Mindfulness in Therapy: Beyond the Breathing Exercise
By Kristen McClure, MSW, LCSW | TherapistWorksheet.com
Mindfulness in therapy has been reduced to breathing exercises in many practice settings. The clinical application is far richer than that — and the evidence base supports its use across a wide range of presentations. Here is what mindfulness actually looks like when it is used skillfully in a therapy session.
What Mindfulness Is in a Clinical Context
Mindfulness is the practice of paying deliberate, non-judgmental attention to present-moment experience — thoughts, feelings, sensations — without trying to change or escape them. In therapy, it is both a technique (using mindfulness practices with clients) and a stance (the therapist’s own quality of presence in session).
Mindfulness-based interventions with strong evidence support include MBSR (Mindfulness-Based Stress Reduction), MBCT (Mindfulness-Based Cognitive Therapy for depression relapse prevention), and mindfulness components within DBT and ACT.
Mindfulness Techniques That Work in Session
Brief grounding practices
Even 60-90 seconds of deliberate present-moment attention can shift a client’s state. “Before we dive in, let’s just take a moment to arrive. Notice where you are, how your body feels in the chair, what’s present right now.”
The STOP practice
Stop, Take a breath, Observe, Proceed. Useful for clients in anxious reactivity. Can be taught in session and used between sessions. “When you notice you are caught up in worry or reactivity, try STOP — just pause what you are doing, take one deliberate breath, observe what you are feeling and thinking without judgment, then proceed from that more aware place.”
Labeling emotions and thoughts
Research shows that labeling an emotional experience — putting words to it — activates the prefrontal cortex and reduces amygdala reactivity. “I notice that as you talk about this, something is happening. If you had to name what you are feeling right now, what would you call it?”
Mindfulness of thoughts
Observing thoughts as events rather than facts — consistent with ACT defusion. “Instead of following that thought, see if you can just notice it. ‘There goes my mind again, saying I’m going to fail.’ The thought is there — you do not have to argue with it or believe it.”
Body scan
Moving attention systematically through the body, noticing sensation without judgment. Useful for clients who are disconnected from body experience, and for building interoceptive awareness. Can be done briefly in session (5 minutes) or as a longer practice for home.
Open monitoring vs. focused attention
Focused attention practices (concentrating on breath) are good for training sustained attention and calming. Open monitoring practices (noticing whatever arises without grasping or aversion) build equanimity and decentering. Match the practice to the clinical goal.
Mindfulness and the Therapeutic Relationship
The therapist’s own mindfulness practice — or lack of it — shows up in the room. Presence, attunement, and the ability to stay with difficult material without anxiety or urgency are qualities that mindfulness cultivates in practitioners. Therapists who practice mindfulness themselves tend to be more effective than those who teach it without embodying it.
When Mindfulness Is Not the Right Intervention
Mindfulness is not appropriate for all clients or all moments:
- Clients with psychosis — unstructured internal attention can be destabilizing
- Acute dissociation — closing the eyes and turning inward can worsen dissociation
- Early trauma work — mindfulness of body sensation before adequate stabilization can flood the system
- Clients in crisis — a breathing exercise when someone is in acute distress can feel dismissive
Adapt the approach. Eyes open, contact with external environment, brief rather than extended practices are modifications that work for many clients who struggle with standard mindfulness.
Frequently Asked Questions
Do I need my own mindfulness practice to teach it to clients?
The evidence suggests yes — therapists with personal mindfulness practice tend to have better outcomes with clients when using mindfulness interventions. At minimum, have enough experiential familiarity to guide practices from the inside, not just read scripts.
What if a client says they “can’t” meditate?
Explore what they tried. Most people who say this have tried one form of mindfulness (often breath-focused, eyes closed) and found it unhelpful or activating. There are many entry points — mindful walking, mindful eating, brief eyes-open attention practices — that work for clients who struggle with traditional meditation.
How do I introduce mindfulness to a skeptical client?
Lead with the evidence and explain it in non-spiritual terms. “There is actually quite a bit of research showing that training your attention — even briefly — changes how your brain responds to stress. It is a skill, not a belief system. I would love to try a 2-minute version with you and see what you notice.”
Is mindfulness the same as relaxation?
No. Mindfulness is about awareness, not relaxation — though relaxation is sometimes a side effect. Mindfulness asks you to observe your experience, including difficult experience, without aversion. Relaxation techniques aim to reduce physiological arousal. Both have clinical utility; they are different tools.
Kristen McClure, MSW, LCSW is a licensed therapist who creates practical clinical tools to help therapists navigate the hardest moments in their work.