Psychological Inquiry, 7, 295-321. Retrieved from http://www.tandfonline.com/loi/hpli20 Mensinga, J. (2011). The feeling of being a social worker: Including yoga as an embodied practice in social work education. Social Work Education, 30, 650-662. doi: 10.1080/02615479.2011.586562 Merleau-Ponty, M. (1945/2013). Phenomenology of perception. (D. A. Landes, Trans.). London, UK: Routledge. (Original work published 1945). Moore, S. D., & Brody, L. R. (2009). Linguistic predictors of mindfulness in written selfdisclosure narratives. Journal of Language and Social Psychology, 28, 281-296. doi: 10.1177/0261927X09335264 MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 24 Niederhoffer, K. G., & Pennebaker, J. W. (2009). Sharing one’s story: On the benefits of writing or talking about emotional experience. In S. J. Lopez & C. R. Snyder (Eds.), Oxford handbook of positive psychology, 2nd ed. (pp. 621-632). New York, NY: Oxford University Press. O’Connor, D. B., Hurling, R., Hendrickx, H., Osborne, G., Hall, J., Walklet, E., . . . Wood, H. (2011). Effects of written emotional disclosure on implicit self-esteem and body image. British Journal of Health Psychology, 16, 488-501. doi: 10.1348/135910710X523210 Pennebaker, J. W. (1993). Putting stress into words: Health, linguistic & therapeutic implications. Behavior Research and Therapy, 31, 539-548. Retrieved from https://www.journals.elsevier.com/behaviour-research-and-therapy Pennebaker, J. W. (2000). Writing and health: Some practical advice. Retrieved from http://homepage.psy.utexas.edu/homepage/faculty/pennebaker/home2000/ writingandhealth.html Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95(3), 274281. doi: 10.1037/0021-843X.95.3.274 Pennebaker, J. W., & Chung, C. K. (2014). Expressive writing: Connections to physical health and mental health. In H. S. Friedman (Ed.), Oxford handbook of health psychology (pp. 417-437). Oxford, UK: Oxford University Press. Pennebaker, J. W., & Graybeal, A. (2001). Patterns of natural language use: Disclosure, personality, and social integration. Current Directions in Psychological Science, 10, 9093. doi: 10.1111/1467-8721.00123 Pennebaker, J. W., & Keough, K. A. (1999). Revealing, organizing, and reorganizing the self in MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 25 response to stress and emotion. In R. Ashmore & L. Jussim (Eds.), Self and social identity: Vol. II (pp. 101-121). Oxford, UK: Oxford University Press. Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56, 239-245. Retrieved from http://www.apa.org/pubs/journals/ccp/ Pennebaker, J. W., Mayne, T. J., & Francis, M. E. (1997). Linguistic predictors of adaptive bereavement. Journal of Personality and Social Psychology, 72, 863-871. doi: 10.1037/0022-3514.72.4.863 Pennebaker, J. W., Zech, E., & Rimé, B. (2001). Disclosing and sharing emotion: Psychological, social, and health consequences. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 517-544). Washington, DC: American Psychological Association. Poon, A., & Danoff-Burg, S. (2011). Mindfulness as a moderator in expressive writing. Journal of Clinical Psychology, 67, 881-895. doi: 10.1002/jclp.20810 Richards, K. C., Campenni, C. E., & Muse-Burke, J. L. (2010). Self-care and well-being in mental health professionals: The mediating effects of self-awareness and mindfulness. Journal of Mental Health Counseling, 32, 247-264. doi: 10.17744/mehc.32.3.0n31v88304423806 Rogers, C. (1961). On becoming a person. Boston, MA: Houghton Mifflin. Röhricht, F., Gallagher, S., Geuter, U., & Hutto, D. D. (2014). Embodied cognition and body psychotherapy: The construction of new therapeutic environments. Sensoria: A Journal of Mind, Brain & Culture, 56, 11-20. doi: 10.7790/sa.v10i1.389 Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological inquiry, MINDFULNESS-ORIENTED WRITING SELF-DISCLOSURE 26 9, 1-28. doi: 10.1207/s15327965pli0901_1 Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and Education in Professional Psychology, 1, 105-115. doi: 10.1037/19313918.1.2.105 Skosnik, P. D., Chatterton, R. T., & Swisher, T. (2000). Modulation of attentional inhibition by norepinephrine and cortisol after psychological stress. International Journal of Psychophysiology, 36(1), 59-68. Retrieved from https://www.journals.elsevier.com/international-journal-of-psychophysiology Slatcher, R. B., & Pennebaker, J. W. (2007). Emotional expression and health. In S. Ayers et al. (Eds.), Cambridge handbook of psychology, health and medicine: 2nd ed. (pp. 84-87). Cambridge, UK: Cambridge University Press. Sloan, D. M., & Marx. B. P. (2004). Taking pen to hand: Evaluating theories underlying the written disclosure paradigm. Clinical Psychology: Science and Practice, 11, 121-137. doi: 10.1093/clipsy.bph062 Sultan, N., & Fox, K. L. (2013). Vicarious traumatization, burnout, and self-care for mental health therapists: A literature review. Academia, 3, 26-35. Tausczik, Y. R., & Pennebaker, J. W. (2010). The psychological meaning of words: LIWC and computerized text analysis methods. Journal of Language and Social Psychology, 29(1), 24-54. doi: 10.1177/0261927X09351676