Mindfulness is a spiritual concept adopted from Buddhism by Western clinicians and while change processes in Mindfulness Based Cognitive Therapy (MBCT) were initially explained in terms of cognitive/emotional impacts, there is now growing interest in the relationship between mindfulness and spirituality. Seven participants who had completed an MBCT course in a mental health service context gave in-depth interviews about their experiences in relation to spiritual change, and the factors influencing these processes. The themes represented a range of interconnected processes, including connecting with the body, experiencing thoughts and feelings in a less reactive way, a changed perspective on the self, self-insight, a greater sense of compassion and connection, wisdom, a sense of meaning and a sense of connection to a transcendent source. For some, mindfulness helped create a context in which painful experiences could be brought into awareness, and unusual or difficult experiences integrated so that people could experience a deeper and more authentic way of being. While intentions seem to be important in mapping the particular aspects of change that occur, themes were common to people from a variety of spiritual backgrounds, and spiritual changes occurred in some people who had no prior spiritual orientations. The role of intentions versus ‘letting go’ in relation to mindfulness is explored. Clinical implications are discussed and suggestions made for future research.

There is a growing research interest into investigating why NICE (National Institute for Health and Care Excellence) guidelines are not consistently followed in UK mental health services. The current study utilised grounded theory methodology to investigate clinical psychologists’ use of NICE guidelines. Eleven clinical psychologists working in routine practice in the NHS were interviewed. A theoretical framework was produced conceptualising the participants’ beliefs, decision making processes and clinical practices. The overall emerging theme was “considering NICE guidelines to have benefits but to be fraught with dangers”. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, as a result of pressure, and also the rewards that follow from being seen to comply with NICE guidelines, they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. This is the first theoretical framework that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. Attention is drawn to the proposed benefits and limitations of guidelines and how these are managed. This study highlights the importance of clinical psychologists articulating and advertising their specialist skills. The findings are integrated with existing theory and research, and clinical and research implications are presented.