Falling Awake: Mindfulness Comes to Psychotherapy

by Joe Pfeffer, Ph.D., Java Journal Online, Feb 2, 2009

St. Louis, Missouri (USA) -- During the past decade, Buddhist meditation has made significant inroads into the practice of psychotherapy. It’s an unlikely but by no means unhappy marriage.

Psychotherapy is a distinctly Western idea, especially in its current, most popular form—cognitive-behavioral therapy. It’s about identifying problems (“diagnoses” in medical terminology), discovering ways to deal with them, and setting objective goals or end points. Theoretically, in therapy we start in one place and wind up in another—the therapist has a myriad of techniques to help the patient. One of these is to substitute more accurate, health-enhancing thoughts for the inaccurate, unhealthy thoughts the client has been having. After following a certain regimen, the client is healed and the problem is solved. Therapy was a developmental stage, no longer needed.

Meditation is complete in itself - it needs no external justification, it sets no goals, tries to prove nothing, and does not necessarily concern itself with positive change. Unlike psychotherapy which has an end, one learns to practice meditation over a lifetime, and ideally engages in it every day. The experience is like falling awake into deep and total awareness of the present moment.

The idea of giving it up at some point because it is no longer needed is irrelevant, since it can be an integral part of life. It deals with moment-to-moment identification of thoughts and emotions, and accepts them all, regardless of content. In meditation, one does not judge thoughts and feelings as good or bad, healthy or unhealthy, but observes and accepts whatever comes. Let your mind be the sky. Thoughts, sensations and feelings drift by like clouds, and you observe them without trying to change them.

Mindfulness is the term used for the state that one achieves through insight meditation, which comes from the Theravada Buddhism of South Asia and is approximately 2,500 years old. It is an integral part of other Buddhist systems, including and especially Zen. At its core is nonjudgmental observation, the ability of the mind to observe its content without criticizing. The mindful person is similar to a scientist observing an object under a microscope. She has no preconceived notions. Her only desire is to see the object exactly as it is.

How does this emotional acceptance fit with the very American notion that we must constantly work on improving ourselves? The answer comes in the realization of more and more therapists that there is a major flaw in the fundamental cognitive precept: we cannot hope to change our thoughts and feelings until we know what they are, and we cannot know what they are if we try to censor them, to throw out the “bad” ones and develop the “good” ones. In judging our thoughts, we suppress ourselves and wind up living a life of flat unawareness.

The seminal Buddhist writer Bhante H. Gunaratana expresses this well in his book, Mindfulness in Plain English, Updated and Expanded Edition. He claims we have an endless flow of thoughts and feelings that come to us all the time, whether or not we try to repress them. We try to stick the flow of life into pigeonholes labeled good, bad and neutral. If we label a particular perception good, we try to freeze it just where we found it instead of letting it ebb and flow, come, go and change. According to Gunaratana, “we fondle it, hold it, and try to keep it from escaping. Then we make an effort to repeat the experience that caused the thought.” Gunaratana calls this the mental habit of grasping.

Then there is the box of thoughts and sensations labeled bad. We try to push these away. We deny them, reject them, try to get rid of them in any way possible. We run from pieces of ourselves. This is called rejecting.

In between good and bad is the box labeled neutral. According to Gunarantas, “This contains the tepid and uninteresting. We pack experience away in the neutral box so we can ignore it and return our attention to where the action is, namely our endless round of desire and aversion.”

He goes on to say, “The direct result of all this lunacy is a treadmill to nowhere, endlessly pounding after pleasure, endlessly fleeing from pain and endlessly ignoring 90 percent of our experience.” We can end up with no stable sense of self or center.

To achieve mindfulness is to experience something exhilarating. In a state of nonjudgmental, open meditation, one begins to observe everything as though it is occurring for the first time. Because it maintains attention to the present moment without worrying about the future, the past, or external meanings that different emotions have acquired, it allows people with supposedly intractable disorders, as well as “normal” people, to observe negative thoughts and emotions without defensiveness. They are seen as the building blocks of experience, not as truths out there.

For example, an individual with Borderline Personality Disorder may feel she is unloved. Through meditation, she can see the difference between feeling unloved and being unloved. She has begun to make the crucial distinction between the reality of thoughts and the reality of the external world. Learning to identify and describe emotions and thoughts involves learning not to take them literally. Meditation and therapy agree that thoughts and emotions are not literal reflections of environmental events.

Marcia Linehan was one of the first cognitive-behavioral therapists (CBT) to make mindfulness a core part of her work. She changed the name from CBT to DBT (Dialectical Behavior Therapy). The name tells the story: the relationship between mindfulness and therapy is dialectical, not fused.

Dialectical Behavior Therapy, as well as other therapies, incorporate techniques for using mindfulness in therapy sessions. This is not the elaborate meditation of the Buddhist masters, but it does allow for people in therapy—or on their own—to experience some of the benefits.

The idea is to accept emotional suffering in order to let go of it, which sounds Zen—because it is. In therapy, the technique works somewhat as follows: the therapist instructs the client to sit quietly, feet planted on the floor, in a position relaxed yet alert, open yet focused. It is important not to give into external thought, but to observe and experience what comes from within. Emotions become sensations when they get unhooked from the conditioned objects to which we have habitually attached them. These sensations—now no longer seen as good or bad, healthy or unhealthy, helpful or harmful—begin to speak to us in ways we could not have imagined had we not sat quietly and given them our full attention.

The client is instructed to observe her sensations without trying to do anything about them or hook them to old scripts. It may be helpful to concentrate, at first, only on their physical characteristics. Most important is to accept them fully, as they are, at which point they will begin to “speak” to us and tell us very different things from what we thought they said in the past. A new consciousness emerges that leads to liberation.

Mindfulness, whether it comes from full meditation or from a therapeutic exercise, is filled with apparent contradictions. Zen calls these koans, which translates to a problem or riddle that has no rational answer. In a sense, this applies to the union of psychotherapy and mindfulness—in theory the two cannot meet, and there is no way to reconcile the problem solving orientation of therapy with the nonjudgmental focused attention of meditation.

Mindfulness and therapy can co-exist, work together in mysterious ways, and fertilize one another, but they can never really be melded into one thing. It is this that keeps their relationship alive, and allows them, and us, to grow in unexpected ways.

Joe Pfeffer, Ph.D., is a psychologist and writer. He is interested in relationship theory, family evaluation, and current trends in client-centered therapy. You can reach him at josephpfeffer@me.com.