In the article Loving-Kindness Meditation and Empathy: A Wellness Group Intervention for Counseling Students by, Monica Leppma and Mark E. Young

Did the researcher clearly restate the purpose and research hypotheses or questions?

Did the researcher clearly discuss the implications of the findings and how they relate to

theories, others' findings, and actual practice?

Did the researcher(s) provide alternative explanations of the results obtained when there is discrepancy with other sources or expected outcomes?

Did the researcher(s) identify potential limitations of the study and the results?

Did the researcher(s) identify possible directions for future research?

Article Below

Received06/11/14Revised 09/10/14 Accepted09/15/14

DOI:10.1002/jcad.12086

The effect of a 6-week loving-kindness meditation (LKM) on the multidimensional empathy of 103 master's-level counseling students was evaluated, in addition to the correlation between reported levels of time spent meditating andempathy.StatisticalanalysesindicatedthatparticipantswhoreceivedtheLKMinterventionexperiencedgainsin dimensions of empathy.A significant relationship between quantity of meditation and perspective taking was noted. Implications and suggestions for future research are explored.

Keywords:loving-kindnessmeditation,mindfulness,counseloreducationanddevelopment,wellness,empathy

Counselorsarechargedwithmaintainingtheirownpersonal wellness because counselor characteristics have a significantimpactonthetherapeuticalliance(Ackerman&Hillsenroth, 2003;Norcross,2002;Roach&Young,2007;Rogers,1957).Inaddition,empathyiscriticalfordevelopingthetherapeu- tic alliance and is associated with positive client outcomes (Bohart,Elliott,Greenberg,&Watson,2002;Elliott,Bohart, Watson,&Greenberg,2011;Greenberg,Watson,Elliott,& Bohart,2001).Empathy,however,isalsorelatedtocounselor burnout and impairment (Cherniss, 1995; Maslach, 1982; Skovholt, 2001). Meditation is one established means for promotingwellnessandcultivatingpositiveemotionswhile increasingempathy(Creswell,Way,Eisenberger,&Lieber- man,2007;Fredrickson,Cohn,Coffey,Pek,&Finkel,2008; Kabat-Zinn, 2005).

Researchers have generally agreed that empathy is a multidimensionalconstructthatencompassescognitiveand affectivecomponents(Davis,1980;Pearson,1999).Cogni- tiveempathyisdefinedastheaccurateperceptionofanother person'semotionalexperiencecombinedwithfeelingconcern fortheotherperson'swell-beingwhilenotvicariouslyexpe- riencing the other person's emotional state (Miller, Stiff,& Ellis,1988).Anothertermforcognitiveempathyisdetachedconcern(Savicki & Cooley, 1982). Emotional empathy, or affective empathy, is the term used to describe when an in- dividualisinfluencedbyanotherperson'semotionalstateto theextentoftakingontheotherperson'semotions.Adispro- portionateamountofemotionalempathy,alsoreferredtoas

emotionalcontagion,isassociatedwithburnoutandimpair- ment (Cherniss, 1995; Maslach, 1982; Miller et al., 1988).

Mindfulnessmeditationmayprovideameansforpromot-ingempathyandmanagingstress.Mindfulness-basedstress reduction(MBSR)wasdevelopedbyKabat-Zinn(2003)andcolleaguesandhasdemonstratedsuccessfulapplicationtoa variety of physical and psychological problems, as well as theabilitytoincreasewell-being.MBSRcalmsthemindand bodysothatparticipantsmaygaininsightandbecomeawareofhabitualreactions,thoughts,andbehaviors.Mindfulness involvesacceptance,attentivenesstothemoment,awareness, relaxation, and suspension of judgment and can potentially transform the practitioner's perceptions and interpretations oflifecircumstances(Beddoe&Murphy,2004).According to Beddoe and Murphy (2004), "attending to the present moment,whileincorporatingself-reflectionandsuspending judgment,canbeparticularlybeneficialinfosteringthedepth andauthenticityofhumanconnectionrequiredbyhealthcareprofessionals" (p. 307).

Loving-kindness meditation (LKM), a type of mindful- ness meditation, is a compassion-based meditation that in- corporatescognitiveandemotionalaspects.LKMincreases feelings of warmth and caring for oneself and others. The practice begins with directing loving-kindness, or compas- sion,towardone'sself.Asasenseofrespect,friendship,and loveorcompassiondevelopswithoneself,thepracticethen expands to include others (Salzberg, 1995). Unlike cogni- tivebehaviortherapy approaches,LKMdoes notattempt to

Monica Leppma,Department of Counseling, Rehabilitation Counseling, and Counseling Psychology,WestVirginia University;Mark E.Young,DepartmentofChild,Family,andCommunitySciences,UniversityofCentralFlorida,Orlando.CorrespondenceconcerningthisarticleshouldbeaddressedtoMonicaLeppma,DepartmentofCounseling,RehabilitationCounseling,andCounselingPsychol- ogy, West Virginia University, PO Box 6122, Morgantown, WV 26506 (e-mail: M..a@mail.wvu.edu).

2016bytheAmericanCounselingAssociation.Allrightsreserved.

modifycognitive or behavioral factors.The primary purposeofLKMistouseanaffectivetechniquetocultivatepositive emotions (Carson et al., 2005).

LKMandEmpathy

Preliminary research on LKM has suggested that this type of meditation may result in increased empathy (Corcoran, 2007; Weibel, 2007); thus, LKM may be most suitable for counselors-in-training. Preparing counseling students in- volvesteachingthemtobeempathic(Greenbergetal.,2001;Skovholt,2001).Ameditationtechniquethatcouldimprove empathicperformance,andserveasprotectionagainstimpair- mentthroughthecultivationofpositiveemotions,wouldbeanimportantcontributiontocounseloreducationandthecoun- seling field by promoting counselor wellness and efficacy.

Shapiro, Brown, and Biegel (2007) demonstrated that meditation may be an effective intervention for therapists- in-training by reducing stress, anxiety, negative affect, and rumination and significantly increasing positive mood and self-compassion. Meditation was also effective with medicalandpremedicalstudents,resultinginreducedanxiety,reduced psychological distress, and increased empathy (Shapiro, Schwartz,&Bonner,1998).Finally,GreasonandCashwell (2009)providedempiricalsupportforarelationshipbetween mindfulnesspracticeandimportantcounselorcharacteristics, suchasempathy and counselor self-efficacy.Thus, meditationmay be an effective technique in counselor development.

Ifcounselingstudentscanbetaughttousemeditationasa self-caretooltoenhanceempathyandcultivatepositiveemo-tions, they may also gain the tools needed to buffer against stress and impairment. LKM was shown to be effective in increasing several personal characteristics and resources importanttocounselorwellnessandefficacy,suchascompas- sion(Weibel,2007),connectedness(Seppala,2009),empathic response(Lutz,Brefczynski-Lewis,Johnstone,&Davidson, 2008), environmental mastery, social support, and purpose inlife(Fredricksonetal.,2008).LKMwasalsoshowntobe effectiveinreducingnegativereactions,suchasanger(Car- sonetal.,2005)andphysiologicalstress(Paceetal.,2010). TheuseofLKMinpreservicecounselors,however,hasnot beentested.Thepresentstudywasdesignedtodetermineif LKM is an efficient and effective mechanism for enhanced counselor development.

QuantityofMeditationTime

Studiesofmindfulnessmeditationhaveyieldedmixedresultswithregardtotheeffectsoftimespentinmeditationoutside ofgroupsessions(Baer,2003;Shapiroetal.,2007;Weibel, 2007). Carson et al. (2005) indicated that minutes practic- ingLKMpredicteddailyangerscoresthefollowingdaybut did not predict improvement in pain or other psychological symptoms.BeddoeandMurphy(2004)foundasignificant

relationship between regular mindfulness meditation and thebelief in one's ability to improve one's health in a study of nursingstudents;increasedawarenessofstressanditscauses, better self-care, and hopefulness were also observed. Fred- rickson et al. (2008) found that the amount of time spent in meditationwasasignificantpredictorofpositiveemotions. In contrast, Shapiro et al. (2007) found no relationship betweenthequantityofmindfulnessmeditationpracticeand changes in stress or well-being among counseling psychol- ogystudents.Similarly,Davidsonetal.(2003)foundno relationshipbetweentheamountoftimespentinmindfulness meditationpracticeandphysiologicaloutcomesinasample ofbiotechemployees.Finally,Weibel(2007)foundnorela- tionshipbetweentheamountoftimespentinLKMbetween sessionsandimprovementinoutcomemeasuresamongun- dergraduatepsychologystudents.Thus,whethertheamount oftimespentmeditatingaffectsoutcomesisstillnotknown. The purpose of this study was to explore the effect of an LKM-basedwellnessgrouponcounselingstudents'empathy. We also aimed to examine if the effects were related to the amount of time spent in meditation and to explore LKM as a possible means to improve mood.The study was the first to examine LKM as an empathy training intervention for preservicemaster's-levelcounselors.Weposedthefollowing

research questions:

ResearchQuestion1:WillLKMhaveapositiveeffectoncounseling students' levels of empathy?

ResearchQuestion2:Istherearelationshipbetweenthe amount of time spent in meditation and empathy?

Method

Design

Thisstudyusedaquasi-experimentaldesigntomeasurethe effectofanLKMinterventiononpreservicecounselingstu- dents.Afterreceivinginstitutionalreviewboardapproval,we divided107master's-levelcounselingstudentsintotreatment and control groups based on their ability to attend a group at a particular time. Four participants did not complete the study, leaving a total sample size of 103.

The majority of participants (n= 60) were in their first semester, enrolled in an introductory counseling course. This course included a mandatory experiential psychoedu- cationalgroupduringclasstime,consistingof6weeksina wellnessgroupand6weeksinaninterpersonalskillsgroup. Participants from this introductory course were randomly assignedtooneoffourgroups:twowellnessgroupsandtwo interpersonal skills groups.Those assigned to the wellness groups received the LKM intervention. Those assigned to the interpersonal skills groups served as the control group. Theremaining(n=43)participantswereinvaryinglevelsofthemaster'sprogram.Twenty-fourparticipantswereableto

participateaspartofawellnessclass,andtheremaining19 participants did not receive any class credit.The instructor forthewellnessclassprovidedhalfanhourofclasstimeto participate in the LKM group. Consequently, this interventiongroupbeganhalfanhourbeforeclassandcontinuedthrough thefirsthalfhourofclasstime.Thus,thecontrolgroupand treatmentgroupparticipantsfromthewellnessclassstarted class half an hour later than originally scheduled to accom- modatethestudy.Theremainingparticipantsattendedtheir groups outside of any class time.

Toavoidresearcherinfluenceorbias,theprimaryinvesti-gator(thefirstauthor)didnotfacilitateanyofthegroups.A total of six facilitators conducted the LKM group interven- tions. Four facilitators were 1st-year doctoral students who wererequiredtocofacilitatepsychoeducationalgroups.The fifthfacilitatorwasa3rd-yeardoctoralstudent,andthesixth facilitator was a postdoctoral instructor in the counselor education program.

Thefacilitatorsparticipatedina1-hourtrainingandwere providedwithmanualsdevelopedbytheprincipalinvestigator for this study, which included scripts for the group curriculumandthemeditations,sessionoutlinesdelineatingthetimeal- lotted for each component of the session, and copies of the psychoeducational handouts for the participants. (Copiesof the manual may be obtained from the first author.) The facilitatorswereinstructedtodeliverthepsychoeducational sessionsinlanguagethatwascomfortabletothembuttouse thescriptswhenfacilitatingthemeditations.Allfacilitators were experienced in running counseling groups; thus, they wereadvisedtousetheircounselingskillsforthediscussion andprocessingduringthesessions.Thefirstauthorrandomly observed treatment groups to ensure adherence to the manual-ized group curriculum using a fidelity checklist.

PowerAnalysis

AnaprioripoweranalysiswascalculatedusingG*Power3.1(Faul, Erdfelder, Lang, & Buchner, 2007) for all statistical analysesusedinthisstudy.Thepoweranalysisforarepeated measuresmixed-modelanalysisofvariance(ANOVA)with tworepetitions,apowerequalto.80(Cohen,1992),andan alpha level of .05 indicated that a sample size of 25 partici- pants in the treatment and control groups (i.e., a total of 50 participants) would be needed to detect a moderate effect size of .25.

The a priori power analysis for a Pearson product-mo- mentbivariatecorrelationwithapowerequalto.80(Cohen, 1992)andanalphalevelof.05indicatedthatasample of 84 participants would be required to detect a medium effect size of .30. Therefore, data on the amount of time spent meditating were collected for 12 weeks and included meditation logs from the interpersonal skills control group when they switched to their 6-week wellness groups in the second half of the semester.

Participants

The initial sample for this study was 107 counseling stu- dentsenrolledinmaster's-levelcounseloreducationclasses at a large university in the southeastern United States.The sampleincluded94women(88%)and13men(12%).Three studentswithdrewfromthestudyandonedidnotcomplete theposttest,leavingatotalof103.Allfourparticipantswho did not complete the study were women. The mean age of all participants was 27.5 years (SD= 8.2, range = 20-57), withamodalageof23years.Fifty-threepercent(n=57)of thestudentswereintheirfirstsemester.Thereportedracial composition of the overall sample included Caucasian (n= 80,75%),Hispanic(n=12,11%),Black(n=4,4%),Asian (n=2,2%),andotherorbiracial(n=9,8%).Fifty-oneper- cent(n=56)oftheparticipantsreportedthattheyhavetried meditating in the past, but only 12% (n= 13) reported that they currently meditated.

Aprogram-widee-mailwassentoutbeforethebeginning ofthesemestertointroducethestudyandrecruitparticipants.In addition, the first author visited the introductory class to describe the study and offer students the option to exclude theirdatafromthestudy.Thefirstauthoralsovisitedawell- ness class to recruit additional participants.

Eachparticipantreceivedaninformedconsentformprior to the commencement of the study. No participants'grades wereaffectedbylevelofparticipationinanyofthegroups, and their empathy scores had no effect on their standing in the program. Participants receiving class credit for group participation were advised that they were not required to engage in the meditation practice. The wellness concepts discussedinthegroups,however,incorporatedLKM-related components,suchasmindfulness,self-care,connectedness, and compassion.

Measures

Participantdemographics,theoutcomemeasureofmultidi- mensional empathy, and two independent variables (LKM treatment and quantity of meditation) were assessed in this study. The demographic questionnaire gathered informa- tionregardingage,sex,race,education,andemployment.

Inaddition,self-reportinformationwascollectedregarding
meditationexperience,spirituality,stress,wellness,andlife
satisfaction.	WhileparticipantswereintheLKMgroups,they
completedweeklymeditationlogsdocumentingtimespent
dailypracticingformalmeditationbetweengroupsessions.
ThelogsalsoaskediftheparticipantslistenedtotheCDthat
wasprovidedforthestudy,andifso,whichtrack(s)they
listenedto.	Finally,each meditationlog asked participants to
ratehowwelltheywereabletobringtheattitudes,intentions,
andprinciplesdiscussedinthegroupintotheirdailylives.
Theywereprovidedoptionsona5-pointLikertscaleranging
from1=stronglydisagreeto5=stronglyagree.

Procedure

Datacollection.Thedatacollectedduringthefirstsession
includedademographicquestionnaireandtheIRI.Weekly
meditationlogswerecollectedfromWeek2throughWeek6.
Finally,asecondadministrationoftheIRIwascollected,along
withaposttestquestionnaire.Thecontrolgroup participants
received the6-week LKMinterventionduringthesecond half
ofthesemester.AnadditionaladministrationoftheIRIwasnot
includedbecausethedelayedinterventionincludeddifferent
groupfacilitators,therewasapossibleprimingeffect,andthe
participantswerenolongerblindtothetreatment.Because
thesefactorsdidnotinfluencetheamountoftimespentmedi-
tating,wecollectedweeklymeditationlogsfromtheseformer
control group participantsfor thecorrelationalanalysis.
Intervention.	TheLKMinterventionconsistedofsix
weekly60-minutesessionsinagroupformat.Therewerefive
treatmentgroupsandfour controlgroups.Groups consisted
of13to17participants.Thehour-longinterventionincluded
30minutesforcheck-in,processing,andpsychoeducation
relatedtomeditationandcounselorwellness;10to20minutes
fortheLKMexercise;andtheremaining10to20minutes
forprocessinganddiscussion.Themeditationscriptswere
adaptedprimarilyfrom Weibel(2007),withadditionalver-
biagefromFredricksonetal.(2008),theMindfulnessAware-
nessResearchCenter(n.d.),andSalzberg(2005).

liffordson, 2002;Greason&Cashwell,

2009).

(Greason

&Cashwell,2009;Skovholt,2001).

itemsintheotheremo-

tionalempathysubscale,

others(Cliffordson,2002;Constantine,2001;Davis,1983). The IRI was designed to allow for individual interpretation of each subscale to capture the multidimensional nature of empathy. Higher scores suggest higher levels of empathy (Davis, 1980).

TheIRIhasdemonstratedacceptableinternalreliability. ThefinalformoftheIRIwasnormedonapopulationof1,161college students (579 men and 582 women). Standardized alpha coefficients for scores on the four subscales ranged from .70 to .78 (Davis, 1980). Research has supported the four factors included in the instrument (Cliffordson, 2002; Davis,1983).Fortheparticipantsinthisstudy,scoresonthe IRI demonstrated acceptable internal reliability, with an alphacoefficient of .76.

Thepsychoeducationalaspectofthetreatmentexplicitly connected meditation with counselor wellness. Session 1 introducedtheconceptsofmindfulnessandLKM.Session2 covered the importance of counselor self-care and strategies. Session3introducedparticipantstosixareasofwellnessandexploredhowthinkingpatternsaffectwellness.Sessions4and5providedpsychoeducationonconnectednessandempathy, respectively. The final session consisted of a review of all the concepts, an expanded LKM experience to include all beings, closure, and posttests.Throughout the intervention, participantswereencouragedtoremainmindfulandtoprac- tice loving-kindness principles in their daily lives.

Results

Before discussing sample integrity and the results of the researchquestions,weaddressseveralvariablesthathadthe potential to affect study outcomes.We report data from the participants who responded (N= 99, 100%).The first vari- ablewasself-reportedlevelofparticipationinthestudy.Five (5%)participantsindicatednone,65(66%)indicatedmoder-ate,and29(29%)indicatedhighlevelofparticipation.(All percentages have been rounded to total 100%.)The second variablewasthenumberofLKMgroupsattended.Sixty-three (64%)participantsattendedsixsessions,23(23%)attended five sessions, nine (9%) attended four sessions, three (3%) attended three sessions, zero (0%) attended two sessions, andone(1%)attendedonesession.Thefinalvariablewas

levelofsatisfactionwithLKM.Four(4%)participantswere verydissatisfied,24(24%)weredissatisfied,54(55%)were

satisfied(55%),and17(17%)wereverysatisfied.Descriptivestatistics indicated that the majority of participants (64%) indicatedimprovedmoodresultingfromLKM,31%reported nodifferenceintheirresultantmood,and5%reportedworsemoodresultingfromLKM.Thus,LKMappearedtosubjec- tivelyimprovethemoodstatesofthemajorityofparticipants.

SampleIntegrity

WeconductedANOVAstoinvestigateanygroupdifferencesbetweentreatmentandcontrolgroupswithregardtosex,race,age, stress level, wellness level, and life satisfaction level. The analyses showed no significant difference between the groups.Weconducted independent-samples ttests to examineanypretestmeandifferencesbetweentreatmentandcontrol groups. There were no significant differences between the treatmentandcontrolgroupsoninitialFSorPDscores.Re- sults indicated that there was a significant difference in pretestscoresbetweenthetreatmentgroup(M=26.74,SD=3.69) andthecontrolgroup(M=29.19,SD=63.63)onPT,t(105)

= 3.38, p = .001.There was also a significant difference on pretestscoresbetweenthetreatmentgroup(M=27.20,SD

=4.50)andthecontrolgroup(M=29.14,SD=3.31)onEC, t(103)=2.57,p=.012.Thecontrolgroup'spretestscoresforPT and EC were higher than those of the treatment group.

Datawerecollectedregardingparticipants'self-reported wellness,lifesatisfaction,stress,andimportanceofspiritual- ity,whichmayprovideinsightsintoparticipants'mind-sets. Abouthalfoftheparticipantsreportedhighorveryhighlevels ofwellness,and42%reportedamoderatelevelofwellness. Over70%oftheparticipantsreportedhighorveryhighlife satisfaction.About half of the participants reported experi- encingmoderatestresslevels,and35%reportedhighorveryhigh stress. Seventy-seven percent of the participants reportedthat spirituality was important or very important, and 28% reported that spirituality was only a little important. Thus, themajorityofparticipantsreportedpositiveevaluationsof theirownwellness,lifesatisfaction,andspiritualityandwereexperiencing at least moderate levels of stress.

ResearchQuestion1

TheIRIassessesthemultidimensionalconstructofempathy withfourseparatelyinterpretedsubscales.Therefore,weused repeatedmeasuresmixed-modelmultivariateanalysisofvari-ance to determine if there was a difference between groups (i.e., treatment group and control group) and within groups (i.e.,atpretestandposttest)withregardtoIRIsubscalescores. Althoughsamplessizeswereunequalforthesegroups,the treatment group was less than twice the size of the control group,whichisacceptable(Pallant,2007).Box'sMtestfor equality of covariance wassignificant (p< .001), so the as- sumptionofequalcovariancewasviolated.However,Box's

Mtestisparticularlysensitivetodeviationsfromnormality (Hair, Black, Babin,Anderson, &Tatham, 2006). We con- ducted tests for skewness and kurtosis and determined that the EC scores at ObservationTime 1 were slightly skewed, nearlywithintwostandarddeviations(g1=-.49).Reviewof thehistogramrevealedthatthescoreswerenegativelyskewed, indicatingthatbothtreatmentandcontrolgroupparticipants respondedtowardthehigherendofthescaleattheoutset.It is common in the social sciences that data are not normally distributed,andthestatisticaltestsaregenerallyconsideredto berobustenoughtoaccommodatedeparturesfromnormality forsamplesizeslargerthan30.However,becauseoftheas- sumptionviolations,Pillai'stracewasconsulted,becausethistestismorerobustthanthecommonlyusedWilks'slambda (Pallant, 2007).

Results from the multivariate test indicated a signifi- cant interaction effect between time and treatment, Pillai's trace = .11, F(4, 98) = 2.89, p= .026, partial2= .11. We examined univariate test results to determine which of the four subscales demonstrated a significant Time Treat- ment interaction effect. Results indicated that there was no interaction effect between time and treatment for either of the two emotional empathy subscales: for EC, F(1, 101) = 1.35,p>.05,partial2=.01,andforPD,F(1,101)=0.21, p > .05, partial2= .00. Between-subjects treatment main effect results for these two subscales were also not statisti- cally significant: for EC, F(1, 101) = 3.20, p> .05, partial2=.03,andforPD,F(1,101)=2.60,p>.05,partial2

= .03. Because there was no Time Treatment interaction effectforECorPD,weexaminedtheunivariatetestresults anddeterminedamaineffectfortimeforthetreatmentand control groups for both emotional empathy subscales: for EC,F(1,101)=6.75,p=.011,partial2=.06,andforPD, F(1, 101) = 8.10, p= .005, partial2= .07. Because of the multipletestsofsimplemaineffectsinthefollowinganaly- ses, we used Bonferroni correction to adjust alpha levels to controlforinflatedTypeIerror.Theadjustedalphalevelfor the following simple main effects tests was .01.

Weconductedasimplemaineffectstesttodeterminethe effect sizes of the change within the control and treatment groupsforthetwoemotionalempathysubscales(ECandPD) asassessedbypartial2.ResultsindicatedthattheincreaseinEC scores for the treatment group was statistically significant,F(1,101)=8.21,p=.006,partial2=.12.Therewasalarge (Sink&Stroh,2006)relationshipbetweentheLKMtreatment andtheincreaseinECscores.TheLKMtreatmentaccounted for11.5%ofthevarianceinECscoresinthetreatmentgroup. TherewasnochangeinECscoresforthecontrolgroup,F(1,38) = 1.08, p= .306, partial2= .03.

The results of the test of simple main effects for the PD subscaleindicatedthatthedecreaseinPDscoresforthetreat-ment group was not statistically significant at the adjusted alphalevel,F(1,63)=6.11,p=.016,partial2=.09.There

was also no change in PD scores in the control group, F(1, 38) = 3.29, p= .078, partial2= .08.

There was a statistically significant interaction effect betweentimeandtreatmentforthetwocognitivesubscales: forPT,F(1,101)=5.05,p=.03,partial2=.05,andforFS, F(1, 101) = 9.46, p= .003, partial2= .09.A simple main effects test was conducted for the two cognitive subscales (PT and FS) exhibiting the statistically significant Time Treatmentinteractioneffect:forPT,F(1,101)=13.18,p

=.000,partial2=.21,andforFS,F(1,63)=13.18,p=

.001, partial2= .17.There was no change in PT scores in the control group, F(1, 38) = .232, p= .63, partial2= .01, and no change in FS scores in the control group, F(1,38)= 1.27,p=.273,partial2=.03.Participantswhoreceivedthe treatmentscoredhigherontheposttestthanonthepreteston thePTandFSsubscalescomparedwiththoseinthecontrol group.There was a large (Sink & Stroh, 2006) relationship between the LKM treatment and the increase in PT scores. TheLKMtreatmentaccountedfor21.3%ofthevariancein PTscoresinthetreatmentgroup.Therewasalsoalarge(Sink&Stroh,2006)relationshipbetweentheLKMtreatmentand the increase in FS scores. The LKM treatment account for 17.3% of the variance in FS scores in the treatment group.

ResearchQuestion2

The relationship between mean weekly meditation (as measured by mean meditation time calculated from com- pleted meditation logs) was investigated using the Spear- man correlation coefficient. There was a medium (Cohen, 1992) positive correlation between meditation time and the cognitiveempathysubscaleforPT(rs=.292,n=96,p=

.004),withhighermeditationtimescorrelatedwithhigher

PT levels. No significant relationships were found between meanweeklyreportedmeditationtimeandtheIRIsubscales EC, PD, or FS.

Discussion

We chose LKM as the intervention because it has been showntoimprovemoodinpractitioners(Carsonetal.,2005;Fred- ricksonetal.,2008;Seppala,2009)andwashypothesizedto increasemultidimensionalempathy.Themajorityofpartici- pants in this study did report improved mood attributed to the LKM treatment.

Results from Fredrickson et al. (2008) may explain the failure of LKM to improve mood for some participants in thepresentstudy.Fredricksonetal.observedinitiallylower levels of positive emotions in the LKM group. Beginning meditation practice involves doing something unfamiliar anddifficultwithoutimmediaterewards.Fredricksonet al. theorized that beginning a meditation program is simi- lar to starting any self-change project when individuals realizetheymustactuallydothework.Fredricksonetal.

postulated that this may be due to "increased awareness of challenging inner states" (p. 1059) that participants were not previously aware of. Kabat-Zinn (2005) outlined five typical obstacles to meditation: craving, anger, boredom, restlessness, and doubt. In the present study, some partici- pants expressed such feelings in the comment section onthe posttest questionnaire.

Theresultsofthisstudysuggestthatawellnessinterven- tionwithanLKMcomponentmaybeaneffectivemeansfor increasingthecognitiveaspectsofempathyincounselors-in- training.Thisfindingisimportantbecausetheliteraturehas indicated that counselors need a balance of emotional and cognitiveempathy(Maslach,1982;Skovholt,2001).Although emotionalempathyfacilitatesconnectionwithclients,itcan also lead to emotional vulnerability and burnout. Cognitive empathy is a protective factor against emotional contagion becauseitallowscounselorsnotonlytosustainaconnection withclientsandaccuratelysenseclients'emotionsbutalsotomaintain a detached concern.Although emotional empathy scores (EC) also increased in this study, the effect sizes for thecognitiveempathyscoresforPT(.21)andFS(.17)were largerthantheeffectsizeforEC(.12).Therefore,ourresults demonstratethatitispossibletoincreasecognitiveempathy scoresthroughanLKMinterventiontomaintainthebalance between emotional and cognitive empathy.

The emotional empathy pretest scores for counseling studentsinthisstudywere20%to30%higherthanthoseof typicalcollege-agefemalestudentsinotherstudies(Atkins & Steitz, 2000; Davis, 1980) and 30% to 50% higher than thoseoffemalepsychologists(Hall,Davis,&Connely,2000). Womengenerallyscorehigherthanmenonthesemeasures (Davis, 1980), and pretest means in the present study were alsoconsiderablyhigherthanthoseofmeninotherstudies. AlthoughemotionalempathyscoresforECimprovedinthe presentstudy,theconcurrentfindingofincreasedcognitive empathyscoresispromising.Individualshavinghigherlev- elsofemotionalempathyaredrawntohelpingprofessions, yet this same characteristic predisposes them to experience burnout(Maslach,1982;Pines&Aronson,1988).Aninter- ventionthatincreasescognitiveempathymayhelptooffset susceptibility to burnout.

Thepretestcognitiveempathyscoresofparticipantswerealso higher than those of other populations. For example, the PT and FS scores of participants were 25% to 40% higher than those of typical college-age female students (Atkins&Steitz,2000;Davis,1980).ThePTpretestscores for participants in the current study were 26% higher than those of female psychologists (Hall et al., 2000).Thus, the intervention positively affected cognitive empathy scores that were already elevated.

The increase in cognitive empathy resulting from the LKM intervention in the present study is consistent with Fredricksonetal.'s(2008)finding ofincreasedmindfulness.

The process of mindfulness allows one to disidentify from emotionsandvaluejudgments,therebyincreasingawareness ofthepresentmomentwithclarityandobjectivity(Shapiro & Carlson, 2009). This is analogous to detached concern, whichisdefinedastheaccurateperceptionofanotherperson's emotionalexperiencecombinedwithfeelingconcernforthe otherperson'swell-beingwhilenotvicariouslyexperiencing theotherperson'semotionalstate(Milleretal.,1988;Savicki & Cooley, 1982).

Itisuncleariftheamountofmeditationtimesignificantly affectsvariablesimportanttocounselordevelopment,suchas empathyandwell-being.Shapiroetal.(2007)suggestedthattheremaybeacriticalthresholdofmeditationpracticetime necessarytosignificantlyaffectpsychologicalvariables,but quality may be a more potent factor than quantity. No measuresofqualityofmeditationpracticecurrentlyexist.Inthepresent study,timespentinmeditationwaslimited.Still,theobserved positiverelationshipbetweentheamountofmeditationand cognitiveempathy(PT)suggeststhatincreasingtheamount ofpracticecanhelptoimprovePTability,acriticalfactorin counseling.BecausethisstudydemonstratedthatabriefLKMgroup intervention could improve both emotional and cognitiveaspectsofempathyincounselingstudents,webelievethatLKMhas significant potential for counselor training.

Limitations

Althoughthisstudyprovidesstatisticallysignificantresults, several limitations should be considered. The majority of participantswererandomlyassignedtotreatmentorcontrol groups; however, 20 self-selected volunteers were included inthetreatmentgroup.Thispresentsathreattointernalvalidity owing to possible pretreatment differences between groups (Campbell &Stanley, 1963; Heppner, Kivlighan, &Wampold,1992),particularly because most of thevolunteers were includedinthetreatmentgroup.Inaddition,itispossiblethatthereweredifferences in the teaching or presentation skills of the different facilitators.To helpcontrol forthese possibilities,we conductedstatisticalanalyses.Weconfirmedthattherewasnointeraction effectbasedontheparticulargroupattendedandnobetween- groups differences in demographics.There were, however,dif- ferencesin pretestscoresforECandPT.Thetreatmentgroup's EC mean (M= 29.22)was slightlylower than the control group's ECmean(M=29.67;bothps=.001).Thetreatmentgroup'sPT mean(M=29.05)wasslightlylowerthanthecontrolgroup'sPTmean(M=29.51;bothps=.01).Thus,findingsonthesetwo subscalesshouldbeinterpretedwithcaution.

Furthermore, the intervention itself consisted of two components:LKMandpsychoeducationoncounselorwell- ness.Consequently,itisdifficulttodeterminewhichspecific componentsledtochangesinoutcomes.Itwouldbebeneficial for future studies to investigate the specific mechanisms of changebyseparatingandcomparingthedifferentaspectsof the intervention included in this study.

ImplicationsandRecommendations for Future Research

ThisstudyisthefirsttoexploretheuseofLKMasaninter- vention for counselors-in-training. In addition, it is the first studytoinvestigateatheoryofpositiveemotionsasameans toenhancetheinternalresourcesandefficacyofcounseling students.Despitethelimitations,thefindingsfromthisstudyprovide support for the use of the LKM intervention to increasecognitiveempathyinpreservicecounselors.Previousstudies have indicated that it is important for counselors to have a balanceofemotionalandcognitiveempathy(Maslach,1982;Savicki&Cooley,1982;Skovholt,2001).Participantswho experiencedtheLKMinterventioninourstudydemonstrated significant increases in cognitive empathy compared with thoseinthecontrolgroup.Althoughemotionalempathyisalsonecessaryforeffectivecounseling,thefindingsareimportant becauseadisproportionateamountofemotionalempathycanpredispose counseling students to potential burnout (Maslach,1982;Skovholt,2001).Moreover,thefindingsofourstudy suggest that spending time in meditation is associated with increasedPT.PTisacognitiveaspectofempathy,definedasthe propensity to understand another person's viewpoint or perspectivewhilemaintainingdetachedconcern.Thus,medi- tationingeneral,andLKMspecifically,maypositivelyaffectcognitive empathy in counseling students.

OurfindingsalsoprovidedpreliminarysupportforLKM as a means for cultivating positive emotions. Nearly two thirds of the participants reported that LKM had a positive effectontheirmood.Wesuggestthatfutureresearchexplore additional means for cultivating positive emotions, which have been shown to increase social resources, an important buffertostress.Moreover,positiveemotionsimproverelevant internalresourcesforcounselors,suchascognitiveflexibility andresilience.Researchisneededtodetermineifthecultiva- tionofpositiveemotionswouldindeedpromotewellnessandresilience in counselors.

Participants'written comments on the posttest question- nairewereprimarilypositive;however,severalparticipants indicatedthatLKMwasnottheirchoiceofmeditation.The mostcommoncomplaintswereannoyanceattheredundancy of the meditation verbiage and a distracting environment. Othercommentsindicatedthatmeditationwasnotforthem, or participants preferred other wellness activities, such as relaxation, deep breathing, or yoga. Furthermore, very few participantslistenedtotheCDbetweensessions.Researchers havesuggestedthatitispreferabletoprovidevariousoptions inmeditationinterventions(Christopher,Christopher,Dun- nagan,&Schure,2006).Thepresentstudyofferedalternatives for meditation practice outside the sessions, but LKM was theonlytypeofmeditationpracticedduringthesixsessions. Future studies may investigate and determine the mechanismsandmediatorsofchangewithrespecttoLKMandexplore

what practices or aspects of meditation are most helpful (e.g.,breathwork,loving-kindness,mindfulness,meditation withoutanobjectofconcentration;Bruce,Shapiro,Constan- tino,&Manber,2010).Thefindingsofourstudysuggestthe possibilitythatsimplyexposingcounselingstudentswhoarenovicemeditatorstotheideasandvaluessurroundingLKM may be enough to produce change.

TheprinciplesofLKMweredeemedparticularlysuitable forcounselorsbecausetheprocessentailsdirectingcompas- sion toward oneself and then toward others, while emphasizingthe importance of self-care. It is imperative that counselors maintaintheirpersonalwellnessandcounselingefficacy.A counselor'sroleistointeractwithothersinapersonal,emo- tionallydemanding,empathic,andcaringmanner.Theability tofosterpsychologicallyintimateandcaringrelationshipsis fundamentaltoeffectivecounseling,butitalsomayincrease professionalcounselors' riskof stress, burnout, andimpairment(Cherniss,1995;Lawson,2007;Maslach,1982).Researchers havesuggestedthatcounselingtrainingprogramsshouldhelpstudents become aware of these risks (Savicki & Cooley, 1982;Skovholt, 2001) andprovide the tools to maintainpersonal well-ness(Roach&Young,2007),becausethesefactorspotentially affectclientwell-beingandcounselingoutcomes(Lambetal., 1987;Norcross,2002).Sustainingempathiccaringisessential for counselor efficacy (Skovholt, 2001). Greason and Cashwell(2009) proposed that it would be beneficial for counselor edu-cationprogramstoaddresstheinternalprocessesofempathy, inadditiontotheobservableempathyskillsthatarecurrently includedincounselortraining.Moreover,efficaciouscounsel- ingrequiresanappropriatebalanceofcognitiveandemotional empathy.LKMoffersthepotentialtoaddressinternalaspects of empathy as well as promote balanced empathy.

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