Elements of Buddhist Psychotherapy

Dr. Tom Neilson on Buddhist Psychotherapy

Nashville psychotherapist Dr. Tom Neilson has written a helpful article entitled “Why I Am a Buddhist.”  He writes, “Another reason Buddhism appeals to me is that it is not based on beliefs that we are asked to accept on faith.  Buddhism offers a series of practices (meditations) that allow us to have a deeper and clearer view of reality.  Meditation is, in a sense, a scientific experiment that allow us to empirically discover the workings of the mind and the nature of reality…From this perspective, Buddhism turns out to be a 2,500-year-old science of mind.”

Neilson states, “The Buddha taught that there is no self as an object.  In other words, there is no solid and separate self.  We are a flow, which is always changing and always in relationship to the rest of the universe.  Truly seeing the impermanence of ourselves and everything around us can be a difficult and scary experience.  The groundlessness of life, the utter uncertainty of everything, is the root of all our fears.”

Neilson adds, “But ultimately, the seeing of anatta (not-self) tends to be profoundly freeing.  It opens us to a flow that does not need to grasp, struggle, or resist life, and when we stop grasping and resisting, we stop suffering.  For me, living in this flow without resisting and grasping has led to an ease of being and a joy in living…The main focus of Buddhism is on this fundamental existential problem of being human: the universal suffering that all beings experience.  Rather than teach a set of beliefs to be accepted on faith, the Buddha taught an experiential path through suffering and beyond it.”

Dr. Mark Epstein on Mindfulness and Psychotherapy

I will quote from an interview of Mark Epstein by the writer David Bullard, entitled “Mark Epstein on Mindfulness and Psychotherapy.”  Epstein states, “The insights from my psychotherapy teachers were many but came later, after, to my dismay, I realized that what I was learning from Buddhism still left me sometimes struggling, especially in my relational life.  So I went back to psychotherapy informed by Buddhism, and then was touched by how deftly certain of my therapists worked with my relational self in the actual interactions with them in the moment.  It seemed very Buddhist to me, only active and engaged.”

Epstein continues, “A lot of therapists come to me with an interest in how to use Buddhist psychology to enhance their work…I always feel that the most important way Buddhism can impact psychotherapy is by helping the therapist.  What Buddhism teaches very practically is a psychotherapeutic attitude: how to deploy psychotherapeutic attention both intrapsychically within the self and as well as interpersonally.”

“What I remember being impressed by…is that the type of psychotherapy is less important than the relationship which ends up being fostered between the patient and the therapist.  And the quality of that relationship probably contains much of whatever it is that is healing in any kind of therapy.  How to define that quality, other than using words like ‘love’ and so on, I think will prove difficult, but clearly people know when there is a positive and trusting relationship, and when there isn’t.”

“At the same time, a therapist has to primarily be able to wait, and wait, and wait, and wait, and not be so anxious to display his or her intelligence or understanding or insights into what they think is going on, and to trust that there will be a time when it is obvious that what needs to be said can be said…This does not mean that I do not respond, that I am not myself when I work, that I do not care, or that I do not sometimes need to probe.  But by not having a personal agenda in my therapeutic interactions, by putting myself on hold, I can make room for whatever appears on its own.  We practice meditation when we listen to the feelings of another, to their pain, their distress, and their suffering.  In this sense, psychotherapy and meditation are one.”

The Meeting of Meditative Disciplines and Western Psychology

Roger Walsh and Shauna Shapiro wrote an article in The American Psychologist (April, 2006, pp. 227-239) entitled, “The Meeting of Meditative Disciplines and Western Psychology.”  They write: “Refinement of awareness may therefore be a central process mediating the therapeutic benefits both of meditations and of psychotherapies and may also be a necessary precondition for a further important meditative process: disidentification.  Disidentification is the process by which awareness (mindfulness) precisely observes, and therefore ceases to identify with, mental content such as thoughts, feelings, and images…Robert Kegan suggested that the process of disidentification ‘is the most powerful way I know to conceptualize the growth of the mind…(and) is as faithful to the self-psychology of the West as to the ‘wisdom literature’ of the East.’” (pp. 231-232)

The authors continue, “Dramatic heightening and continuity of awareness are said to allow meditators to recognize and disidentify, not just from the problematic subset of thoughts, emotions, or images, but from all of them.  The result is said to be the ability to observe all experiences with imperturbable calm and equanimity.”

“An obvious implication of this Buddhist model is that meditation might facilitate psychotherapy…the potential therapeutic enrichment is clearly mutual, and growing numbers of therapists and meditation teachers have concluded that meditation and psychotherapy can be mutually facilitative.  Meditators seem to progress more quickly in therapy, whereas psychotherapy—particularly by meditatively experienced therapists—may speed meditation progress.” (p. 233)

The authors suggest: “Meditative disciplines offer a good news—bad news view of the mind.  The bad news is that our usual state of mind is significantly underdeveloped, uncontrolled, and dysfunctional and that the extent of these dysfunctions usually goes unrecognized.  Freud shocked the Western world with his claim that ‘man is not even master in his own house, his own mind.’ However, meditators have made similar claims for millennia.  They have suggested that the untrained mind is so unruly that ‘the wind is no wilder’ and that this lack of control underlies considerable psychological suffering and pathology.  Indeed, the first response to beginning meditation is usually one of shock—shock at how out of control, fantasy-filled, distracted, and dreamlike one’s usual mind state is.” (p. 235)

The authors add, “Meditative traditions aim for a two-fold process of emotional rebalancing.  Like Western therapies, they aim to reduce destructive emotions…for the Dalai Lama ‘the true mark of a meditator is that he has disciplined his mind by freeing it from negative emotions.’

An implication is that long-term meditation can raise the happiness set point, which psychologists usually assume to be tightly genetically restrained.  There is initial experimental support for such shifts.  Meditators show reduced anxiety, hostility, and depression, together with enhanced subjective well-being.”

Equanimity is one of the most important benefits of long-term meditation.  The authors write: “Emotional transformation is facilitated by equanimity—the ability to experience provocative stimuli nondefensively and with minimal psychological disturbance.  Equanimity is the opposite of reactivity and emotional lability, is highly valued across meditative traditions, and is said to be ‘the characteristic temperament of the sages.’  Equanimity overlaps but extends beyond the Western concepts of ‘affect tolerance’ and ‘emotional resilience’ to include not only tolerance but even serenity in the face of provocative stimuli, and it has obvious clinical potential.”(p. 237)

The authors conclude: “…the extent to which certain psychological capacities can be developed (through meditation) has clearly been underestimated and lends preliminary support to Maslow’s provocative claim that ‘what we call normal in psychology is really a psychopathology of the average, so undramatic and so widely spread that we don’t even notice it ordinarily.’” (p. 237)

The Oak Tree in the Garden

Eric Kolvig, Ph.D., an experienced Buddhist teacher, has written his personal story entitled “The Oak Tree in the Garden.” (Journal of the Hidden Valley Zen Center).  He writes, “For tens of centuries now, Buddhists have taken refuge in three precious things: Buddha, the awakened mind and our own innate capacity to awaken; Dharma, the way to awaken; and Sangha, the community of those supporting each other to awaken.  Those three things constitute a safety net below which we cannot fall.  For those of us with mental illness, Sangha becomes extra-precious: a reliable network of support that can shelter us through the storms of both emotional healing and spiritual awakening.” (p. 2)

Kolvig states, “The Buddha said that freeing our hearts from suffering and the causes of suffering is the most difficult thing that any human can accomplish…You need to want to be free more than you want anything else. You need to be ready to sacrifice everything else, if necessary, in order to pursue this purpose…If you have mental illness I hope that you will not heed those in therapeutic communities who disparage meditative work, or those in meditative communities who disparage therapeutic work.  For decades I personally have combined the two; I could not have cultivated health and freedom without both.” (p. 4)

Kolvig adds, “Both psychotherapy and Buddhist tradition…offer us ways to stabilize our minds/hearts, and also ways to uncover information, hitherto hidden, that can help us to heal and to liberate ourselves.  We stabilize before we uncover, because what we uncover can be painful.  If we lack enough mental stability to handle pain, it can overwhelm us and make us sicker.  We don’t want to tackle painful experience, either in therapy or in meditation, until we are stable enough to accommodate it.”

“’There is pain that leads to more pain, and there is pain that leads to the end of pain,’ the Buddha said.  Uncovering pain before we have enough stability can lead to more pain; uncovering with enough stability can lead to insight and the end of pain.  A good therapist and a good meditation teacher can discern when to encourage us to stabilize and when to uncover…

Good therapists can give us the first reliable, wholesome, loving relationships, free from judgment, that some of us have ever known.” (pp. 4-5)

Kolvig continues, “Developing what psychology calls ‘ego strength’ also brings stability. ‘You have to be somebody before you can be nobody,’ wrote the research psychologist and Vipassana meditation teacher Jack Engler.  Psychotherapy can help us to stabilize, among other ways, by giving those of us with mental illness a more stable sense of what Engler calls ‘a sense of continuity, identity, and ongoingness in existence’…without a strong, cohesive, integrated sense of self, we can’t tolerate the uncovering work that frees us in both psychotherapy and meditation.” (p. 5)

The Cushion or the Couch?  Psychotherapy and Buddhism

Barry Magid wrote an article entitled “The Cushion or the Couch?  Psychotherapy and Buddhism,” in the journal Buddhadharma. (Winter, 2003). Magid writes, “Therapy runs the danger of becoming ‘too busy’ and can turn into an endless self-improvement project.   We run the risk of an endless preoccupation with our own story, failing to see that self-absorption is not the same as self-awareness.”

“Meditation lets us become intimately aware of ‘the one who isn’t busy.’  We can experience the reality that nothing needs fixing…But we can also use meditation to bypass confronting our anger, sexuality and conflicts about the legitimacy of our needs and desires.  We can narcotize ourselves with samadhi (a deep state of meditative consciousness and total absorption where the mind becomes completely unified with the object of meditation, dissolving the separation between the observer and the observed).” (p. 81)

Several meditators responded to Magid’s article.  Jeff Berger writes, “As a guy who has been a psychiatrist/psychotherapist for fifteen years and a Buddhist practitioner for about as long, the distinction between psychotherapy and Buddhist practice vanished long ago when it dawned on me that attention, compassion and insight underlie both endeavors. What we call ‘psychotherapy’ and ‘Buddhist practice’ are simply different methods…to help alleviate suffering and sow the seeds of lasting happiness.”

“Wherever we are on the path to Buddhahood, there is a method that can aid us and take us one step further.  Sometimes it’s relating more deeply to our autobiographical stories or being received, witnessed and understood by another.  Sometimes it’s recognizing that our attachment to these very stories contributes to the cause of our suffering and that the stories do not define us.  Either way, and many gradations in between, we all need our own awareness, as well as loving and wise mentors, guides, teachers, gurus, spiritual friends, healers and doctors who will walk with us on the journey.” (p. 82)

Christopher Ross writes, “’Essentially complementary,’ is how I would describe the relationship between Buddhism and psychotherapy.  In my experience, most people derive benefit from both.  The best timing for each is specific to each life situation.  For many of us it will not matter which one we first engage…Psychotherapy may speed working through (one’s) issues.  By the same token, starting a Buddhist meditation practice toward the end of a series of psychotherapy sessions may be an excellent way to continue the deep self-exploration that was started with the help of another.” (p. 82)

Another meditator responded to Magid: “Both the Buddhist model of mind and psychotherapy’s model of mind give me the relief of distance: they take me out of the emotional hurricane and allow me to view it from a place of safety.  Psychotherapy gives me distance by putting labels on habitual patterns.  This helps me gain a keener awareness of what patterns are causing problems and pain.  Of course, I also get caught in the downside of analysis, which is always trying to fix myself, and I sometimes find that the psychotherapeutic labeling has a negative effect on my morale.  Buddhist mind offers relief from this dilemma with the idea that I am already a complete and perfect whole.  There is nothing I need to do, to learn, or to prove.”  (p. 82)

Natalie Dawson replys to Magid: “I was lucky to find a wonderful therapist, whom to this day I consider to be one of my teachers.  When I was going through difficult states of mind and would ask him for help, his response always was ‘Can you stay with it?’  Without psychotherapy I would never have decided to try meditation.  For me, psychotherapy did not provide as broad or detailed an exploration of mind as I later found in Buddhism…Buddhist practice has continued to be more than enough to meet my needs, and has carried me as far as I want to go in terms of self-exploration, study of mind, and dealing with difficult issues that arise.” (p. 83)

Bob Lapides writes, “The respectful joke I make about psychotherapy is that it helped me identify all the wandering thoughts I need to let go of.  Since thoughts have always been pretty hard for me to ignore, I found that talking to a shrink about my mental contents lessened their power and helped to loosen their grip.  Both my Buddhist teacher and my shrink would say, ‘It’s no big deal.’”  (p. 83)

Linda Zallen responds to Magid: “I am a practicing Buddhist and psychotherapist.  When the average patient comes to my office, they often see themselves as having a relationship problem, low self-esteem, grief, anxiety, and so on.  But they don’t know the cause of suffering, or how to achieve happiness, and here lies the important difference between the typical psychotherapy patient and the Buddhist.  Since several of my patients practice some form of Buddhism, I have witnessed over and over the advantages of having both psychotherapy and Buddhism in one’s life.  At times the results are awesome.”  (p. 83)

What Buddhist Psychotherapy Really Is: The Professional Training Program of the Nalanda Institute

I was introduced to Buddhism in the summer of 1975 at Naropa University in Boulder, Colorado.  My teachers in this intensive five-week immersion in Buddhist meditation and Buddhist psychology were Jack Kornfield, Joseph Goldstein, and Sharon Salzberg.  Naropa employs a method stemming from the teachings of Tibetan Buddhist Kagyu-Nyingma master Chogyam Trungpa.  This may differ from the approach taught at Nalanda Institute for Contemplative Science in New York City, developed by American Buddhist Gelugpa scholar and psychiatrist Dr. Joseph Loizzo.  Practitioners of both approaches may call themselves Buddhist psychotherapists.

According to the professional training program of the Nalanda Institute, “Buddhist psychotherapy views our usual state of mind as significantly underdeveloped, dysfunctional, and outside of our conscious control.  In short, we are all delusional from this perspective.  Our state of dysfunction goes unrecognized because it is so common that it is considered ordinary…

The entire range of psychological suffering—from mere dissatisfaction to severe psychopathology—is a function of this untrained mind, which has been adversely habituated away from its natural state of balance and health.”

“The goal of Buddhist psychotherapy is to retrain dysfunctional processes of perception, cognition, emotion, and behavior so as to achieve a psychological state, and eventually a trait, of happiness…The mind that eliminates the root cause eventually achieves freedom (nirvana) from negative emotions (klesha) and compulsive actions (kharma), and arrives at a state of awakening (buddha)…The awakened mind completely reverses the causal cycle of suffering and therefore perceives the relative nature of self and reality clearly, feels completely contented, loving and interconnected with all of life, and consciously acts skillfully for the welfare of all.”

“To achieve this goal, Buddhist psychotherapy tends to assume a relatively stable personality in patients and concerns itself with optimal health, peak potential, and advanced stages of human development along the continuum from adulthood to enlightenment.  In contrast, conventional therapies have tended to focus on psychopathology, dysfunction, and arrest in the development of personality.  Some theorists (Wilber, 1993) argue that combining the developmental models from both Buddhist and Western traditions offers a more comprehensive view of human development that spans childhood to enlightenment.”

“Buddhist psychotherapy maintains that the purpose of a human life is to achieve its highest evolutionary potential and experience sustainable happiness and complete freedom from suffering…In the Buddhist approach therapist and patient work together to identify dysfunctional mental patterns of thinking, feeling, and behaving that stem from a patient’s identification with their traumatic narrative.  Once these specific issues are recognized, patients are prepared to use the healing relationship as an emotional corrective and employ meditation techniques to counter their particular cognitive-affective-behavioral habits.”

“Meditation comes from the Sanskrit word bhavana, meaning to familiarize or to cultivate the mind.  Individuals typically cultivate the mind towards obsession, repulsion, and self-preoccupation, resulting in depression, anxiety, and narcissism.  Buddhist meditation offers a number of antidotes to counteract such afflictions and redirect the mind towards healthier states.”

“Concentrative meditations (Shamata) such as mindfulness of the breath, help still and clarify the mind on a single object of focus, eliminating its usual mode of dullness and agitation.  Contemplative meditations on the four sublime attitudes (brahma viharas) cultivate lovingkindness, compassion, joy, and impartiality towards self and others, thus overriding our tendencies towards hatred, disinterest, envy, and prejudice.”

“In the Buddhist contemplative educational method, meditation techniques are not practiced in isolation but are conjoined with contemplative study and lifestyle modification to forge a comprehensive rehabilitation program known as the three trainings (trishiksha), with the depth, power, and sophistication to transform the whole person.  In this three-pronged approach, meditation (samadhi) corrects imbalanced mental attitudes of addictive clinging and defensive hostility, the empirical study of the nature of reality (prajna) corrects unrealistic outlooks that reify and identify a self alienated from the world, and a conscious code of conduct (shila) corrects reckless lifestyles that endanger self and others.”

“In sum, Buddhist psychotherapy combines three major elements into its practice: interpersonal dialogue aimed at recognizing core issues and blind spots specific to a patient’s identification with their traumatic narrative; 2) role-modeling aimed at providing a corrective emotional experience within the long-term process of reparenting; and 3) individual meditation training yoked with wisdom and ethics, which empowers a patient in their own process of conscious self-correction…It is extremely generous in its therapeutic goal, honoring man’s innate potential to achieve complete freedom and sustainable happiness.”

Conclusion

I have yet to find, within the field of Western psychology, an actual method which a patient can utilize to finally make peace with, and put to rest, the extraordinarily tenacious and shaming superego developed in a patient’s childhood.  Freud was not able to articulate an attentional method whereby the patient would be able to “stay with” whatever came up.  Dr. Mark Epstein, in his wonderful Buddhist psychotherapy book Thoughts Without A Thinker, which I quoted at the beginning of this article, articulately outlines the substantial benefits of an approach with combines psychotherapy and meditation.  “Much of my work as a therapist with a meditative perspective involves teaching people, in the context of therapy, how to pay attention to what they are repeating in a manner that is both meditative and therapeutic.”  (p. 193)

Epstein quotes Suzuki Roshi, from what is still my favorite book on meditation practice, Zen Mind, Beginners Mind: “So even though you have some difficulty in your practice, even though you have some waves while you are sitting, those waves themselves will help you.  So you should be grateful for the weeds, because eventually they will enrich your practice.  If you have some experience of how the weeds in your mind change into mental nourishment, your practice will make remarkable progress.  You will feel the progress.  You will feel how they change into self-nourishment…This is how we practice Zen.” (p. 127)

Commenting on Suzuki Roshi’s words, Epstein concludes: “This is the promise of bare attention and the great discovery of the Buddha.  The relevance of this discovery to psychotherapy cannot be overstated, since, as every veteran of psychotherapy can attest, analysis can easily give understanding without relief.  Meditation offers a method of recycling psychic pain, bringing about the very relief that is otherwise so elusive.  This is the reason for its extraordinary appeal to those conversant with psychotherapy.  Meditation offers a method of working with emotional material that may be implied in the best psychotherapy but is rarely made explicit.  The Buddha was a master at making the method explicit.”  (pp. 127-128)

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