Mindful Therapy - Selections
CHAPTER 1: Envision Psychotherapy as a Spiritual Path
A therapist has to practice being fully present and has to cultivate the energy of compassion in order to be helpful.1
– Thich Nhat Hanh
Therapy is not easy work. If you are a psychotherapist, a counselor, or anyone who routinely seeks to relieve suffering in others through any of the arts involving deep listening and true presence, you are a special person. You are part of a long line of healers and shamans, of gurus and bodhisattvas stretching back to the beginning of human history and even earlier still.
Yet no time in the brief history of psychotherapy has been more challenging than this one. We continue to live in a world of increasing alienation, disconnection, and fragmentation. Our patients are not immune to this, and neither are we. Those of us who try to help in such circumstances as these will at times feel underappreciated and overwhelmed. Every year our paperwork increases, while our fees remain the same or are even reduced. Sometimes we have to fight to just get a few more sessions for a severely depressed patient. We may become the target of the negative transference of our patients who see us as the depriving mother or the severe father, and the economic conditions and bureaucratic struggles surrounding our work make it increasingly difficult to tolerate. In decades past, people had high expectations for therapy, perhaps too high. But today we more often encounter unwarranted skepticism. Perhaps in part this skepticism has resulted because, while a wider range of people may now experience a service they’ve been told is psychotherapy, they have in reality received no such thing. Instead of a deep, healing human encounter, they may in at least some instances have received only a few sessions of well-intentioned advice-giving or a brief interview for the purposes of pharmacological treatment, particularly in areas where managed care dominates. And if that is therapy, and the world does not value it very much, can we blame them for being skeptical about it? Beyond this, in the United States there is a deeply entrenched feeling that we should rely on ourselves and that therapy is a kind of dependency, rather than the process of self-discovery it actually is. What is more, we live in a culture that is largely outside without inside, biased toward the extroverted and doing-oriented side of life. In such a context, psychotherapy and other techniques involving increased awareness are all too easily lampooned as frivolous navel-gazing.
There are no readily identifiable villains in our complex and often inadequate system of health care. We are all caught together in it, doing the best we can. It may have seemed like a good idea, some years ago, to “medicalize” psychotherapy in order to qualify for insurance reimbursement, but when the pressure of spiraling medical costs became too great, we who jumped aboard the medical bandwagon last were of course the first to pay the price, the first to have our services reduced and controlled. Unwisely so, I believe. But not surprisingly.
I want to suggest, to all my colleagues in the art of deep listening, that in order to withstand the difficulties of our work and the ups and downs of its valuation in the marketplace, we require a powerful inoculation. And in my experience the best inoculation is the capacity to envision our work as a that of a healer, a part of a long and honorable lineage—to view it as a path of service, a calling as well as a business—and to sincerely offer up this work to the good of all beings.
Science is Not Enough
I am a psychologist. My training is scientific. I am versed in experimental design and statistical analysis. In my education I received the great mantras: “What does the research say?” and “Where are your data?” And I value that training. Whatever we can learn from science about our work is grounding and helpful.
At the same time, it is not enough.
You knew this, if you were honest, the first time you had the experience of sitting down as a therapist with a person you were supposed to help. If you were open to acknowledging it, you knew right away that you needed more than what your training had provided you.
Zen scholar D.T. Suzuki expressed the trouble with science, and scientific objectivity, this way:
Scientists . . . like to be objective and avoid being subjective, whatever this may mean. For they firmly adhere to the view that a statement is true only when it is objectively evaluated or validated and not merely subjectively or personally experienced. They forget the fact that a person invariably lives a personal life and not a conceptually or scientifically defined one. However exactly or objectively . . . the definition might have been given, it is not the definition the person lives, but the life itself, and it is this life which is the subject of human study.
When I emerged from graduate training, my ideas about the nature of therapy were not too different from what they are now. But if you and I could watch a video of me doing therapy at that time, I shudder to imagine what we would see. We would probably have had a hard time knowing that my view of therapy was anything much like what I describe in this book. In keeping with the great mantras I had learned, I fear you would have seen someone ready to pounce on anything a patient said and trot out some prized bit of information: “Actually, research shows that . . .” Contrary to what I would have said about my work even at that time, in practice I seem to have viewed my role as providing people with the information I had accumulated in graduate school. I was like the learned scholar in the familiar story, puffed up with knowledge, who called upon the Zen master to discuss Buddhism. Sitting at tea with the professor, the master kept pouring into the scholar’s cup, filling it to overflowing. The scholar said, “It is already full! No more can go in!” “You are like this,” the master explained. “How can I show you Zen unless you first empty your cup?” This may be a somewhat unkind caricature of myself as a therapist at that time, but I’m afraid I resembled it rather too much for comfort, and even today, with some regularity, leave a session with the feeling that once again I talked too much.
Looking back at myself at that time, I can see that I was attempting to lead with my knowledge base, rather than allowing it to inform me in the background. As Zen master Thich Nhat Hanh writes, “On the path of practice, knowledge is an obstacle that must be overcome. We must be ready to abandon our knowledge at any moment in order to get to a higher level of understanding.”
In this perspective, we may consider the metaphor of water and ice. A living encounter is water, continually flowing, always ready to take new shape; knowledge is ice, hardened, fixed. Being mindful means allowing the ice of our knowledge to melt into the living water of a personal encounter with another human being. It is only in such an encounter that true healing, true therapy takes place.
I believed then, and believe now, that the task of the therapist is to practice deep listening, to produce one’s true presence, to be deeply available and thereby create the living water of a true encounter. This is what I call mindful therapy. Mindful therapists know it is the relationship that brings the healing. It is the capacity to use our own personhood in the authentic meeting with another person that is most important. “The great healing factor in psychotherapy,” writes Carl Jung, “is the doctor’s personality.” In our context, we might talk about presence or mindfulness rather than personality, but we can readily understand Jung’s meaning.
Our training may be scientific, but our true lineage is not only scientific. We are the descendants not only of scientists, but also of shamans, gurus, healers, and bodhisattvas—spiritual teachers, philosophers, and wise people of all kinds from all times and places. We might attempt to deny being the offspring of disliked parents, but we cannot deny the truth that remains in our bodies, in our genes. In this same sense, we are the descendants of these healers. Like them, we inevitably bring a worldview to our work, a philosophy, stated or not, about what the good life is and how to live it, and about how we get sick when we stray too far from that life. It is an essential and unavoidable part of our calling to be practical philosophers and spiritual teachers.
And yet, while it is necessary that we claim our role as spiritual teachers and healers, we also need a way to fulfill that role, a way that feels possible, practical, and human-sized. We need a way to do this, in today’s pluralistic world, that does not include a lot of specific religious dogma that may conflict with the beliefs of our patients. To be a healer, to be a practical philosopher and spiritual teacher without ourselves succumbing to the risks of ego inflation, we need a grounded, realistic, and humanistic framework for such work.
If we are to acknowledge this as our true task, then we need a way to produce our true presence, to deepen our spiritual understanding, and to enhance our capacity to listen calmly. We require a vision for our psychotherapy practice that is at the same time lofty and practical, head in the clouds, perhaps, but feet firmly on the ground.
One approach highly suited to meet this need is the Buddhist practice of mindfulness. Mindfulness, the practice of deep awareness, of calm presence, involves a minimum of metaphysical or dogmatic belief, making it a spiritual path accessible to the agnostic as much as to the practicing Jew, Protestant, or Catholic. It is an approach to living that we can share with patients of diverse backgrounds and belief systems. Immensely practical, it is also simply a wonderful way to live. We will explore mindfulness and a mindful life more deeply in later chapters.
If you are a practicing psychotherapist, you may imagine you know enough about the science, theories, and the techniques of therapy—but at any rate, these things are not the focus of this book. In my opinion and my experience, if we are to avoid the fate of our science becoming an obstacle and of our techniques becoming gimmicks, we need to learn how to bear the mantle of the shaman, the guru, the healer, the bodhisattva. Let’s take a closer look at what this means.
The Shaman and the Psychotherapist
The word shaman originates with the Tungu tribe in Siberia, where it refers to people who heal through their capacity to deal with the spiritual realm. I use the word here to refer to aboriginal healers in general. We find shamans in the tribes of New Guinea and Australia, and we find them in Native American tribes and the cultures in the Artic circle. Human beings seem to have recognized very early on that there are people especially suited to this role. Whether we explain this regularity by a model of cultural diffusion, or are inclined to believe that such a role is archetypal, rooted deeply in the Jungian collective unconscious, such a role is fundamentally and uniquely human. Archetypally, the career of such individuals begins with an initiatory experience, often an illness of some sort. If they survive this ordeal, the shaman emerges as a wounded healer, one with a capacity to interact with the realm of spirits and help others.
If not always so dramatically, this applies to many of us who practice psychotherapy as well. Many of us are attracted to the archetype of the wounded healer, and choosing to be a therapist is an expression of that attraction. The choice to become a therapist reflects an inclination to become a wise person, not only to help other people, but also to bring light and healing to our own wounds. Without such a motivation, it is difficult to understand why someone would take on this difficult work.
When I look around at a meeting of therapists, I see no psychological supermen and superwomen. If you have that kind of expectation, you will be quite disappointed in your colleagues. In many I see wounded healers—people who have come through some difficulty of their own, and have learned something along the way about how to help others. This knowledge is clearly not just what we learned in our training. Our human suffering—both specific and universal—is the very door through which we have become healers, and not our training and education alone.
The Guru and the Psychotherapist
The Sanskrit word guru means “heavy.” To be a guru is to be a person of weight and substance, a teacher. The exact role of the guru varies from tradition to tradition, but in its most exalted form, devotion to the guru is paramount. From a Western point of view, it often looks like such devotion is a very questionable matter at best, and indeed it has been subject to abuse. The guru relationship is particularly subject to abuse when Eastern gurus come to the West, unaccustomed to the sort of projections—sexual and otherwise—that Westerners place on them. While we in the West may view such devotion with distaste, what we may miss is the way the guru, in taking on a student, takes on an extraordinary commitment to that individual—a commitment for nothing less than that person’s total salvation in this and perhaps even future lives.
In re-visioning the therapist as a kind of guru in our own contemporary cultural context, we must know that there are limits to our understanding, to the “devotion” we deserve and can expect, and to the commitment we can honestly give to the other person. Yet contrary to many media images, I find most therapists to be devoted to their patients. I know of more than one therapist who has retired, but nonetheless continues to consult with patients by telephone, feeling a continuing responsibility to them, sometimes despite serious personal health and other issues.
Some may have ethical questions about such practices. It might be better to make a good referral once we retire than to try to provide ongoing care. But such examples demonstrate the deep responsibility we often feel toward our patients. For therapy is and must be, first and foremost, a decent human relationship. And if it is a decent human relationship, it is difficult to completely confine it to fifty minutes per week. Even if we have no other contact, with the possible exception of a rare phone call, we think of our patients between sessions—and indeed I believe we should think about them. If it is a deep relationship, they penetrate our psyches as we do theirs. They dream about us, and we may sometimes dream about them. This surely reflects a deep commitment.
And thus, while of course we should not expect unquestioning devotion from our patients, we are nonetheless worthy of respect for what we offer. We are people of weight, of substance. The fee for our service is only one expression of this. In fact, if our patients do not have some minimal level of respect for us, we will not be able to help them at all. If a patient is simply too skeptical, too mistrustful of us and our intentions, or if they see us as only interested in the money—if they believe that it is not possible for us to care about them and earn our living from them at the same time, if they think we are too young or too old or in some other way too different to understand them, our capacity to help will be limited.
In some traditions, the guru is viewed with almost deifying reverence. Psychologically, this means that to be healers, we must be people who can temporarily bear for the patient what Jung called the archetype of the Self, the Jungian equivalent of the Totality or the Divine. We function like gurus in the limited sense that, in a successful therapeutic process, patients project this archetype onto us. This is a heavy burden to bear, and would in fact be unbearable were it not that we only hold it in trust for the patient until such time as the patient becomes capable of holding it for himself.
In this way, by bearing the archetype of the Self, the therapist functions as a transitional object, like a child’s security blanket that stands in for the presence of the mother until the child incorporates her presence into his own psyche. An apt analogy from popular culture is that the therapist or the therapy process is a little like Dumbo’s magic feather. Holding the magic feather, Dumbo believes that he can fly. Dumbo clings tightly to the feather until he learns that the capacity for flight resides in himself and not in the feather.
Fortunately we do not have to have to be god to our patients. We do not require any god-like, all-knowing, superhuman wisdom or power. In fact, patients coming to know our limitation and humanness is part of how they claim the power they attribute to us as their own. We are not gurus in the sense of being in any way superhuman, yet at the same time, we have power to heal and help. Gurus who do not know their power are dangerous.
To be healers we must be convincing and worthy of trust. We must have enough connection with the archetype of the Divine— with wholeness and full humanity—that we can receive and hold the projection of the archetype of the Self, of wholeness. In other words, patients project wholeness onto us, and then claim it back as their own. For this to work, we must be at least somewhat suitable targets for the projection. We must be people who attend to our own growth, who find our own spiritual practice. That’s part of the job description of a mindful therapist.
Given the burden of the therapist to bear the archetype of the Self, the image of wholeness, it is no wonder that so many of us— especially in starting out as therapists—are comforted by formulaic approaches that seem to provide all the answers, and tell us just what to do, session by session. Otherwise, it would be difficult to know just how to begin this awesome process, to carry the weight of the therapist’s role. But however useful such strategies may be for research or for learning, ultimately no formula can suffice. Only the involvement of our whole selves will do. As gurus, we need to be weighty persons, authoritative while not authoritarian, people who are authentically interested in human spirituality and well-being, and who do our human best to live in accord with these aspirations ourselves.
Psychotherapists of any school who have made their mark, from the psychoanalytic to the behavioral, from the humanistic to the transpersonal, often have one thing in common: they are convincing. There may be many reasons why this is so, including the clarity and originality of their thought and the lucidity of their writing. But I would like to suggest that another reason is that they all have a special presence and confidence. From Freud and Jung to Ellis and Maslow, all of them exude this quality, even if in profoundly personal and differing ways. As we learn to deepen our mindfulness, we too come to share this quality of presence. In some fashion and to some extent we become weighty persons capable of bearing the archetype of wholeness and healing.
Many of the people who go to visit a physician today do not have a problem amenable to medical treatment. But they go anyway. Even if they have a cold, and know that the doctor will simply say to rest and drink fluids, they go. Why is this?
One reason may be that they are seeking something beyond the modern, scientific medical arsenal. They are seeking the presence of a person who bears the mantle of healing.
Ancient healers knew what many today have forgotten: Every disease is at least in part a spiritual problem. This is not to say that healing should be confined only to spiritual techniques, or that being spiritual means perfect health. On the contrary, even great spiritual masters get sick, and modern medicine is an obvious blessing. But denying the spiritual component is short-sighted.
Ancient healers had to be learned in many fields. They studied human anatomy and physiology and the effects of nutrition, as we might expect. But they also were often experts on the effects of music, on the stars and planets, and much else besides. Spirituality has to do with life in its wholeness, in its unfragmented entirety. And therefore, to say every disease is spiritual means that no disease can really be understood apart from its context. Healing is therefore not only a matter of treating the symptomology, but of also aligning ourselves with the universe, of restoring harmony and balance. Any healing which stops short of that will not have reached the root of the problem. Otherwise our efforts are like treating a patient for lung cancer who continues to smoke.
Noted author and physician Larry Dossey makes this point regarding heart disease as an example:
Heart disease cannot be understood by confining our scrutiny to single persons or to body parts . . . Transpersonal events such as misperceptions of meanings, job dissatisfaction, lack of communication between individuals, and lack of love and trust are capable of setting this disease in motion. Not only are these factors causative of illness, they can ameliorate it too, as is demonstrated by the reduction in angina in men with heart disease who have loving wives . . .
The Gospels portray Jesus as a wandering healer and exorcist. In those days of course, the one belonged naturally to the other. In Judeo-Christian thinking, where there is disease there is sin— superficially considered as breaking the rules, profoundly considered as alienation from the Divine Ground. Where there is disease, there are negative spiritual forces (demons) at work, and these must be driven out.
This point of view, pushed to extreme, creates the problem of blaming the victim. If disease is caused by sin, in the superficial sense of rule breaking, as such tortured logic would have it, they are sick through their own fault. We then have grounds to blame and ostracize the sick for being ill in the first place. Nor is this, unfortunately, simply a benighted ancient attitude. It is one that occurs frequently in our own time as well, sometimes behind but the thinnest of veils. This error, which Christ specifically repudiated, (Matthew 5:45), pointing out that God makes the sun to shine and the rain to fall on the just and unjust alike, is not confined to spiritually-oriented people. Many interactions of healing professionals with their patients are contaminated with the same attitude. Our diagnostic categories, while designed to be descriptive, first of all, and prescriptive second of all, are used in a way that often contains a barely hidden moral judgment. This is particularly evident in the case of personality disorders, where to diagnose someone as having a narcissistic or borderline personality disorder is roughly the same as saying someone is a bad person, and that, since their problems are their own fault, they do not deserve kindness or compassion. This can be a seductively comforting point of view. Further, if we can believe that others suffer through their own fault, we can imagine that we might avoid such misfortune, since we, of course, would not do the things that would cause such ills.
Consider, for example, the attitude of therapists toward addicted individuals. Most therapists believe that people generally respond to empathic understanding. But in counseling and psychology, we used to teach, and some still believe, that empathy will not work with the addicted person, that you have to smash though their denial. It is very interesting, and very questionable, that we should reserve the harshest approach for those with diagnoses carrying the greatest stigma, especially addiction and sexual misconduct. Traditional alcohol counselors would not agree to even see a patient until he had already stopped drinking—thus requiring a positive outcome before even engaging in the treatment! Just imagine if your physician were willing to treat your strep throat only if it was already better, or if we as therapists said to a new patient who is depressed, “Okay, you can come in. But no acting sad around here, for crying out loud!”
As modern medicine has learned more about disease, we have come to see it as an isolated thing. Some doctors see only a diseased liver, not a person with a certain job, a happy or an unhappy marriage, who has found a way to feel in harmony with the world or who feels isolated and alienated, and so on. As therapists, as healers, we are the ones whose task it is to see the whole person in their life context.
If you are a true psychotherapist, you are a healer. You are someone who sees the whole person. You help the patient on the level of mind, of emotion, and of spirit, as well as of body. Your role in doing this is crucial. You may be the only person some ever meet who embody the lineage of human healing in this way.
A bodhisattva is a person who has put off fulfillment of her own ultimate peace in order to help others. The bodhisattva vow in the Zen tradition is an awesome undertaking:
Innumerable are sentient beings; I vow to save them all.
Inexhaustible are deluded passions; I vow to transform them all.
Immeasurable are the Dharma teachings; I vow to master them all.
Infinite is the Buddha’s way; I vow to fulfill it completely.
To the Western mind, this may sound overwhelming and burdensome—to say nothing of impossible! But to see these vows like that misses the point. It may be less overwhelming if we take the point of these vows to be generating aspiration, to cultivate a certain attitude and intention.
There is evidence that people who view their work as a calling obtain more satisfaction from it then those who work primarily for money or for advancement. The practice of vow is similar. When you do your work with a sense of satisfaction in being helpful to others, in making a difference, paradoxically, you will be the first one to benefit.
If, in facing your work day, even with cases in which you doubt your progress, your intention can provide some encouragement. With this intention, you remember that you can make a difference and at least to some extent reduce suffering in the lives of your patients, and in all the lives touched by their lives; for you have bodhisattva energy at your disposal. Even Monday morning becomes easier to tolerate.
We’re In This Together
At one point in graduate school, I worked extensively with the cognitive-behavioral approach. I found that the techniques I was learning as interventions were also helpful in my own life. I was practicing the things I was teaching. So by the time I had recommended an exercise to identify and rebut irrational thoughts, for example, I already had intimate experience of it. I knew something about my own irrational thought patterns, had some sense of what it was like to do such exercises, how they were helpful, and what their limitations were.
In a meeting with my supervisor one day I asked whether he had worked with these ideas himself. Surprised by my question, he admitted he hadn’t. That supervisor may have been caught to some extent in his categories. He was the DOCTOR and the people he worked with were PATIENTS (even if he called them clients). As he saw it, he didn’t need to undertake these exercises any more than, say, a healthy oncologist needs to undergo chemotherapy. His was a treatment for the sick, and he was not one of the sick.
This is crucial: True healers do not stand outside of the struggle of those they help. Healers know themselves as wounded, know their own suffering as a part of the human condition. Buddhism is very frank and explicit on this point. Until and unless we traverse the enlightenment path, suffering is the human lot and is not something incidental or added on. A healer may be relatively free of anxiety, for example, but she may still experience it. We are all in this human dilemma, facing the same human difficulties.
I hope that you will use the exercises and practice suggestions in this book with this in mind. I hope you will use them with your patients, but I also hope you will find ways to use them yourself.
Life difficulties may trigger more severe reactions in vulnerable patients than in ourselves, but we too must know ourselves as quite capable of reacting at times in less than helpful or even destructive ways. There may be a difference of degree between the reaction patterns of our patients and our own, but there is more we have in common with our patients than there is that holds us apart.
What we can learn from ancient models of healing—shamans and gurus, healers and bodhisattvas—is that a good relationship to our patients is one of trust, responsibility, and healing in the broadest sense. We limit the scope of our responsibility primarily to the therapy appointment, as we must. This in part acknowledges that we are not literal gurus, an important distinction for us not to lose track of. But if our responsibility must have limits and boundaries, within these it can still have great depth. We cannot always be available, but when we are, it is our capacity for true presence that does the healing.
Hold Concepts Loosely
According to modern medicine, a disease is a discrete entity. It has a beginning, requires a prescribed course of treatment, and predictably comes to an end. Yet this may not always describe the truth. Dr. Dossey writes:
. . . [O]ur picture of human illness and health will be considerably enriched and more accurate if we can relax our insistence on strict beginnings of illnesses, for they do not exist. They can be defended only out of a kind of clinical or therapeutic convenience. In effect, we detract from our role as participants in the universe when we install the “strep” bacterium as the sole progenitor of disease in this case. This is a bad habit not only in this illness, but in all illnesses. It denies the richness of the world . . . and it installs simplicities where a greater complexity always reigns.
In psychotherapy illness is even less clear. Often the “disease” we are treating is part of the human condition itself, a condition in which we sometimes lose what we love most, fail to attain what we want, and are faced ultimately with the prospect of our own death. Our task is to be helpful. And if we are prepared to do depth psychotherapy but a patient turns out to only need a little practical advice and enouragement, so be it. This fits nicely with Buddhist teaching, which encourages us to go beyond our cherished concepts and deal with what is real and practical. In Buddhist practice one strives for the extinction of notions and concepts that we interpose between our awareness and reality. Zen Buddhism especially teaches that we must hold our concepts lightly—even our Buddhist ones.
In light of this attitude, we must recognize that our diagnoses, for example, are not ultimately real things, and we do not reify them. For example, if you think depression is a real entity, try to take it out and show it to someone! When we talk about a diagnosis, it is important to remember we are talking about a convenient description rather than reality itself. A diagnosis is simply a collection of signs that more or less cohere, and which give us an idea about what kind of treatment may be helpful—especially with regard to medications. While great strides have been made in making our diagnoses more consistent and valid, they remain, inevitably, imprecise. Or if you regard diagnoses as something real, you will miss the obvious absurdity of our diagnostic criteria, by which a person with seven symptoms qualifies for a diagnosis, while a person with only six does not and, by implication, is therefore just fine.
Placing therapy within the tradition of healing, however, does not require discarding diagnostic terms. Discarding diagnosis may be a worse error than giving diagnosis ultimate credence. So long as we hold our diagnostic concepts loosely, they can be a help rather than a hindrance.
In mindful therapy, diagnosis is considered broadly. The most useful sort of diagnosis is to see the person as a whole and his life context as a whole. The label is only the palest reflection of this broad, holistic, contextual process. It is the difference between the letters p-e-b-b-1-e and the feel of a small stone in your hand.
Looking at therapy this way, as a deep, healing relationship not always capable of being contained by labels and not always subject to discrete, specific endings, helps us avoid being caught in our concepts. Ours would be a healthier society by far if we all had someone to provide us with an hour of deep listening once a week—whether we qualified for a clinical diagnosis or not.
The specter raised by the prospect of interminable therapy is unhealthy dependence. Yet I find this to be largely chimeric. Contrary to expectation, my experience in practicing mindful therapy has been that an unhealthily dependent relationship is rare, and when it does happen, can develop as easily in a shorter-term therapy relationship as in a long one. Few people in our society schedule a weekly appointment and pay even a modest copay unless they feel that they benefit. The reason I think that dependence occurs so rarely has to do with the nature of mindful psychotherapy—therapy as a practice of deep listening and true presence. Unhealthy dependency is more likely to develop in cases in which the therapist attempts to offer advice for every problem or dilemma the patient encounters in living than when the basic therapeutic stance is one of offering deep listening, understanding, and acceptance.
In mindful therapy, dependence is unlikely because its very nature is to help people connect with their own wisdom, their own Buddha nature. Sometimes a patient who has never been in therapy comes for a first session, and immediately declares his ambivalence about therapy, contending that one should solve one’s own problems. I always agree heartily. I tell the patient that I also believe that we have to solve our own problems. And I add that therapy is not about someone else solving our problems for us, but about creating a space in which we can connect with our own capacity to find what we need. But this concept, too, must be held lightly, and there will always be those people who benefit from a bit of concrete advice.
Unifying Work and Life
In former times, and still in traditional societies today, “work” and “life” were more of a piece. Work was not a separate fragment of life existing apart from the rest. It did not need to be isolated, removed from personal and family life. The farm was a family endeavor: everyone contributed. The work of the farm was not a job outside of the rest of one’s life, but very much part of it. The shopkeeper often lived over his store, so that when he was in the shop, he was never far away from other family members.
Our work, too, can feel quite different when it is integrated with the rest of life, when it flows naturally out of our mindfulness, our sense of what needs doing rather than being something artificial, added on from the outside to meet financial need.
Of course, as therapists, we cannot completely eliminate boundaries between our work and life; we require some protection from patients who might abuse their access to us, perhaps calling us continually at all hours or otherwise failing to respect emotional boundaries. Yet once again, in my experience, those who actually abuse access are few. Most people are respectful of my time, unwilling to intrude too much into my life beyond our appointed meetings. In fact, I am more often in the position of having to encourage people to call me when doing so is actually appropriate, such as when feeling a suicidal despair or other major crisis, than of having to set limits with people who take advantage of my willingness to be available.
Unifying our work and personal time means first and foremost having a unified vision of our life. If you connect with the shaman, the guru, and the healer in yourself, you know that your healing work grows organically from the ground of who you are. Knowing that we ourselves are not always wise, we see the importance of being devoted to our own growth as well as to that of our patients. We know we are in the same predicament as our patients, trying our best to deal with the dilemma of human life, practicing with them, meditating by ourselves before work and then teaching what we have found helpful.
Therapy thus is a calling, a way of life. If mindful therapy is not part of our way of life we run the risk of becoming only technicians, not healers.
Can I Live Up To This Vision?
The vision that our work fits into the lineage of shamans, gurus, healers, and bodhisattvas has an edge to it. If we can hold this vision of our work, we may be able to tolerate the skepticism, the negative transference, and the other difficulties of being a therapist more easily. If we see ourselves as healers, we can accept these realities, and need not be crushed by them—because we then have a wider vision in which to hold these experiences. Without such a vision, we are more vulnerable. The mindful therapist knows that her compassion, growing out of a clear vision of her task, is her greatest help and protection. Yet it is challenging to think of ourselves this way—to think of ourselves as healers or shamans or gurus. Who are we to adopt this role? Is this not a little grandiose?
Let us first clarify that in taking on such a vision of our work, we do not mean feigning some inor superhuman perfection. Nor does such a vision require us to squash our sense of humor, our playfulness, our sensuality, or any other aspect of ourselves that gives our humanity its authenticity. It is enough to be dedicated to our own inner growth and well-being, working on our spiritual life, progressively shedding ourselves of limitations and blind spots—in full knowledge that we are always beginners, and there is always more to be done. If this is the case, our life and our work will teach us what we need to know.
There is a Jewish tradition of the zaddik—the holy person. The zaddik differs, it is said, from ordinary people, in that the zaddik is more fully human. In the Christian tradition, Saint Irenaeus says something similar. He says that the glory of God is a human being fully alive. Buddha too was nothing more than fully human. Buddhist teaching stresses that the Buddha is a human being in order to emphasize that we can accomplish what he accomplished. When asked if he were a god or a saint, he always denied both, saying simply, “I am awake.”
To be fully and completely alive, fully and completely human, is goal enough. There is no other sort of completeness or perfection to attain. The plum tree in my back yard can only express its plum tree-ness. No other kind of perfection is available or needed. A flower is only itself. It does not have to strain and struggle to be a flower, but lets its flowerness unfold of itself.
You may ask, “Who am I to do this work?” and I might respond, “Who are you not to do this?” “You are the light of the world,” said Christ. And that light must be allowed to shine. You already express Buddha nature. To become a full and whole human being is your main task in life—not some secondary one to be taken care of after you somehow find a way to earn a living.
Avoiding a Great Misunderstanding
We mustn’t confuse spiritual aspiration with a striving for some kind of insipid, limp goodness. The therapist who goes into the consulting room hoping to be liked is sunk from the start. For while some of our patients will appreciate us more than we deserve, many will not understand that what we do is difficult. And in fact, the better you are at it, the easier it seems from the outside.
In a seldom-discussed passage of the Bible, Christ himself rejects being called good (Mark 10:17). In this account, a man approaches him respectfully with a question, calling him “Good Teacher.” Christ responded, “Why do you call me good? No one is good but God alone.”
A healer must be on the way to to full humanity. But “trying to be good” in the sense of achieving a superhuman perfection inevitably activates the opposite. Striving in this sense creates a sense of lack of acceptance, not only toward ourselves, but toward our patients as well. The work we do requires faith in our humanity.
The Need for Practice
Most of the time we live in forgetfulness. We are distracted. We are not really present to what we are doing or saying, but are already planning what we will do or say next, and perhaps a few things after that. That is why it can be such a relief to do a simple thing like mindful breathing. If you can be fully aware of the sensation of breathing in and out for the space of one breath, then you have brought body and mind together for that length of time. The essence of becoming a fully awake, mindful human being is to know that you are already Buddha. And remember, if this feels overwhelming, it is really very simple—as close and available as your next mindful breath. In the context of mindful therapy it is essential to listen deeply. Yet we cannot become capable of deep listening in the therapy room if we do not practice mindfulness elsewhere.
In order to be deeply present, in order to truly listen, we need a way to calm the mind. This is in fact what mindfulness is about, and part of what meditation is about. Meditation is simply a process by which we calm the mind, or more precisely, allow the mind to calm
itself, without our forcing it. This takes a little time and a little practice. Our minds are extraordinarily busy places, as we learn the first time we try to meditate. If we cannot develop a calm, clear mind while we are sitting in meditation, how can we expect to have one in daily life? How can we expect to suddenly have this when we listen to patients? But if we can establish a base of mindfulness in meditation, we can then begin to learn how to bring the same calm, clear awareness out into our life and into our work.
Mindful breathing is the basis of many exercises in this book, so let us explore it here. Please take a few moments to try it after you have read this.
To breathe mindfully is in essence simply to be fully aware of your breathing. First sit in an upright, comfortable position. You might like to take a few deep breaths to start, just to get in touch with the sensation of breathing. Then imagine your awareness sinking down into the abdomen. From there, become aware of the gentle rising and falling of your diaphragm with each breath, letting the body breathe just as it wants and needs to, letting your awareness just rest on the breath without struggling or forcing. When your mind wanders (as it will!), just treat this as the most natural thing in the world (as it is!), and gently bring your attention back to the breath. Remind yourself that you are not trying to do or accomplish anything special. You are just allowing your mind to rest on the breath. Please take care of yourself every day by allowing some time to breathe mindfully.
Become the Guru
In talking about re-visioning the role of psychotherapist, I am not talking solely, or even primarily, of an intellectual vision. Intellectual vision is important. It is the beginning of the process, but it is only the beginning.
For this exercise, spend a little while deciding first upon an image of a person who for you personifies numinous wisdom. It might be, for example, the Buddha, Christ, a saint or bodhisattva. It might be an image from an old photograph you have of a Native American healer. It might be an image of someone very loving and wise that comes from your own imagination. (But it should not be someone from your actual life, as we are seeking an image of transcendent wisdom.)
You may know right away who it is you want to choose for this purpose, or it may take a few days to work this out and make the choice that feels right. When you have decided, you are ready to take the next step.
Now spend a few moments sitting quietly. Allow the body and mind to rest by bringing your awareness to your breathing. Experience the body breathing in and breathing out, at its own pace and rhythm. Now imagine the wise person you have chosen standing before you. You may envision this person in some detail, or just form a sense of her presence.
Spend a little while with that person before you. Imagine him smiling to you, transmitting light and love and wisdom. Take your time. Don’t rush.
Finally, imagine that person becoming all light and energy, or perhaps something like smoke, rising up before you and entering your body through the top of your head, then dispersing through every part of your body. Experience the warmth and wisdom of this person permeating every cell. Notice how this feels: in your thinking, your emotions, and in your body. Then imagine yourself going through your day feeling this way: driving, talking on the phone, meeting with patients, being at home. See yourself as going through the day in peace, understanding, and joy—full of concentration and loving-kindness.
Then imagine yourself being challenged in some ways during the day, perhaps losing this peace for a little while, but then finding your way back to it.
Make it a practice to take this person into you again at the start of every work day, and again briefly between sessions.
Know yourself as guru, as shaman, as healer.
How to cite this document:
© Thomas Bien, Mindful Therapy (Wisdom Publications, 2006)
Mindful Therapy by Thomas Bien is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
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