Meditation: The New Psychotherapy

[Sujatin]

What is your perspective on the recent growth of Mindfulness Based Psychotherapy. Is it valid to use Buddhist techniques therapeutically? Is to do so undermining of Buddhism per se?:

The patient sat with his eyes closed, submerged in the rhythm of his own breathing, and after a while noticed that he was thinking about his troubled relationship with his father.

"I was able to be there, present for the pain," he said, when the meditation session ended. "To just let it be what it was, without thinking it through."

The therapist nodded.

"Acceptance is what it was," he continued. "Just letting it be. Not trying to change anything."

"That's it," the therapist said. "That's it, and that's big."
::read more

[majid khan]

I wonder if the type of therapy that a therapist uses is simply a reflection of what they feel the problem is?
If we feel that the source of anguish, say in a drug addict is that he has been overcome by the forces of mara, then I would suspect that the only way to overcome this would be the same way in which the Buddha overcame Mara, which would lead us naturally to mindfulness etc as the only sensible option. If, on the other hand, we feel that satan has taken a grip, then exorcism might seem a reasonable therapeutic response. if we feel it's the result of a chemical imbalance, then drugs to counteract this would be the 'appropriate' response. if we feel that all of the addict's troibles lie in factors other than himself ( his environment/ friends etc) then the appropriate therapy would be to provide them with alternative surroundings/ alternative 'friends' etc. fundamentally, I would suspect that the type of therapy offered by the threapist is none other than a reflection of what the therapist feels to be the problem. I hope someone can reply to this. I would be interested in what you have to say. majid

[caroline brazier]

Responding first to Majid, I agree, as you will see below. I think indeed, as bombu beings, we are neither enlightened or omniscient and our views as therapist will affect both how we see the client and what we diagnose to be the problem and its solution.

Responding to the broader issue of mindfulness, I think there are two issues in what Sujatin was originally asking.

1) Does using Buddhist approaches as therapy strip out the spiritual?
To this my response would be that it depends how they are used. I prefer to work in ways that see Buddhist approaches as reintroducing the spiritual to psychotherapy rather than psychotherapy taking the spiritual out of Buddhism. Psychotherapy is about the psyche (soul) and I do not see how anyone can work therapeutically at anything other than the most superficial problem solving level without addressing the person's spiritual being. All the life decisions, views, meaning and so on which we hold are founded in our spiritual sense. If we change our spiritual life it impacts on our day to day behaviour and vice versa. So although it is not always recognised, the therapist has to be addressing the spiritual level alongside the pragmatic and psychological.

For this reason, the involvement of directly spiritual approaches in therapeutic theory building makes a valuable contribution, not least as a gadfly, stiring up debate about the nature of our process. In particular I think much Western psychotherapy is embedded in a paradigm of our modern culture which is in many ways spiritually deficit, being deeply entwined with ideas of personal entitlement, individual action and ambition, blame and judgement of others, and other manifestations of greed, hate and delusion. Buddhism can offer a significant critique and counterbalance to this staus quo.

This said, it is quite possible for therapy practitioners to use Buddhist techniques such as mindfulness or other meditation based techniques and ground them in a paradigm of non-Buddhist thought and ethics. This leaves me feeling uncomfortable. The importation of Buddhist ideas to secular thinking does not always have good outcomes. One only has to think of the way the Zen idea of 'nowness' has been used as a basis for killing people in war.

Therapy is not about pushing values (though in practice I think all therapy can be critiqued for peddling new values to clients). For this reason the myth of non-directiveness is perpetuated. Therapists want to believe they do not influence. I think those of us who support people psychologically need to be honest and recognise we do influence and therefore ask ourselves, this being so, how do we influence? Values are conveyed in the manner of the therapist, the focus of her/his interest, the verbal form of reflections used etc. Whether mindfulness is being taught or other methods, the Buddhist therapist will inevitably influence the client towards a different world view. This does not mean teaching Buddhism or expounding philosophy. The process is more subtle and therefore more difficult for therapist or client to spot.

In an other-centred model, we would overtly suggest that the influence a therapist's attention and interest has should be, in accordance with Buddhist principles, more outwardly concerned and willing to embrace new understand of 'others'. It should be less preoccupied with upholding conditioned perceptions or beliefs in personal entitlement or attachment to identity.

2) Is mindfulness-based work helpful in this paradigm?
On the Amida training programme our central integrating principle is other-centredness. We primarily focus on the relationship of the client with 'others' in their world (people and environmental objects). We all live in our personal worlds of deluded perception and conditioned self-view. The models of Buddhist psychology offer many possible points of intervention (hence the number of Buddhist therapeutic approaches) but we see working with the perceptual frame as one of the most ammenable and least defended points in the self-building (skandha) cycle by which change can occur.

This leads to an approach which is other-centred. In other words we are interested in investigating the client's perception of things and on the one hand seeing how it is conditioned (rupa) and on the other trying to move beyond this basic conditioning to a more realistic, empathic understanding of third parties and the world at large.

Mindfulness-based approaches can offer methods which work with this exploration, in that they suggest a detailed way of seeking for specific experiential evidence. They are, however, from an other-centred perspective, most effective when they encourage the practitioner to focus on the other, and not on his/her internal process or feeling response. This is actually quite close to Thich Nhat Hanh's description. He talks of holding the tea cup with awareness when washing it with mindfulness. This means seeing and feeling the tea cup as a tea cup, not as our perception of a teacup.

Although often billed as a present moment exercise, this focus on the cup in fact encompasses past and future. Hanh recommends reflecting on the clay, the potter and the user of the cup, and also of its final demise. It is temporally fixed in the present but not limited to it.

More, though, Hanh talks of washing the cup as if it were a baby Buddha. This 'flight of fancy' is surely hardly what most people think of as present moment mindfulness. In fact it takes us back to the real meaning of mindfulness - that of remembering, of seeing Buddha in everything; of holding the Buddha in mind. In this mindfulness in its true meaning is nembutsu.

Thus I wholeheartedly agree that the practice of mindfulness in therapy is both therapeutic and honouring of the Buddhist tradition when it is other-focused rather than self-focused, honouring of past and future as they manifest in the minutiae of present experience, and most importantly, appreciative of the sacred within the mundane.

I've written more on both these topics in my new book Other-Centred Therapy.

Having talked about the positive aspects of mindfulness, I would like to also mention a difficulty which can occur. It is common for mindfulness practitioners to see mindfulness as a way of controling unwanted feelings. It can be effective in doing this, but not, I think, for the reasons most would think. Also it can be problematic.

Buddhist psychology asserts that the mind is conditioned by the object of attention (conditional relations, Abhidharma). From this principle we can see that changing the object of attention, changes the mental experience. Particularly it often changes the emotional state.

Where mindfulness is directed towards the feeling, therefore, the feeling itself will change. This is because there is a shift of object. The first object is the thing which causes fear. The second object is the fear. Encountering a tiger conditions a reaction: fear. Mindfully observing the fear (if it can be done without being distracted by the tiger) conditions something else - interest perhaps ("that's interesting, I've just seen a tiger and now my body is reacting with symptoms of fear!")

Distraction of this sort can be helpful where one has a habit of negative thought or anxiety. It breaks the habit and establishes a new habit in its place which is more benign. We should, however, recognise that this is in fact what is going on. This is not some magical effect of spiritual breakthrough coming from our mindful attention. We have not transformed our relationship to the tiger. It is simply that a shift of attention from the tiger to the feeling has changed the emotional response.

Of course, it is not always healthy to be distracting ourselves, and much distraction is effectively suppression or repression which itself can have bad psychological effects in the longer run. It may also lead us into a sort of quietism in which instead of encounterig the world and acting on it, we filter all our relationships and responses through a secondary level. This may prevent us being angry with our parent or spouse but it may also nail us into a box of self-observation from which we relate in a more distanced way. Sometimes such momentary retreat can give breathing space and break a habit of mindless irritability but other times it becomes a kind of deadening of affect which fails to address real inter-personal issues

So its a mixed bag, but a interesting one. I hope I've raised a few new topic threads, for there is much to be explored in this issue.

[Michael John Smith]

If the therapist is Mahayana Buddhist we must assume his/her primary motivation in life is compassion - both relative and absolute. As Buddhists if we have a certaintity that we can help we would be going against our conscience if we did not in fact offer that help. Of course the patient should be receptive to the idea that a Buddhist technique would be of benefit to him/her so the Buddhist therapist must be careful not to force his/herself on the patient if that patient perceives the cure as unconventional. Confidence is needed on both sides - the practitioner must not be afraid when his/her motivation is compassion and the patient must be willing to accept any possible religious or otherwise exotic overtones - for the practice to be beneficial.
A factor to be taken into consideration is of course the often quite brutal (life-changing) consequences of using Buddhist and similar techniques. We must be careful not to do more harm than good and this could be the case if the patient is not "prepared" to take on such therapy.

[Robert McCarthy]

Dear Caroline, I had just tried to send you a message and couln't really work out how, although it is related to my family and is in one sense very personal, it is very much connected with these discussions. So, i talk here among friends i trust. My youngest daughter is hanging very much by a thread. after nearly ten years of the most serious drug abuse and lifestyle issues- she is only 22 now- she has reached her best physical health in all that time after three months in prison. Well the last month has been in a secured psychiatric ward. I naively did not realize discussions were monitored and on sunday, after a long passionate discussion with anica about love in encounter, a nurse drew me aside. She told me that anica has had acute schizophrenia since puberty, that because she was non responsive most likely on friday of this week would be sent back to prison, from where she will surely remain in her world of pain. but she told me this was the first time she had ever seen anica open and responsive, she told me this lovingly, not through professional responsibility. So today i try to find the wisdom to write a letter to take to my visit to anica tomorrow, a letter that just may turn anica, turn her to say help me, help to the loving people who have encountered her. In doing so i have enough wisdom to turn to people who in turn have shown me love in encounter. It is a most diffiicult request, but any practical guidance of what to include- i request namo amida bu

[majid khan]

Hello, Robert.
I really don;t visit this site as often as I should!. I've just read your post about Anica. It was about six weeks ago, so i really hope that all went well at your visit. I get the feeling that the types of things to include in your letter ( though all this has obviously passed now) are things that only you can know should go in. I'd simply go with your heart. remember that no answer is also an answer...
I hope that Anica is well. I am a firm believer that adversity simply is a signpost to direct us where to turn to for our own happiness. Anica is your teacher...so you should love her even more....
majid

[Clark Strand]

The following is an excellent question, Caroline:

What is your perspective on the recent growth of Mindfulness Based Psychotherapy. Is it valid to use Buddhist techniques therapeutically? Is to do so undermining of Buddhism per se?:

My answer would be that if it works, and yet some Buddhists persist in feeling that their Buddhism is being undermined, that indicates that they are following a model of life serving religion, rather than religion serving life. In which case, I wouldn't even bother to argue with them about it. When the boat they're riding in reaches the level of the water, they'll get out of it, but not until then. At that point, a helping hand into a bigger boat is in order, but not before.

Does that make sense?

[Clark Strand]

I might add that I live near a Buddhist monastery that took this approach to psychotherapy for quite some time, but now a new wave of younger teachers is taking over there, and they don't seem to have this hang-up at all. So maybe it's a by-product of what I call "conversion mania," whereby the first generation of converts are overly concerned with such issues as purity and legitimacy and therefore tend to get arrested at the level of formalistic understanding of the teachings. I might add that even that generation was adapting Buddhism in ways that would seem radical to most Asian Buddhists--nevertheless, they were able to maintain some idea of orthodoxy (fictitious but functional) in the midst of that process and were therefore able to create a foundation for the next generation to build on...and in some cases to readapt.

[caroline brazier]

I agree. I think we only really come to grip with our spiritual sense by applying it. Preciousness and concern with legitimacy seem to me to go against the spirit of the religious life.

I don't see the argument as being about not using a Buddhist based therapy - I think it is about not imposing any kind of therapy or philosophy on others. As with any therapy the Buddhist therapist should not be forcing a method or view. My points about influence are about the more subtle level of influence that inevitably happens in any meaningful relationship and particularly in therapy. The latter is problematic whether one is talking about Buddhism or secular humanism, yet I meet a lot of people who I would see as having been sucked into secular humanistic views by therapists and, I would argue, hurt as a result.

[Clark Strand]

I agree. I think psychotherapists who don't respect the spiritual beliefs or inclinations of their clients often do a lot of damage (unless, of course, those beliefs or inclinations are harmful in themselves, which--sad to say--is sometimes the case).

[majid khan]

Hello, team. I am finding this discussion a fascinating read...

I work in my local prison with heroin addicts, and today had a most interesting experience. a young man was brought in from court, having not had his methadone ( Heroin substitute medication given on prescription), and so he was 'withdrawing'. ('Cold turkey'). Indeed, he had the gooseflesh, his pupils were dilated, he was rocking back and forth, holding his stomach which was causing him agony, in the form of his abdominal cramps.

As a potential 'therapist' for this man, I really feel the need to understand what is actually going on within the mind.

Is he 'being deceived by Mara'?
Is he misunderstanding reality, assuming that his cravings are fixed and independent from him?

What would Buddha have said if he had been standing next to me watching this young man?

I feel that I could best help him if I had a base from which I was working, and one which understood what it was that I was actually dealing with. How much 'understanding myself' does one need to go throgh before one can work from this vantage point?

I look forward to your replies.
Majid