Friends of Amida - Spiritual Networking -
BUDDHISM & PSYCHOTHERAPY - Paper
The following is a draft contribution to a chapter on Buddhism and Psychotherapy for a book to be publishede in Polish. Since I gather the final version has been very cut down from the original word limit, I am putting my original here so others can read it. I may eventually publish elsewhere so if you want to quote me please check out the reference. Ning strips out foot notes (of which there are 68 in the original) so if you want the references for this piece, do email me for a word version. Being part of za collaboration, I'm aware this piece lacks introduction and conclusion, but perhaps this does not matter. I hope you find it interesting and look forward to comment
Buddhism and Psychotherapy
Although at first sight Buddhism as a religious tradition founded in the fifth century BCE might seem far removed from the world of psychotherapy in the twenty-first century, in fact the Buddhist ideas have contributed to the development of Western thinking in the psychological fields since the times of William James and Carl G Jung . In recent years this influence has increased and brought with it a substantial body of theory and practice, expressed in a number of different therapeutic integrations.
With such a strong history of involvement, it is clear that the connections between Buddhist thought and the study of mental processes are more than simply coincidental. In fact, the relationship arises from the nature of Buddhism itself. A concern with psychological process pervades its thought, and the practices which it teaches. Such ideas are primarily concerned with the human condition and a response to the suffering intrinsic to everyday life. They are concerned with the manner in which, as ordinary people, we respond to the inevitable afflictions, pain and disappointments which life presents to us.
The Buddha, founder of the tradition, was, according to the Buddhist texts, a wealthy young man who, troubled by encounters with examples of human suffering, of sickness, old age and death, left his palace home to become a wandering spiritual seeker. India at that time was a ferment of religious and philosophical enquiry, and there were many teachers in the region, offering a range of practices and insights that addressed questions of life, death and meaning . In this respect, its atmosphere must have presented a stimulating and diverse culture, not unlike some aspects of that which we have recently encountered in the emerging fields of psychology and human communications. The Buddha himself studied with a number of teachers before becoming dissatisfied and pursuing his own path of enquiry. His search culminated in an experience of spiritual breakthrough in which he received insight into the nature of affliction and the processes whereby that suffering which ordinary life entails is compounded by our attempts to escape from it through psychological entanglements.
Key Buddhist Teachings: The Four Noble Truths
The core teachings of Buddhism, which derive from the Buddha’s profound insight, are primarily concerned with the relationship between existential afflictions such as sickness, old age and death, and the creation of the self . This material is presented in the teaching of The Four Noble Truths. The teaching of the Four Noble Truths, which is set out in many of the Buddhist Suttas, but particularly the Samyutta Nikaya 56 , sets out four fundamental assertions: The truth of affliction (dukkha); the truth of arising (samudaya); the truth of cessation, or, one might say, containment (nirodha); and the truth of the spiritual path (marga) . These are elaborated in various texts within the Buddhist canon, in ways which clarify their implications. Despite this, there remains some room for modern scholars to discuss finer points of interpretation . This chapter does not give scope for such debate, however the reader interested in Buddhist studies should be aware of such variations.
Put simply, the first Noble Truth asserts that afflictions are an inevitable part of life. Events such as illness, disability, ageing and death are not something which can be avoided, so facing their inevitability provides a psychological challenge which each of us must meet in some way. How we meet it will affect our mental well-being. The remainder of the teaching sets out what are effectively two alternative paths, firstly that of the ordinary person, trying to cope with life’s difficulty through various patterns of avoidance, and secondly, an ideal-type response which might be experienced by a spiritually advanced person.
According to the second Noble Truths, when we experience afflictions of this kind, there is an arising of feelings or anxiety. This leads, according to the descriptions given in various Buddhist texts , to craving and clinging. The person, experiencing suffering, longs for relief. In the language of the texts, he or she thirsts. This thirsting constitutes the impulse to escape the unpleasant or afflictive circumstance, and initially it is expressed through sensory desire (kama). The person grasps at something which occupies their senses. Generally this happens in a pleasant way, but sometimes in an unpleasant way or a way that involves some form of rejecting behaviour. In other words, one can imagine the situation where a person experiences a difficult day at work, and returning home buries his irritation or disappointment by having a drink or watching a compelling film on the television, by overeating or by engaging in sexual activity. Such responses are quite normal and, as such, are usually pretty harmless, but according to the Buddhist teachings are not the optimal response.
In particular, because such reactions are really attempts to escape from unpleasant feelings, they have an element of compulsiveness. They tend to be repeated, and the person builds up habitual ‘fixes’. This tendency to repetition is the subject of another area of Buddhist theory, the concept of karma, which suggests that each action sows the seeds of its repetition. We will return to this later.
The Creation and Destruction of the Self
With the repetition of familiar patterns of sense-based distraction, the person moves into a second phase of escapist behaviour. This second level, being (bhava), is the birth of the self. In other words, as the habits of behaviour multiply, these form a web of activities, objects and places with which the person identifies. The person starts to think in terms of my favourite drink, my new clothes, my dining room, my sort of film. He or she constructs a lifestyle based on a particular constellation of behaviours.
Once again, there is no abnormality in this process. It is a common human phenomenon to feel at ease in familiar surroundings and activities. It functions, as the text suggests, as a protection against our fears and unhappiness. Once again, however, the element of compulsiveness which underlies the process can create a psychologically limited and sometimes pathological situation. Depending on his or her level of confidence and willingness to face some level of distress, the person’s life may be restricted in various ways. It may become ruled by desires for the reassuring familiarity of the favourite ‘fix’ or a regular situation.
In this model, then, it is easy to see how ordinary psychological processes which mediate our existential fears and traumas, may intensify and lead obsessive-compulsive or addictive patterns arise. Indeed the Buddhist model of human process can be seen as suggesting that we are all to a degree addicted to our identities.
The final stage described in the second Noble Truth is that of non-becoming (abhava). This is the phase of reaction in which the accumulation of elements which makes up the identity ceases to function. At this point, the self breaks down and destructiveness takes its place. The person exhausts their capacity to escape through their habitual routes and feels that they have no options remaining other than to seek oblivion, either literally through suicide, or in other ways through psychological retreat, drugs or other forms of mental destructiveness.
Such psychological crisis often follows the loss of familiar surroundings. The loss of those elements which support identity brings about a breakdown of the self-structure. In particular, a person who is already vulnerable may fall into psychological crisis as a result of a bereavement or similar loss, since such a loss is not only itself an instance of affliction (dukkha), but also removes significant elements in the self-world. Without the psychological resources to face the opportunity for growth which such an event might offer, instead the person falls into a deeper level of withdrawal.
In this way, we can see that the model offered in the second Noble Truth illustrates a graduated distancing of experience. The response to affliction, or the fear of its inevitability, leads the person to use firstly action based distractions and then psychological rooted constructions and associations in order to build what is effectively a protective cocoon of identity. Through the selective use of activities, perception and interpretation, the person builds both a sense of self and a way of seeing the world which are mutually dependent. This creates psychological stability, and in most cases is considered normal, however, it produces a less than optimal condition and, more importantly from a therapeutic point of view, contains within itself the seeds of behaviours and thought patterns which would be considered problematic.
Specifically, from Buddhist perspective, we can view mental illnesses and disorders as extreme or particular instances of the normal human condition. In doing this we can both recognise the ways in which an individual’s thinking has moved beyond the normal range and discover ways to address the situation by helping them to re-engage with experience which is less caught up in the maintenance of the problematic self-structures.
Buddhist Views of Change
The identity or self which is created in response to affliction is considered to be a limitation of experience and a defensive structure. Ultimately it is seen as a problem to the person . At an everyday level, many Buddhist practices recognise that the person is not going to let go of such compulsive self-building behaviour immediately. Indeed to attempt to do so would be counter-productive and probably create more anxiety and clinging and psychological breakdown. Practices, then, often focus more on creating positive habits, rather than eliminating all habit formation .
The teaching of the Four Noble Truths, however, offers a model which illustrates the optimal as well as the ordinary position. The Buddha’s injunction to his followers is to give up this self and to let go of the attachments which support it. The third Noble Truth describes the process of stepping beyond the comforting limits of the familiar by a process of unhooking the attention from the habitual focuses and moving from a state of ‘not-seeing’ (avidya) into a state of direct involvement with life, however difficult it may seem. Such an engagement with reality constitutes the spiritual path. This spiritual path is described in the texts relating to the fourth Noble Truth. This path takes the form of eight activities which constitute the spiritual life. These are known as the eightfold path .
At this point, we may see that the teaching can be viewed as offering two courses of action which may arise in response to suffering: the commonplace reaction with its pathological tendencies and the ideal path of complete maturity. At one end of the spectrum, we are offered a picture of enlightenment in which nothing is avoided and reality is encountered. At the other end we see a descent into psychological turmoil and defeat. The psychology of the normal person occupies the middle ground of ordinary misery and moderate neurosis.
The teaching of the Four Noble Truths can be seen to offer a good parallel to modern Western therapies. In particular it encourages the person to face the reality of their life circumstances in a similar way to that found in existentially orientated models. It also encourages the practitioner to achieve a more objective relationship with the truth which is parallel to phenomenological methods. In addition, its concern with the construction of identity on the basis of habits of thought and action might be seen to parallel cognitive behavioural models.
The Buddhist Model of the Self
As we have already seen, Buddhism offers a model of the self which is based on patterns of thought and behaviour which arises out of the person’s attempt to escape from the various uncomfortable experiences which occur, or which they fear will occur, in the course of their life. The teaching of the Four Noble Truths locates this self-building in relation to affliction and describes the way that the process escalates through ordinary distractions into habit formation and identity creation. Other Buddhist theory describes how the self is maintained through a cycle of perception, reaction and the formation of action traces .
Specifically, a teaching called The Five Skandhas describes a cycle involving five steps. The first stage describes the way that the object world is perceived with a colouration (rupa). The person sees the world in a biased way, filtering their experience by selective viewing, interpretation, and sometimes misconception. Two people walking down the same street will notice different things. Two people attending the same event will give different accounts. Our attention is coloured by our history and interests as well as our fears and preoccupations.
This selective view is followed by other steps. The person reacts to their perception, engaging with it in a visceral way. Specifically they are attracted to it or reject it (vedana). We can see that this description is parallel to that in the second Noble Truth. Both emphasise the role of the senses or bodily response in initially engaging the person’s attention.
Through sense-based attachment, the person is then drawn into a pattern of association (samjna). They fall into old scripts or thought patterns. They are hooked into a particular self-state which depends upon the particular object of perception at that moment. This state is both a recreation of a past identity and the seed of future associations. The person moves on to create further layers of patterning, or mental formations (samskaras) and these in turn lead to a distancing and cutting off of the self from the world which the person inhabits (vijnana). It is this self-orientated world view which leads back to the perception of the object in a personally distorted way; as rupa .
Once again, it is important to emphasise that Buddhism is talking about the ordinary case. Vijnana, the consciousness of the ordinary person which creates a division between self and non-self material should not be regarded as abnormal. The cycle of ordinary thought in which we constantly re-create our self-structures out of the habits established by past activity is referred to as samsara.
In terms of spiritual ideals, Buddhism proposes that a state of aliveness, called enlightenment, in which such everyday compulsion to view the world through a personalised paradigm and to adapt experience to fit one’s preconceptions and prejudices is suspended, can become possible through particular spiritual experiences or practices, but it does not suggest that most of us will attain such a position, at least in the foreseeable future. At the ordinary level, however, these teaching show remarkable understanding of human process and offer particular models for therapeutic intervention.
Dependent Origination, Mental Formations and Karma
As we have seen, according to the Buddhist model, the mind accumulates mental formations (samskaras) as part of the process of perception and assimilation described in the skandha teaching. This process is broadly referred to as ‘conditioning’. The Buddhist theory of conditions is part of another core teaching, that of Dependent Origination , which suggests that all things arise in dependence upon causes and conditions. In other words, one thing leads to another which leads to another .
A specific version of this teaching , referred to as the Twelve Links of Dependent Origination, offers an expanded version of the cycle described in the Skandha model, but a more general understanding of dependence suggests that all processes, whether human or environmental, originate in response to particular circumstances or activities or the presence of particular factors or objects. All things are conditioned. The theory is one of probabilities and likelihoods. It suggests that without certain conditions, some things cannot happen, but it is not deterministic. The theory always leaves space for a different outcome to happen.
Mental Formations: If considered in relation to psychology, this theory points to the fact that our mental processes are conditioned by prior events or factors. They are made likely by certain prior occurrences but are not inevitable. We create mental formations on the basis of our action, which is in turn determined by past cycles of perception and reaction and in particular by our pre-existing mentality. Mental formations perpetuate our habitual mind states by directing our attention and framing our interpretation. In this they may be likened to the Jungian notion of complexes or Kelly’s theory of personal constructs . They create the channels for future thinking and action.
This creation of mental tracks may also be seen in terms of ideas about karma. As we have already seen, Buddhism is grounded in ideas of cause and effect which were common to many Indian philosophical traditions of the Buddha’s day . In particular, however, in Buddhism the notion of karma is linked with that of mental formations in as much as both theories describe the way that the mind is built up on propensities to act in particular ways. When a person acts with intent, as opposed to accidentally, their action leaves a trace, or, we may say, plants a seed. That seed is the seed of future action and it is created in particular circumstances of the original activity. So if a person has a drink in a bar, they sow a seed for having a drink on a future occasion. The circumstances of the drink are being in the bar, so the seed is most likely to ripen and initiate a repetition of the action the next time the person finds him or herself in a bar. In between times the person may give the matter little thought.
Karma: The idea that repeating conditions initiate repeating patterns of behaviour is not so different from many Western understandings. It has obvious relevance to addictive patterns, which have often been created over many repetitions. The Buddhist theory of karma offers some insight into this process. This theory emphasises the importance of intention and of action in the creation of mental formations, which are here conceptualised as seeds (bija). Karma is the process whereby the things which a person does create the conditions for particular outcomes. Sometimes this outcome might be a repetition of the original action. Other times it might be a consequence. Thus being overweight might be seen as a karmic consequence of over-eating.
The theory of karma is complex and sometimes confused. It does in fact embrace a collection of ideas from Indian philosophy which are not all Buddhist and some of which may be contradictory to others. At a simple level, however, the idea of karmic seeds can be useful to an understanding of psychological process.
Intentional action creates karma . Accidental occurrences are not strictly within the remit of karmic theory, though there are interesting discussions to be had concerning the nature of intentionality. Just as a dandelion, each action creates a number of seeds in the mental store (alaya). Action may include mental action, but particularly refers to physical and practical activity. This suggests that on the one hand, if a person is caught in a compulsive cycle and in that habitual process repeats a particular action (say getting drunk) each time the action is repeated, the activity will sow many karmic seeds. In this way, repeating a compulsive action multiplies the possibility for future relapses. On the other hand the theory also suggests that repetition is not inevitable and if a new response to the situation is found, new karmic seeds will be created, taking the person in a new direction.
Whilst action is important in creating mental states, the process described is cyclical, and Buddhism emphasises the role of the mentality in forming action. Mind is the forerunner of all things, according to the Dhammapada . Action follows the mind as the wheel follows the Ox.
The Construction of Experience
Perception is a conditioned phenomenon. The perceived object is related to a real object, but not identical to it. Its appearance to the perceiver depends upon a variety of factors including the prior experience of the viewer, exposure to similar objects in the past, associations at the time, surrounding events and circumstances and so on (The Seventh book of the Abhidharma, a traditional text which sets out Buddhist psychology in a systematic way, identifies twenty four factors which condition the perception of objects ). The fact that humans are generally caught in mental processes which distort the world to fit in with their expectations and psychological needs means that their relationship with the world is always in some way inauthentic. It always includes a subtle (or not so subtle) element of appropriation.
Consciousness: The cost of the process of self-protection is that consciousness is always compromised. Each person is in a state which is commonly referred to as ignorance (avidya) which carries an implication of refusal to truly see reality. This restricted consciousness is maintained by habit patterns but driven by fear and anxiety. Buddhist practices focus in differing ways on moving the person into fuller awareness and thereby diminishing some of the grosser manifestations of avidya, by turning the mind away from self-preoccupation toward engagement with others and the world.
On the other hand, consciousness in its basic nature is always selective. Buddhism asserts that consciousness is of an object. We must therefore in any instance where consciousness is discussed ask ‘consciousness of what?’
Since mental states are conditioned by the object of attention, Buddhist theory and practice often centres on giving the practitioner a suitable object of attention, one which is wholesome and will be inspirational and will condition positive mind states.
Emotions: Just as perception is conditioned, so too, emotional reactions are conditioned by past experiences, expectations and association. The initial reaction to any phenomenon, as we have seen, is one of attraction or aversion, and an automatic grasping onto experiences which enhance identity, or rejection of those which threaten it, seeming to be ‘not like me’. These first reactions, however, are immediately followed by associations which may bring in their wake many other emotional responses. Such emotional reactions initially triggered by the experience of some phenomenon, appearing to the person. It follows therefore that in order to understand a person’s emotional responses better, the perceptual object may be deliberately emphasised as a focus of attention in some Buddhist therapies. Such work is termed ‘objected related’.
Whilst some Buddhist approaches seem to emphasise the creation of calm mind states, we should not forget that the cycle of avoidance, which forms the ordinary mentality, is driven by our fear of hurt, loss and grief. Facing difficult emotions can therefore be important to the process of improving mental health. In terms of Buddhist psychology there may be some requirement therefore to distinguish between the expression of feeling which are a response to existential afflictions (dukkha) and might otherwise be suppressed and those emotional reactions which are compulsive and habitual and part of the replication of self-creating patterns.
Intuition: the question of intuition is an interesting one in Buddhism. There are clearly occasions when a person senses something or ‘knows’ it without consciously being aware of the source of that knowledge. In these instances it would appear there might be several possible explanations. Firstly, although our perception is coloured by a range of personal factors, the world to which we are relating is in fact real. Aspects of that world may be filtered out by our selective attention or distorted views, yet may still be recognised at some level. We often know more than we think we do. Also, we all carry a range of stories and associations. Although the process of association may focus our attention on a particular aspect of a situation, another weaker association may provide us with additional insight into what may be occurring.
Diversity within Buddhist Approaches
As with all modern religions, Buddhism today is diverse. Some of this diversification is the result of geographical spread and the integration of local philosophical and cultural ideas into the interpretation of Buddhist teaching. Other diversification is the result of differences of view on particular doctrinal points or difference of emphasis in the adoption of practice. In the West Buddhist traditions or schools from all over Asia have influenced the development of different groups. As Buddhism has become established, largely over the past fifty years, though in some part through earlier contacts, it has gradually absorbed Western biases and ideas which have both enriched and confused aspects of traditional Eastern approaches. To some extent, Westerners have looked for the roots of teachings in an attempt to get ‘back to the source’, often bringing to bear the Western interest in historicity and analysis. Also, though, they have, often unconsciously, imported modern, often humanistic, values and in particular sought to distance themselves from elements which seemed to echo Western theistic traditions which they were rejecting.
This diversification has had its impact upon the development of therapeutic approaches. So too has the diversity of Western therapies, for those interested in finding Buddhist therapeutic models have general had prior training in some Western therapeutic model, and therefore bring the basic values and concepts of that approach into their integration, or at least develop it in critique of aspects of their prior training. This we have a variety of Buddhist traditions interacting with a variety of Western therapies.
A third factor in creating complexity in the field is that Buddhism offers both conceptual frameworks and methodologies for working with mental process. Although clearly linked, these two facets of Buddhist experience may be differentially emphasised when imported into a therapeutic paradigm, thus some Buddhist therapies are primarily grounded in method (one might think here of meditation or mindfulness based approaches) whilst others are primarily grounded in particular models of teaching (such as aspects of contemplative therapy and other-centred approaches). Therapies vary also in how much they adopt the Buddhist spiritual and ethical paradigm or alternatively secularise the material which they utilise. In this latter field, the same therapy may be presented in different ways for different audiences. Thus the same therapy may emphasise its clinical applications and make little reference to spiritual roots when presented in professional spheres, whilst drawing more overtly on Buddhist ideas and practice in settings where those present are Buddhist adherents.
Some Key Doctrinal Differences
Although this chapter is not the place for detailed debate about different doctrinal and practice positions between Buddhist and therapeutic schools, it is probably worth mentioning a number of distinctions which may help to clarify differences of approach. These distinctions are inevitably ‘broad brush’ and in practice cross-overs and influences tend to blur boundaries. Thus, what follows is to some degree stereotyped to draw out differences. It should however aid the reader’s comprehension of what can seem a confusing variety of approaches.
We have already noted that the three variables of emphasis - method based, doctrine based and paradigmatic based approaches – will each provide different styles of therapy even within the same school. These may be combined with different Western therapies. A meditative approach can deepen the use of psychodynamic understanding, for example, as in the work of Mark Epstein (who also integrates various Buddhist models into his interpretation). Alternatively it may be used as a basis for body therapies or Hakomi or in the form of mindfulness approaches .
Within Buddhism, a number of distinctions exist. Firstly, a common division is made between South Asian Buddhism, represented primarily by Theravada, and other Buddhist schools of northern and Eastern Asian, which collectively are termed Mahayana. These differences which go back to divisions in early Buddhist history centre around on the one hand, adherence to the details of lifestyle and spiritual training believed to originate in the time of the Buddha in Theravada, and on the other hand a plurality of practices and views in Mahayana which were seen as following the spirit of the Buddha’s teaching. This difference is characterised in the differences of ‘ideal-type’ seen in each approach. In Theravada the ideal is the Arahat, an enlightened person who has achieved spiritual awakening through diligence, personal effort and the attainment of wisdom in a steady, graduated process of personal refinement. Mahayana, meanwhile, holds as its ideal the Bodhisattva . The Bodhisattva, in the Mahayana frame is the embodiment of compassion, a being who has forgone personal enlightenment to devote their energy to the wellbeing and salvation of all beings. Thus, put simply, the Theravadin ideal is purity, whereas the Mahayana ideal is compassion. Neither precludes the other, but the differences of emphasis pervade practices and therapies which derive from each. For example, a therapy such as Core Process Therapy places emphasis on achieving clarity in the moment by moment observation of inter-personal, mental and bodily process whereas Compassion-Based Psychotherapy has obvious links with the Mahayana tradition.
Another important division affecting Buddhist schools is that between self-power and other-power schools. Originating in Nagarjuna’s positing of the easy path and the difficult path, the former being the path of effort and the latter that of faith. These ideas developed through Chinese where other-power practices were associated with Pureland schools. In Japanese Buddhism, Pureland schools became particularly strong, making up the largest single denomination. Self-power Buddhism emphasises the practitioner’s task is to eradicate those patterns of habit energy and thought which get in the way of spiritual progress through personal endeavour, whether this is on the Arahat path or that of the Bodhisattva. Other-power Buddhism emphasises that the source of salvation is not to be found within the self, and that it is through the assistance of the Buddha that people change. Other-power Buddhism therefore sees the human state as unenlightened and cultivates attitudes of humility, gratitude and faith. In Western therapies, many of the approaches which have already been discussed might be seen as self power approaches, however, approaches such as Naikan and Other-Centred Therapy work from a primarily other-centred approach.
Other Western therapies have drawn on particular Buddhist traditions. Japanese Morita therapy , for example, grew mainly out of the Zen tradition. This tradition, with its emphasis on sudden transformation, also gave rise to various personal growth methods which became popular in the nineteen seventies and eighties such as the Enlightenment Intensive . Tibetan Buddhism, with its complex mandalas and training systems has given rise to Contemplative Healing .
Yet other therapies took a particular aspect of Buddhist teaching as their inspiration. Acceptance and Commitment Therapy , for example, draws on the central role of intention in the formation of karma.
Despite this diversity, however, Buddhist therapies do all derive from one source, namely the Buddhist teachings, and as such they all embody something of a system of thought which is both insightful into the human condition and resourceful in its provision of methods of working with mind-states.
Other-Centred Approaches
As we have seen, the Buddhist understanding of mental process suggests that people construct a self largely as a defensive structure. They ward off dukkha by creating habits of view and behaviour. The teachings of the Skandhas and of the Twelve Links of Dependent Origination both suggest a cycle of responses. This involves, on the one hand, perception of the world which is coloured by past experience, personal preference and habits of view, and, on the other hand, in reaction to this perception. The mentality is conditioned in this way by repeating behavioural tracks . This conditioned mentality, in turn, leads to a reinforcement of the conditioned view.
In this way, at its simplest, the mind is seen to have two aspects. One aspect of mind is the perceptual relationship with the world, which is mediated through the senses. The other aspect is about the patterns of response which a person has, and the related ‘story’ which is created. Of these two aspects, the second (the pattern of responses and self-story) is generally identified as the self. The other aspect, the perception of things, is thought of as the world (as it is). This is really the ‘frame of reference’ to use the term popularised by Carl Rogers and this frame can be limiting . Different Buddhist approaches may focus on different aspects of this cycle. For example, they may emphasise exploration of the ‘self’ end of the cycle, seeing it as the focus of the problem and the part of the cycle where there is most leverage. Methods such as Vipassana focus on deconstruction of the self. An Other-Centred approach , on the other hand, focuses predominantly on the person’s relationship with the world.
Many psychological problems arise from the human tendency to impose personal agendas on other people and environmental factors. Other-centred therapy helps the client to gain a clearer view of the world as it really is. It loosens the cyclical pattern of self-building . Therapeutic change results from understanding the process of perception, and changing the conditions which distort it.
The other-centred perspective, as the Buddhist model itself, provides a paradigm within which different therapeutic methodologies can be integrated. It lends itself particularly to those approaches which do not draw attention to the self. On the Amida Psychotherapy Training Programme we have been developing a multi-dimensional approach to other-centred work .
Core Skills of Other-Centred Work
Object-Related Work: One of the conditional relations described in the Abhidharma is that of object relation . The mind-state is dependent on the object to which it gives attention . This principle can be seen, for example, in the practice of meditation. Meditation frequently involves focusing the mind upon a wholesome object, which might be an image, the breath, a mantra or physical object.
Object-related work is a development of this principle. Instead of making the object of attention the self, as happens in many therapeutic approaches, the other-centred therapist tends to hold the client’s attention on the other as object of attention. The therapist observes significant ‘objects’ (people and things) which the client mentions as he talks. She encourages the client to say more about these things which are significant in his world and does not get drawn into discussing his feelings or views about them. This focus on the object often evokes a series of strong reactions. The object (person or thing) which is being talked about conditions the mental response, so an immediate attraction/aversion response follows (vedana) , which are often emotionally charged, but the therapist will continue to hold the client’s attention on the object-world, rather than bringing it back to the client’s self. This process of holding attention on the object and making it more vivid is called amplification .
For example.
A client says: “My boss at work was really angry today” Typically a Western therapist might respond: “So how did that feel?” or “What did you do then?” bringing the client’s attention back to himself. An object-related response might be: “tell me more about your boss” or “What did he/she look like?” or “tell me about your office” keeping the client’s attention on the scene and on the other person.
Empathy: Empathy is a perceptual process. It is the attempt to see the world ‘as if’ through the eyes of the other (Rogers C 1951). A fundamental principle, in an other-centred approach, is, not just for the therapist to achieve empathy for the client, but also for the therapist to help the client to develop empathy for the ‘others’ in their world . This includes developing understanding of the significant people in their current life and from the past. Such empathy is focused not only on seeing the client’s ‘others’ in terms of their impact on the client him or her self, but also on seeing them as people with their own reasons for being. The basic question which the therapist might implicitly be asking the client is not ‘how is it for you’ but rather ‘how is it for them?’
Investigation and Objectivity: Buddhism is concerned with a search for truth (Dharma) and with moving beyond limited or distorted views (ignorance) . It therefore follows that a Buddhist therapist is concerned with supporting the client in investigating the truth of his or her life, rather than in clinging to a subjective position. Other-centred work is particularly concerned with achieving this sort of degree of honesty. It is also interested in looking at different viewpoints in any given situation, and in doing so, in gaining more leverage on its various dimensions.
Relationship: Because the emphasis is on others, the therapeutic relationship itself is an important example of encounter with the other in other-centred work. Sometimes it may be directly discussed. More commonly, the emphasis on relationship, shared investigation and discussion of ‘others’ creates a quality called fellow-feeling. This is a collaborative mode of working, in which therapist and client engage in exploration in an adult-adult mode .
Different Focuses of Attention in Other-Centred Work
In other-centred work, the therapist follows the client’s natural process. Within this, she tends to call to attention the perceived world rather than the client’s internal process. The method may thus be seen as outwardly directed. This still leaves many choices of response which will be determined by clinical experience. In broad, however, outwardly orientated responses may be considered to fall into two types:
Exploring the conditioned (rupa) quality of the object: The investigation may focus on the object’s ability or power to hold the clients attention. People talk about particular things because they have personal associations. They have a story, history or assumption. Each object brings with it an imagined world which is itself associated with a ‘self’ or sub-personality (Rowan 1990). Work may involve exploring this associated world. By making the object more vivid, the response becomes more obvious. This may lead to spontaneous links in the client’s story. For example a person feels anxiety about an authority figure. By talking about a specific incident involving that figure, they might recall in vivid detail a similar incident from childhood. Patterns of reaction and habit formation become more apparent. This work may lead to understanding of the way that mental formations and identities are conditioned, or to cathartic insight and a change of heart. The work may be very powerful, however, so the therapist must weight up the likelihood of re-traumatisation and may work to help the client to find a safe distance from which to view the scene .
Rupa-based work is useful in:
• Exposing patterns of perception, assumption, reaction, scripts, associations
• Showing how different identities are conditioned by different ‘objects’
• Leading to cathartic expression (focus on the object is more cathartic than focus on feelings)
• Conditioning a change of heart
Investigating the real qualities of the object: Investigating the associations which the client has for the object can be useful. They may reveal barriers to relationship and help the client to develop empathy for his or her world. The therapist may also challenge the client’s habitual patterns of perception. This may be done in a number of ways:
• Challenging the perception directly. The therapist may ask (explicitly or implicitly) “Is that really so?”
• Facilitating the client so that they develop empathy for the ‘other’
• Investigation, deduction and enquiry into the truth using methods such as biography, research through talking to family members or look at historical material, journaling.
• Using role-reversal work, a technique taken from psychodrama , in which a person imaginatively and sometimes dramatically entering the other’s shoes.
Therapies which Offer an Other-Centred Approach
Other approaches which might be used in an other-centred way include:
Grounding and Body-based work: Our physical presence in the world gives us irrefutable evidence of the real nature of things which we come into contact with. Helping clients to develop their awareness of bodily contact with this physical world creates a good foundation for other-centred work.
Psychodrama: Psychodrama is a method of Western therapy developed by Jacob Moreno. Although generally used in a different paradigm, as a method it offers valuable tools with which to explore the other-centred perspective. These include scene setting, enactment and role-reversal. These are useful in making the object-world more vivid, and in particular the use of role-reversal removes the need to focus therapy in the self position.
Naikan Therapy: Investigating the dependent nature of the person is given form in the practice of Naikan, a Japanese therapy which derives from Pureland Buddhism . in Naikan the participant works with three questions:
• What have others done for me?
• What have I done I return?
• What trouble has my existence caused?
Traditionally undertaken in a retreat setting, Naikan therapy tends to encourage a deep appreciation of life and others, and may evoke feelings of regret at past events and ways in which one has not seen the needs or interests of others. Adaptations of Naikan can be done as a personal practice, guided by weekly sessions with a therapist or teacher, or through the internet. Todo Institute in Vermont offers regular programmes .
Morita Therapy: Another Japanese approach, Morita Therapy uses a number of exercises and techniques to break down a person’s attachment to seeing the world in particular ways or to thinking that they can control the feelings which arise in response to it. It suggests that we can choose what we do, but we cannot choose what we feel. It encourages people to be useful and to take an interest in creating a positive social environment.
Mindfulness and Other-Centred Approach: Mindfulness practices focus on here and now attention. They may be used to develop the client’s awareness of the physical world in which they are living and the physical process of tasks which are being undertaken. Mindfulness also implies remembrance of the spiritual dimension. If taken in this way, the practice of mindfulness not only puts a person in touch with the physical reality of their world, but also its spiritual grounding. In these respects, mindfulness can be considered an other-centred approach.
Foundational Attitudes of Other-Centred Approach:
Faith: Faith plays a crucial role in the relinquishment of self-attachment. Because a person is always embedded in a programmed self-world, even the investigation of reality is an act of faith. It takes faith to let go of protective layers of conditioning and face our existential vulnerability and our grief.
A non-judgemental Position: Buddhism offers a paradigm in which judgement is theoretically absent , however, in the West we tend to fall back into concepts which come more from Judeo-Christian roots; those of guilt, blame, rights, forgiveness and judgement. An other-centred approach supports and depends upon realism rather than guilt, and catharsis and action rather than stagnation and self-justification.
Ordinary Nature: The understanding of our dependently originated nature is particularly developed in the thinking of Pureland Schools of Buddhism. Here the emphasis is on the fact that people are not enlightened beings, they are ordinary or “bombu”. People have an infinite capacity to accumulate bad karma and yet as being surrounded by love and support in the form of the conditions which give rise to life. For this reason, judgement is seen to only be something which we do to ourselves or each other, not something that is inherent in the universe.
Gratitude and Appreciation: It follows from our understanding of the human qualities of dependence, ordinariness and fallibility that other-centred approaches are grounded in a deep sense of appreciation and gratitude. Of course this should not be something forced or false, but tends to arise naturally when we look at the reality of our situation.
Buddhism and Psychotherapy
Although at first sight Buddhism as a religious tradition founded in the fifth century BCE might seem far removed from the world of psychotherapy in the twenty-first century, in fact the Buddhist ideas have contributed to the development of Western thinking in the psychological fields since the times of William James and Carl G Jung . In recent years this influence has increased and brought with it a substantial body of theory and practice, expressed in a number of different therapeutic integrations.
With such a strong history of involvement, it is clear that the connections between Buddhist thought and the study of mental processes are more than simply coincidental. In fact, the relationship arises from the nature of Buddhism itself. A concern with psychological process pervades its thought, and the practices which it teaches. Such ideas are primarily concerned with the human condition and a response to the suffering intrinsic to everyday life. They are concerned with the manner in which, as ordinary people, we respond to the inevitable afflictions, pain and disappointments which life presents to us.
The Buddha, founder of the tradition, was, according to the Buddhist texts, a wealthy young man who, troubled by encounters with examples of human suffering, of sickness, old age and death, left his palace home to become a wandering spiritual seeker. India at that time was a ferment of religious and philosophical enquiry, and there were many teachers in the region, offering a range of practices and insights that addressed questions of life, death and meaning . In this respect, its atmosphere must have presented a stimulating and diverse culture, not unlike some aspects of that which we have recently encountered in the emerging fields of psychology and human communications. The Buddha himself studied with a number of teachers before becoming dissatisfied and pursuing his own path of enquiry. His search culminated in an experience of spiritual breakthrough in which he received insight into the nature of affliction and the processes whereby that suffering which ordinary life entails is compounded by our attempts to escape from it through psychological entanglements.
Key Buddhist Teachings: The Four Noble Truths
The core teachings of Buddhism, which derive from the Buddha’s profound insight, are primarily concerned with the relationship between existential afflictions such as sickness, old age and death, and the creation of the self . This material is presented in the teaching of The Four Noble Truths. The teaching of the Four Noble Truths, which is set out in many of the Buddhist Suttas, but particularly the Samyutta Nikaya 56 , sets out four fundamental assertions: The truth of affliction (dukkha); the truth of arising (samudaya); the truth of cessation, or, one might say, containment (nirodha); and the truth of the spiritual path (marga) . These are elaborated in various texts within the Buddhist canon, in ways which clarify their implications. Despite this, there remains some room for modern scholars to discuss finer points of interpretation . This chapter does not give scope for such debate, however the reader interested in Buddhist studies should be aware of such variations.
Put simply, the first Noble Truth asserts that afflictions are an inevitable part of life. Events such as illness, disability, ageing and death are not something which can be avoided, so facing their inevitability provides a psychological challenge which each of us must meet in some way. How we meet it will affect our mental well-being. The remainder of the teaching sets out what are effectively two alternative paths, firstly that of the ordinary person, trying to cope with life’s difficulty through various patterns of avoidance, and secondly, an ideal-type response which might be experienced by a spiritually advanced person.
According to the second Noble Truths, when we experience afflictions of this kind, there is an arising of feelings or anxiety. This leads, according to the descriptions given in various Buddhist texts , to craving and clinging. The person, experiencing suffering, longs for relief. In the language of the texts, he or she thirsts. This thirsting constitutes the impulse to escape the unpleasant or afflictive circumstance, and initially it is expressed through sensory desire (kama). The person grasps at something which occupies their senses. Generally this happens in a pleasant way, but sometimes in an unpleasant way or a way that involves some form of rejecting behaviour. In other words, one can imagine the situation where a person experiences a difficult day at work, and returning home buries his irritation or disappointment by having a drink or watching a compelling film on the television, by overeating or by engaging in sexual activity. Such responses are quite normal and, as such, are usually pretty harmless, but according to the Buddhist teachings are not the optimal response.
In particular, because such reactions are really attempts to escape from unpleasant feelings, they have an element of compulsiveness. They tend to be repeated, and the person builds up habitual ‘fixes’. This tendency to repetition is the subject of another area of Buddhist theory, the concept of karma, which suggests that each action sows the seeds of its repetition. We will return to this later.
The Creation and Destruction of the Self
With the repetition of familiar patterns of sense-based distraction, the person moves into a second phase of escapist behaviour. This second level, being (bhava), is the birth of the self. In other words, as the habits of behaviour multiply, these form a web of activities, objects and places with which the person identifies. The person starts to think in terms of my favourite drink, my new clothes, my dining room, my sort of film. He or she constructs a lifestyle based on a particular constellation of behaviours.
Once again, there is no abnormality in this process. It is a common human phenomenon to feel at ease in familiar surroundings and activities. It functions, as the text suggests, as a protection against our fears and unhappiness. Once again, however, the element of compulsiveness which underlies the process can create a psychologically limited and sometimes pathological situation. Depending on his or her level of confidence and willingness to face some level of distress, the person’s life may be restricted in various ways. It may become ruled by desires for the reassuring familiarity of the favourite ‘fix’ or a regular situation.
In this model, then, it is easy to see how ordinary psychological processes which mediate our existential fears and traumas, may intensify and lead obsessive-compulsive or addictive patterns arise. Indeed the Buddhist model of human process can be seen as suggesting that we are all to a degree addicted to our identities.
The final stage described in the second Noble Truth is that of non-becoming (abhava). This is the phase of reaction in which the accumulation of elements which makes up the identity ceases to function. At this point, the self breaks down and destructiveness takes its place. The person exhausts their capacity to escape through their habitual routes and feels that they have no options remaining other than to seek oblivion, either literally through suicide, or in other ways through psychological retreat, drugs or other forms of mental destructiveness.
Such psychological crisis often follows the loss of familiar surroundings. The loss of those elements which support identity brings about a breakdown of the self-structure. In particular, a person who is already vulnerable may fall into psychological crisis as a result of a bereavement or similar loss, since such a loss is not only itself an instance of affliction (dukkha), but also removes significant elements in the self-world. Without the psychological resources to face the opportunity for growth which such an event might offer, instead the person falls into a deeper level of withdrawal.
In this way, we can see that the model offered in the second Noble Truth illustrates a graduated distancing of experience. The response to affliction, or the fear of its inevitability, leads the person to use firstly action based distractions and then psychological rooted constructions and associations in order to build what is effectively a protective cocoon of identity. Through the selective use of activities, perception and interpretation, the person builds both a sense of self and a way of seeing the world which are mutually dependent. This creates psychological stability, and in most cases is considered normal, however, it produces a less than optimal condition and, more importantly from a therapeutic point of view, contains within itself the seeds of behaviours and thought patterns which would be considered problematic.
Specifically, from Buddhist perspective, we can view mental illnesses and disorders as extreme or particular instances of the normal human condition. In doing this we can both recognise the ways in which an individual’s thinking has moved beyond the normal range and discover ways to address the situation by helping them to re-engage with experience which is less caught up in the maintenance of the problematic self-structures.
Buddhist Views of Change
The identity or self which is created in response to affliction is considered to be a limitation of experience and a defensive structure. Ultimately it is seen as a problem to the person . At an everyday level, many Buddhist practices recognise that the person is not going to let go of such compulsive self-building behaviour immediately. Indeed to attempt to do so would be counter-productive and probably create more anxiety and clinging and psychological breakdown. Practices, then, often focus more on creating positive habits, rather than eliminating all habit formation .
The teaching of the Four Noble Truths, however, offers a model which illustrates the optimal as well as the ordinary position. The Buddha’s injunction to his followers is to give up this self and to let go of the attachments which support it. The third Noble Truth describes the process of stepping beyond the comforting limits of the familiar by a process of unhooking the attention from the habitual focuses and moving from a state of ‘not-seeing’ (avidya) into a state of direct involvement with life, however difficult it may seem. Such an engagement with reality constitutes the spiritual path. This spiritual path is described in the texts relating to the fourth Noble Truth. This path takes the form of eight activities which constitute the spiritual life. These are known as the eightfold path .
At this point, we may see that the teaching can be viewed as offering two courses of action which may arise in response to suffering: the commonplace reaction with its pathological tendencies and the ideal path of complete maturity. At one end of the spectrum, we are offered a picture of enlightenment in which nothing is avoided and reality is encountered. At the other end we see a descent into psychological turmoil and defeat. The psychology of the normal person occupies the middle ground of ordinary misery and moderate neurosis.
The teaching of the Four Noble Truths can be seen to offer a good parallel to modern Western therapies. In particular it encourages the person to face the reality of their life circumstances in a similar way to that found in existentially orientated models. It also encourages the practitioner to achieve a more objective relationship with the truth which is parallel to phenomenological methods. In addition, its concern with the construction of identity on the basis of habits of thought and action might be seen to parallel cognitive behavioural models.
The Buddhist Model of the Self
As we have already seen, Buddhism offers a model of the self which is based on patterns of thought and behaviour which arises out of the person’s attempt to escape from the various uncomfortable experiences which occur, or which they fear will occur, in the course of their life. The teaching of the Four Noble Truths locates this self-building in relation to affliction and describes the way that the process escalates through ordinary distractions into habit formation and identity creation. Other Buddhist theory describes how the self is maintained through a cycle of perception, reaction and the formation of action traces .
Specifically, a teaching called The Five Skandhas describes a cycle involving five steps. The first stage describes the way that the object world is perceived with a colouration (rupa). The person sees the world in a biased way, filtering their experience by selective viewing, interpretation, and sometimes misconception. Two people walking down the same street will notice different things. Two people attending the same event will give different accounts. Our attention is coloured by our history and interests as well as our fears and preoccupations.
This selective view is followed by other steps. The person reacts to their perception, engaging with it in a visceral way. Specifically they are attracted to it or reject it (vedana). We can see that this description is parallel to that in the second Noble Truth. Both emphasise the role of the senses or bodily response in initially engaging the person’s attention.
Through sense-based attachment, the person is then drawn into a pattern of association (samjna). They fall into old scripts or thought patterns. They are hooked into a particular self-state which depends upon the particular object of perception at that moment. This state is both a recreation of a past identity and the seed of future associations. The person moves on to create further layers of patterning, or mental formations (samskaras) and these in turn lead to a distancing and cutting off of the self from the world which the person inhabits (vijnana). It is this self-orientated world view which leads back to the perception of the object in a personally distorted way; as rupa .
Once again, it is important to emphasise that Buddhism is talking about the ordinary case. Vijnana, the consciousness of the ordinary person which creates a division between self and non-self material should not be regarded as abnormal. The cycle of ordinary thought in which we constantly re-create our self-structures out of the habits established by past activity is referred to as samsara.
In terms of spiritual ideals, Buddhism proposes that a state of aliveness, called enlightenment, in which such everyday compulsion to view the world through a personalised paradigm and to adapt experience to fit one’s preconceptions and prejudices is suspended, can become possible through particular spiritual experiences or practices, but it does not suggest that most of us will attain such a position, at least in the foreseeable future. At the ordinary level, however, these teaching show remarkable understanding of human process and offer particular models for therapeutic intervention.
Dependent Origination, Mental Formations and Karma
As we have seen, according to the Buddhist model, the mind accumulates mental formations (samskaras) as part of the process of perception and assimilation described in the skandha teaching. This process is broadly referred to as ‘conditioning’. The Buddhist theory of conditions is part of another core teaching, that of Dependent Origination , which suggests that all things arise in dependence upon causes and conditions. In other words, one thing leads to another which leads to another .
A specific version of this teaching , referred to as the Twelve Links of Dependent Origination, offers an expanded version of the cycle described in the Skandha model, but a more general understanding of dependence suggests that all processes, whether human or environmental, originate in response to particular circumstances or activities or the presence of particular factors or objects. All things are conditioned. The theory is one of probabilities and likelihoods. It suggests that without certain conditions, some things cannot happen, but it is not deterministic. The theory always leaves space for a different outcome to happen.
Mental Formations: If considered in relation to psychology, this theory points to the fact that our mental processes are conditioned by prior events or factors. They are made likely by certain prior occurrences but are not inevitable. We create mental formations on the basis of our action, which is in turn determined by past cycles of perception and reaction and in particular by our pre-existing mentality. Mental formations perpetuate our habitual mind states by directing our attention and framing our interpretation. In this they may be likened to the Jungian notion of complexes or Kelly’s theory of personal constructs . They create the channels for future thinking and action.
This creation of mental tracks may also be seen in terms of ideas about karma. As we have already seen, Buddhism is grounded in ideas of cause and effect which were common to many Indian philosophical traditions of the Buddha’s day . In particular, however, in Buddhism the notion of karma is linked with that of mental formations in as much as both theories describe the way that the mind is built up on propensities to act in particular ways. When a person acts with intent, as opposed to accidentally, their action leaves a trace, or, we may say, plants a seed. That seed is the seed of future action and it is created in particular circumstances of the original activity. So if a person has a drink in a bar, they sow a seed for having a drink on a future occasion. The circumstances of the drink are being in the bar, so the seed is most likely to ripen and initiate a repetition of the action the next time the person finds him or herself in a bar. In between times the person may give the matter little thought.
Karma: The idea that repeating conditions initiate repeating patterns of behaviour is not so different from many Western understandings. It has obvious relevance to addictive patterns, which have often been created over many repetitions. The Buddhist theory of karma offers some insight into this process. This theory emphasises the importance of intention and of action in the creation of mental formations, which are here conceptualised as seeds (bija). Karma is the process whereby the things which a person does create the conditions for particular outcomes. Sometimes this outcome might be a repetition of the original action. Other times it might be a consequence. Thus being overweight might be seen as a karmic consequence of over-eating.
The theory of karma is complex and sometimes confused. It does in fact embrace a collection of ideas from Indian philosophy which are not all Buddhist and some of which may be contradictory to others. At a simple level, however, the idea of karmic seeds can be useful to an understanding of psychological process.
Intentional action creates karma . Accidental occurrences are not strictly within the remit of karmic theory, though there are interesting discussions to be had concerning the nature of intentionality. Just as a dandelion, each action creates a number of seeds in the mental store (alaya). Action may include mental action, but particularly refers to physical and practical activity. This suggests that on the one hand, if a person is caught in a compulsive cycle and in that habitual process repeats a particular action (say getting drunk) each time the action is repeated, the activity will sow many karmic seeds. In this way, repeating a compulsive action multiplies the possibility for future relapses. On the other hand the theory also suggests that repetition is not inevitable and if a new response to the situation is found, new karmic seeds will be created, taking the person in a new direction.
Whilst action is important in creating mental states, the process described is cyclical, and Buddhism emphasises the role of the mentality in forming action. Mind is the forerunner of all things, according to the Dhammapada . Action follows the mind as the wheel follows the Ox.
The Construction of Experience
Perception is a conditioned phenomenon. The perceived object is related to a real object, but not identical to it. Its appearance to the perceiver depends upon a variety of factors including the prior experience of the viewer, exposure to similar objects in the past, associations at the time, surrounding events and circumstances and so on (The Seventh book of the Abhidharma, a traditional text which sets out Buddhist psychology in a systematic way, identifies twenty four factors which condition the perception of objects ). The fact that humans are generally caught in mental processes which distort the world to fit in with their expectations and psychological needs means that their relationship with the world is always in some way inauthentic. It always includes a subtle (or not so subtle) element of appropriation.
Consciousness: The cost of the process of self-protection is that consciousness is always compromised. Each person is in a state which is commonly referred to as ignorance (avidya) which carries an implication of refusal to truly see reality. This restricted consciousness is maintained by habit patterns but driven by fear and anxiety. Buddhist practices focus in differing ways on moving the person into fuller awareness and thereby diminishing some of the grosser manifestations of avidya, by turning the mind away from self-preoccupation toward engagement with others and the world.
On the other hand, consciousness in its basic nature is always selective. Buddhism asserts that consciousness is of an object. We must therefore in any instance where consciousness is discussed ask ‘consciousness of what?’
Since mental states are conditioned by the object of attention, Buddhist theory and practice often centres on giving the practitioner a suitable object of attention, one which is wholesome and will be inspirational and will condition positive mind states.
Emotions: Just as perception is conditioned, so too, emotional reactions are conditioned by past experiences, expectations and association. The initial reaction to any phenomenon, as we have seen, is one of attraction or aversion, and an automatic grasping onto experiences which enhance identity, or rejection of those which threaten it, seeming to be ‘not like me’. These first reactions, however, are immediately followed by associations which may bring in their wake many other emotional responses. Such emotional reactions initially triggered by the experience of some phenomenon, appearing to the person. It follows therefore that in order to understand a person’s emotional responses better, the perceptual object may be deliberately emphasised as a focus of attention in some Buddhist therapies. Such work is termed ‘objected related’.
Whilst some Buddhist approaches seem to emphasise the creation of calm mind states, we should not forget that the cycle of avoidance, which forms the ordinary mentality, is driven by our fear of hurt, loss and grief. Facing difficult emotions can therefore be important to the process of improving mental health. In terms of Buddhist psychology there may be some requirement therefore to distinguish between the expression of feeling which are a response to existential afflictions (dukkha) and might otherwise be suppressed and those emotional reactions which are compulsive and habitual and part of the replication of self-creating patterns.
Intuition: the question of intuition is an interesting one in Buddhism. There are clearly occasions when a person senses something or ‘knows’ it without consciously being aware of the source of that knowledge. In these instances it would appear there might be several possible explanations. Firstly, although our perception is coloured by a range of personal factors, the world to which we are relating is in fact real. Aspects of that world may be filtered out by our selective attention or distorted views, yet may still be recognised at some level. We often know more than we think we do. Also, we all carry a range of stories and associations. Although the process of association may focus our attention on a particular aspect of a situation, another weaker association may provide us with additional insight into what may be occurring.
Diversity within Buddhist Approaches
As with all modern religions, Buddhism today is diverse. Some of this diversification is the result of geographical spread and the integration of local philosophical and cultural ideas into the interpretation of Buddhist teaching. Other diversification is the result of differences of view on particular doctrinal points or difference of emphasis in the adoption of practice. In the West Buddhist traditions or schools from all over Asia have influenced the development of different groups. As Buddhism has become established, largely over the past fifty years, though in some part through earlier contacts, it has gradually absorbed Western biases and ideas which have both enriched and confused aspects of traditional Eastern approaches. To some extent, Westerners have looked for the roots of teachings in an attempt to get ‘back to the source’, often bringing to bear the Western interest in historicity and analysis. Also, though, they have, often unconsciously, imported modern, often humanistic, values and in particular sought to distance themselves from elements which seemed to echo Western theistic traditions which they were rejecting.
This diversification has had its impact upon the development of therapeutic approaches. So too has the diversity of Western therapies, for those interested in finding Buddhist therapeutic models have general had prior training in some Western therapeutic model, and therefore bring the basic values and concepts of that approach into their integration, or at least develop it in critique of aspects of their prior training. This we have a variety of Buddhist traditions interacting with a variety of Western therapies.
A third factor in creating complexity in the field is that Buddhism offers both conceptual frameworks and methodologies for working with mental process. Although clearly linked, these two facets of Buddhist experience may be differentially emphasised when imported into a therapeutic paradigm, thus some Buddhist therapies are primarily grounded in method (one might think here of meditation or mindfulness based approaches) whilst others are primarily grounded in particular models of teaching (such as aspects of contemplative therapy and other-centred approaches). Therapies vary also in how much they adopt the Buddhist spiritual and ethical paradigm or alternatively secularise the material which they utilise. In this latter field, the same therapy may be presented in different ways for different audiences. Thus the same therapy may emphasise its clinical applications and make little reference to spiritual roots when presented in professional spheres, whilst drawing more overtly on Buddhist ideas and practice in settings where those present are Buddhist adherents.
Some Key Doctrinal Differences
Although this chapter is not the place for detailed debate about different doctrinal and practice positions between Buddhist and therapeutic schools, it is probably worth mentioning a number of distinctions which may help to clarify differences of approach. These distinctions are inevitably ‘broad brush’ and in practice cross-overs and influences tend to blur boundaries. Thus, what follows is to some degree stereotyped to draw out differences. It should however aid the reader’s comprehension of what can seem a confusing variety of approaches.
We have already noted that the three variables of emphasis - method based, doctrine based and paradigmatic based approaches – will each provide different styles of therapy even within the same school. These may be combined with different Western therapies. A meditative approach can deepen the use of psychodynamic understanding, for example, as in the work of Mark Epstein (who also integrates various Buddhist models into his interpretation). Alternatively it may be used as a basis for body therapies or Hakomi or in the form of mindfulness approaches .
Within Buddhism, a number of distinctions exist. Firstly, a common division is made between South Asian Buddhism, represented primarily by Theravada, and other Buddhist schools of northern and Eastern Asian, which collectively are termed Mahayana. These differences which go back to divisions in early Buddhist history centre around on the one hand, adherence to the details of lifestyle and spiritual training believed to originate in the time of the Buddha in Theravada, and on the other hand a plurality of practices and views in Mahayana which were seen as following the spirit of the Buddha’s teaching. This difference is characterised in the differences of ‘ideal-type’ seen in each approach. In Theravada the ideal is the Arahat, an enlightened person who has achieved spiritual awakening through diligence, personal effort and the attainment of wisdom in a steady, graduated process of personal refinement. Mahayana, meanwhile, holds as its ideal the Bodhisattva . The Bodhisattva, in the Mahayana frame is the embodiment of compassion, a being who has forgone personal enlightenment to devote their energy to the wellbeing and salvation of all beings. Thus, put simply, the Theravadin ideal is purity, whereas the Mahayana ideal is compassion. Neither precludes the other, but the differences of emphasis pervade practices and therapies which derive from each. For example, a therapy such as Core Process Therapy places emphasis on achieving clarity in the moment by moment observation of inter-personal, mental and bodily process whereas Compassion-Based Psychotherapy has obvious links with the Mahayana tradition.
Another important division affecting Buddhist schools is that between self-power and other-power schools. Originating in Nagarjuna’s positing of the easy path and the difficult path, the former being the path of effort and the latter that of faith. These ideas developed through Chinese where other-power practices were associated with Pureland schools. In Japanese Buddhism, Pureland schools became particularly strong, making up the largest single denomination. Self-power Buddhism emphasises the practitioner’s task is to eradicate those patterns of habit energy and thought which get in the way of spiritual progress through personal endeavour, whether this is on the Arahat path or that of the Bodhisattva. Other-power Buddhism emphasises that the source of salvation is not to be found within the self, and that it is through the assistance of the Buddha that people change. Other-power Buddhism therefore sees the human state as unenlightened and cultivates attitudes of humility, gratitude and faith. In Western therapies, many of the approaches which have already been discussed might be seen as self power approaches, however, approaches such as Naikan and Other-Centred Therapy work from a primarily other-centred approach.
Other Western therapies have drawn on particular Buddhist traditions. Japanese Morita therapy , for example, grew mainly out of the Zen tradition. This tradition, with its emphasis on sudden transformation, also gave rise to various personal growth methods which became popular in the nineteen seventies and eighties such as the Enlightenment Intensive . Tibetan Buddhism, with its complex mandalas and training systems has given rise to Contemplative Healing .
Yet other therapies took a particular aspect of Buddhist teaching as their inspiration. Acceptance and Commitment Therapy , for example, draws on the central role of intention in the formation of karma.
Despite this diversity, however, Buddhist therapies do all derive from one source, namely the Buddhist teachings, and as such they all embody something of a system of thought which is both insightful into the human condition and resourceful in its provision of methods of working with mind-states.
Other-Centred Approaches
As we have seen, the Buddhist understanding of mental process suggests that people construct a self largely as a defensive structure. They ward off dukkha by creating habits of view and behaviour. The teachings of the Skandhas and of the Twelve Links of Dependent Origination both suggest a cycle of responses. This involves, on the one hand, perception of the world which is coloured by past experience, personal preference and habits of view, and, on the other hand, in reaction to this perception. The mentality is conditioned in this way by repeating behavioural tracks . This conditioned mentality, in turn, leads to a reinforcement of the conditioned view.
In this way, at its simplest, the mind is seen to have two aspects. One aspect of mind is the perceptual relationship with the world, which is mediated through the senses. The other aspect is about the patterns of response which a person has, and the related ‘story’ which is created. Of these two aspects, the second (the pattern of responses and self-story) is generally identified as the self. The other aspect, the perception of things, is thought of as the world (as it is). This is really the ‘frame of reference’ to use the term popularised by Carl Rogers and this frame can be limiting . Different Buddhist approaches may focus on different aspects of this cycle. For example, they may emphasise exploration of the ‘self’ end of the cycle, seeing it as the focus of the problem and the part of the cycle where there is most leverage. Methods such as Vipassana focus on deconstruction of the self. An Other-Centred approach , on the other hand, focuses predominantly on the person’s relationship with the world.
Many psychological problems arise from the human tendency to impose personal agendas on other people and environmental factors. Other-centred therapy helps the client to gain a clearer view of the world as it really is. It loosens the cyclical pattern of self-building . Therapeutic change results from understanding the process of perception, and changing the conditions which distort it.
The other-centred perspective, as the Buddhist model itself, provides a paradigm within which different therapeutic methodologies can be integrated. It lends itself particularly to those approaches which do not draw attention to the self. On the Amida Psychotherapy Training Programme we have been developing a multi-dimensional approach to other-centred work .
Core Skills of Other-Centred Work
Object-Related Work: One of the conditional relations described in the Abhidharma is that of object relation . The mind-state is dependent on the object to which it gives attention . This principle can be seen, for example, in the practice of meditation. Meditation frequently involves focusing the mind upon a wholesome object, which might be an image, the breath, a mantra or physical object.
Object-related work is a development of this principle. Instead of making the object of attention the self, as happens in many therapeutic approaches, the other-centred therapist tends to hold the client’s attention on the other as object of attention. The therapist observes significant ‘objects’ (people and things) which the client mentions as he talks. She encourages the client to say more about these things which are significant in his world and does not get drawn into discussing his feelings or views about them. This focus on the object often evokes a series of strong reactions. The object (person or thing) which is being talked about conditions the mental response, so an immediate attraction/aversion response follows (vedana) , which are often emotionally charged, but the therapist will continue to hold the client’s attention on the object-world, rather than bringing it back to the client’s self. This process of holding attention on the object and making it more vivid is called amplification .
For example.
A client says: “My boss at work was really angry today” Typically a Western therapist might respond: “So how did that feel?” or “What did you do then?” bringing the client’s attention back to himself. An object-related response might be: “tell me more about your boss” or “What did he/she look like?” or “tell me about your office” keeping the client’s attention on the scene and on the other person.
Empathy: Empathy is a perceptual process. It is the attempt to see the world ‘as if’ through the eyes of the other (Rogers C 1951). A fundamental principle, in an other-centred approach, is, not just for the therapist to achieve empathy for the client, but also for the therapist to help the client to develop empathy for the ‘others’ in their world . This includes developing understanding of the significant people in their current life and from the past. Such empathy is focused not only on seeing the client’s ‘others’ in terms of their impact on the client him or her self, but also on seeing them as people with their own reasons for being. The basic question which the therapist might implicitly be asking the client is not ‘how is it for you’ but rather ‘how is it for them?’
Investigation and Objectivity: Buddhism is concerned with a search for truth (Dharma) and with moving beyond limited or distorted views (ignorance) . It therefore follows that a Buddhist therapist is concerned with supporting the client in investigating the truth of his or her life, rather than in clinging to a subjective position. Other-centred work is particularly concerned with achieving this sort of degree of honesty. It is also interested in looking at different viewpoints in any given situation, and in doing so, in gaining more leverage on its various dimensions.
Relationship: Because the emphasis is on others, the therapeutic relationship itself is an important example of encounter with the other in other-centred work. Sometimes it may be directly discussed. More commonly, the emphasis on relationship, shared investigation and discussion of ‘others’ creates a quality called fellow-feeling. This is a collaborative mode of working, in which therapist and client engage in exploration in an adult-adult mode .
Different Focuses of Attention in Other-Centred Work
In other-centred work, the therapist follows the client’s natural process. Within this, she tends to call to attention the perceived world rather than the client’s internal process. The method may thus be seen as outwardly directed. This still leaves many choices of response which will be determined by clinical experience. In broad, however, outwardly orientated responses may be considered to fall into two types:
Exploring the conditioned (rupa) quality of the object: The investigation may focus on the object’s ability or power to hold the clients attention. People talk about particular things because they have personal associations. They have a story, history or assumption. Each object brings with it an imagined world which is itself associated with a ‘self’ or sub-personality (Rowan 1990). Work may involve exploring this associated world. By making the object more vivid, the response becomes more obvious. This may lead to spontaneous links in the client’s story. For example a person feels anxiety about an authority figure. By talking about a specific incident involving that figure, they might recall in vivid detail a similar incident from childhood. Patterns of reaction and habit formation become more apparent. This work may lead to understanding of the way that mental formations and identities are conditioned, or to cathartic insight and a change of heart. The work may be very powerful, however, so the therapist must weight up the likelihood of re-traumatisation and may work to help the client to find a safe distance from which to view the scene .
Rupa-based work is useful in:
• Exposing patterns of perception, assumption, reaction, scripts, associations
• Showing how different identities are conditioned by different ‘objects’
• Leading to cathartic expression (focus on the object is more cathartic than focus on feelings)
• Conditioning a change of heart
Investigating the real qualities of the object: Investigating the associations which the client has for the object can be useful. They may reveal barriers to relationship and help the client to develop empathy for his or her world. The therapist may also challenge the client’s habitual patterns of perception. This may be done in a number of ways:
• Challenging the perception directly. The therapist may ask (explicitly or implicitly) “Is that really so?”
• Facilitating the client so that they develop empathy for the ‘other’
• Investigation, deduction and enquiry into the truth using methods such as biography, research through talking to family members or look at historical material, journaling.
• Using role-reversal work, a technique taken from psychodrama , in which a person imaginatively and sometimes dramatically entering the other’s shoes.
Therapies which Offer an Other-Centred Approach
Other approaches which might be used in an other-centred way include:
Grounding and Body-based work: Our physical presence in the world gives us irrefutable evidence of the real nature of things which we come into contact with. Helping clients to develop their awareness of bodily contact with this physical world creates a good foundation for other-centred work.
Psychodrama: Psychodrama is a method of Western therapy developed by Jacob Moreno. Although generally used in a different paradigm, as a method it offers valuable tools with which to explore the other-centred perspective. These include scene setting, enactment and role-reversal. These are useful in making the object-world more vivid, and in particular the use of role-reversal removes the need to focus therapy in the self position.
Naikan Therapy: Investigating the dependent nature of the person is given form in the practice of Naikan, a Japanese therapy which derives from Pureland Buddhism . in Naikan the participant works with three questions:
• What have others done for me?
• What have I done I return?
• What trouble has my existence caused?
Traditionally undertaken in a retreat setting, Naikan therapy tends to encourage a deep appreciation of life and others, and may evoke feelings of regret at past events and ways in which one has not seen the needs or interests of others. Adaptations of Naikan can be done as a personal practice, guided by weekly sessions with a therapist or teacher, or through the internet. Todo Institute in Vermont offers regular programmes .
Morita Therapy: Another Japanese approach, Morita Therapy uses a number of exercises and techniques to break down a person’s attachment to seeing the world in particular ways or to thinking that they can control the feelings which arise in response to it. It suggests that we can choose what we do, but we cannot choose what we feel. It encourages people to be useful and to take an interest in creating a positive social environment.
Mindfulness and Other-Centred Approach: Mindfulness practices focus on here and now attention. They may be used to develop the client’s awareness of the physical world in which they are living and the physical process of tasks which are being undertaken. Mindfulness also implies remembrance of the spiritual dimension. If taken in this way, the practice of mindfulness not only puts a person in touch with the physical reality of their world, but also its spiritual grounding. In these respects, mindfulness can be considered an other-centred approach.
Foundational Attitudes of Other-Centred Approach:
Faith: Faith plays a crucial role in the relinquishment of self-attachment. Because a person is always embedded in a programmed self-world, even the investigation of reality is an act of faith. It takes faith to let go of protective layers of conditioning and face our existential vulnerability and our grief.
A non-judgemental Position: Buddhism offers a paradigm in which judgement is theoretically absent , however, in the West we tend to fall back into concepts which come more from Judeo-Christian roots; those of guilt, blame, rights, forgiveness and judgement. An other-centred approach supports and depends upon realism rather than guilt, and catharsis and action rather than stagnation and self-justification.
Ordinary Nature: The understanding of our dependently originated nature is particularly developed in the thinking of Pureland Schools of Buddhism. Here the emphasis is on the fact that people are not enlightened beings, they are ordinary or “bombu”. People have an infinite capacity to accumulate bad karma and yet as being surrounded by love and support in the form of the conditions which give rise to life. For this reason, judgement is seen to only be something which we do to ourselves or each other, not something that is inherent in the universe.
Gratitude and Appreciation: It follows from our understanding of the human qualities of dependence, ordinariness and fallibility that other-centred approaches are grounded in a deep sense of appreciation and gratitude. Of course this should not be something forced or false, but tends to arise naturally when we look at the reality of our situation.
Add a Comment
-
Comment by caroline brazier on October 11, 2009 at 6:49pm - Thank you. I'm glad you found it interesting. It is always difficult to convey ideas succinctly, and of course when one does there is always reductionism. We are just in the early stages of our autumn psychotherapy teaching block at present, looking at some of these themes.
-
Comment by Stanley Eden on October 11, 2009 at 4:13pm - Prasada, Thank you for presenting your paper on 'Buddhism and Psychotherapy'. As a psychologist I found it to be very readable and an excellent offering of buddhist perspectives related to 'mental health'. I am sure it will be a valuable resource for beginning practioners and as a reminder for those that may already be attempting to use a 'buddhist' orientation in their work, in Poland or elsewhere. Thank you again. Peace to you.
-
Comment by Katrien Sercu on August 31, 2009 at 4:34pm - Dear Prasada, I printed out your paper and i take it with me on holidays in Toscane. There i've time to read it slowly, in good conditions. Althought i'm a Gestaltpsychotherapist, until now i did not dear to begin with the Buddhist Psychology, as if the mountain was too high...Maybe your paper will show a way to become able to climb this new area. So thank you for this. Namo Amida Bu
Badge
© 2009 Created by Kaspalita on Ning. Create Your Own Social Network
You need to be a member of Friends of Amida to add comments!
Join this social network