Therapy and meditation: a path to wholeness
- includes an interview with Buddhist psychiatrist Mark Epstein

A Buddhist psychiatrist who has been meditating for decades elegantly describes how psychotherapy and meditation can help us manage our most powerful emotions--and make us feel more alive and whole in the process.
"Stop trying to understand what you are feeling and just feel," my first meditation instructor told me. This instruction seemed insanely simple: the ability to just feel should come as naturally as the ability to breathe. Yet, in twenty-five years as a psychotherapist and practicing Buddhist, I have found that most of us have not learned how to be with our feelings without rushing to analyze them, change them, or escape them.
If we really want to live a full life, both the ancient tradition of Buddhism and the modern one of psychotherapy tell us that we must recover the capacity to feel. Avoiding emotions will only wall us off from our true selves--in fact, there can be no wholeness without an integration of feelings. Both traditions have discovered that the way to plumb the full depths of our emotional being is by letting ourselves go, by surrendering to who we really are. And both traditions understand that we need a state of reverie in order to know our emotions. Whether that reverie comes through meditation or the quiet holding space of therapy, it is always necessary.
Buddhism has always made the self's ability to relax its boundaries the centerpiece of its teachings. It recognizes that the central issues of our lives, from falling in love to facing death, require an ability to surrender that often eludes us. Psychotherapy, through its analysis of childhood, has tended to turn us in a reflective direction, searching for the causes of unhappiness in an attempt to break free from the traumas of the past. Too often, though, it degenerates into finding someone to blame for our suffering. But within psychotherapy lies the potential for an approach that is compatible with Buddhist understanding, one in which the therapist, like the Zen master, can aid in making space in the mind.
Many of us come to therapy feeling that we are having trouble letting ourselves go: we are blocked creatively or emotionally, we have trouble falling asleep or enjoying sex, or we suffer from feelings of isolation or alienation. Often, we are afraid of falling apart, but the problem is actually that we have not learned how to give up control of ourselves. People come to me most often because they are unhappy with how they feel, not because they are not separate or individuated enough. The traditional view of therapy as building up the ego simply does not do justice to what people's needs actually are.
In my work as a therapist, I have adapted Buddhist teachings to meet the needs of my patients, many of whom have neither the time nor the inclination to pursue formal meditation practice. I have found that therapy through a reciprocal exchange of feelings, can also enable us to let go of the defenses that block us. While the method may differ from formal meditation, the intent is the same: to recover a capacity for feelings that we are all afraid of.
Cross-Legged on a Cushion
Meditation seeks to create an inner holding environment for the raw material of emotional experience through non-judgmental awareness. In this way, meditation acts like a stealth bomber, sneaking through all the defenses and illuminating the central fortress of the heart. When I was first instructed in what is known as "mindfulness meditation," I was taught to simply note whatever I was feeling, pleasant, unpleasant, or neutral. My observing mind functioned almost as another watching the flow of sensation with relative ease. This created a very different relationship with my internal world from the one I was used to. My chronic tendency was to shrink from the unpleasant and reach for the pleasant. Mindfulness meditation encouraged a dispassionate acceptance of both.
Since feeling states are experienced primarily in the body, the ability to maintain a continuous state of physical awareness gives an enormous boost to the capacity to bear feelings. This is fortunate, because one of the most common occurrences in beginning meditation involves the re-experiencing of terrifying feelings. Even in meditation, these feelings can still seem intolerable, but the entire thrust of meditation practice is designed to increase their tolerability.
Because mindfulness of feelings involves the careful attention to the flow of pleasant and unpleasant sensations in the body, there is none of the usual picking and choosing that otherwise colors our experience.
Cross-Legged on the Couch
Opening your attention to your body, feelings, and mind does not have to be restricted to the meditation cushion. It's a process you can attempt with all aspects of your life, and certainly one you can pursue with a therapist. One teacher of mine told me that to achieve a dispassionate state, he would pretend he was dying and that there was nothing to be done. "Rather than judging something," he told me, "take no position. Stop leaning into circumstances and rest in your own awareness." Buddhism teaches us again and again that uncovering and experiencing difficult feelings does not make them go away, but does enable us to practice tolerance and understanding with the entirety of our being.
The same tolerance can be practiced in therapy I remember being asked in my first session with a therapist if I was aware that I was sitting on the edge of my seat. I was not aware of it. I was sitting the way I always sat when talking with someone. "What's wrong with the way I'm sitting?" I wanted to ask. My therapist waited, as if to give me time to get over my sudden self-consciousness and notice how I was sitting. He was right. I was perched like a bird on the edge of my chair and was very uncomfortable there. "You give yourself no support," he said softly.
I spent the rest of the session feeling what it was like to sit back in my chair, making use of my whole body. Already, I was forging a connection with the physical environment that I had been denying myself. My body was the unconscious I was so interested in plumbing. For all my meditation training, I still needed the help of a therapist to show me where I was holding back.
My therapist, just like the Buddha, began with mindfulness of the body. My therapist could just as easily have been a Zen master in the manner in which he related to me. His teaching drove home the lesson of my years of practicing meditation in a particularly vivid and helpful way.
This therapist did not present himself as an authority figure who analyzed my psychic configurations. He did not interpret my Oedipal dilemma. He was not remote and silent. He was very available, quite humorous and playful, and paid particular attention to what prevented me from being part of the relationship with him. My therapist was asking something of me that was an improvisation. He was asking for meditation in action, not for a mere witnessing of psychic debris.
Tolerating our Tempests
If we stop backing away from our unpleasant feelings, we are able to see how they color our experience and how scared we are by them. And we can learn to sit with these difficult feelings, no matter how terrifying they are.
When Betsy, a patient of mine, was learning meditation, she discovered an anxiety in her chest that seemed to run through her like a hollow core. At first, she was deeply afraid of that place. But with some attention, she learned to rest her attention in the hollow core, and saw that it was a rich source of mysterious feeling, sometimes sad and lonely, but at other times filled with the energy and inquisitiveness of a child. The hollow space became an enriching space as well as a scary one, filled with unanticipated qualities that expanded her sense of her own reality.
It is my experience that emotions, no matter how powerful, are not overwhelming if given room to breathe. Western therapy can learn to make use of the Buddhist emphasis on acceptance of feelings rather than talking and analyzing. The therapist and patient can create a situation in which these unacknowledged emotions are finally given breathing space.
Love and Death and Zen
The major obstacle to love, I have found, is a premature walling off of the personality that results in a falseness or inauthenticity. When someone is so uncomfortable with his own sense of emptiness that he struggles to keep it at bay, he won't be able to be open with another person. He will simply be too ashamed to reveal himself in any real manner. In this case, therapy is effective when it allows a person to discover their own capacity for connection.
All of our intimate relationships have intense emotional exchanges that test our ability to know and bear feelings. When I first fell in love, in my adult years, I traveled with my future wife to a rocky point on the coast of Maine that had always been special to me. Embracing her with the surf pounding, we were both filled with a sense not just of love, but of death, as if we were holding on tightly to each other while our lives passed before us. These feelings seemed linked with an implicit sense of the preciousness of our love. In our hug on the beach, we were breathing each other's emotions, making them make sense in a way we could only do with each other's help. Lovers often inject breath into each other's emotions, as parents do in a different way with their children, making those very feelings more tolerable by virtue of their being held and known.
During orgasm, at the moment of death, while one is falling asleep or ending a dream, the underlying luminosity of the mind shines through. In Buddhism, this luminous mind is compared to a clear blue sky. But we have a powerful resistance to experiencing the mind in all of its brilliance. We are afraid to truly surrender to it.
Like meditation, psychotherapy can seem like a long walk that suddenly opens up into an extraordinary vision of something that has always been available but has been unrecognized. A long-time patient of mine, Greta, came to see me every week as she navigated work and family, successfully raising three children alone while working at a full-time job. She wanted therapy because she felt lonely and was vaguely aware of how judgmental she was toward most people. When disappointed or hurt by someone, Greta's tendency was to write them off forever.
Over the years, we developed a very strong connection. My work with Greta felt like untangling my daughter's knotted hair or like untying a fine gold chain. I would get one little strand free, open up a little space, and then start working on the next piece. One evening, after having been at my office that afternoon, she was struck by a huge wave of love for me that made her feel very peaceful. That evening she dreamed of herself with her father when she was three or four years old and felt with great conviction the unconflicted love she had for him at that time. In a second dream, she heard herself yelling at him, "Can't you shut up? You're talking at me all the time."
She remembered how relentlessly he had pursued her as she grew up, how needy he was. He would become irate whenever she disappointed him and she finally had to close herself off from him in order to find some peace. "The defense is what hurt," she told me.
Greta's breakthrough reminds me of an old Zen story about an aged Chinese monk who asks permission to seek enlightenment in an isolated cave. Taking his robes, his begging bowl, and a few possessions, he heads out on foot into the mountains. On his way he sees an old man carrying a huge bundle. This man is actually the bodhisattva Manjushri, who appears to people at the moment they are ready for enlightenment.
"I am going to the furthest mountains," the monk tells Manjushri, "to find a cave. I will stay there and meditate until I die or realize awakening."
Manjushri then drops his bundle onto the ground, and instantly the monk is enlightened. He, too, has put down his whole defensive self, the entire burden.
But he's still a bit confused. "Now what?" he asks Manjushri. And the bodhisattva, smiling, silently reaches down, picks up his bundle and continues down the path.
Putting down our burdens does not mean forsaking the conventional world. It means being in that world with the consciousness of one who is not deceived by appearances. Once Greta, for instance, had recovered her love for her father, she could continue to fend him off with forgiveness instead of rancor. She still needed her defenses, but she was not imprisoned by them. And as the newly enlightened monk realized when he saw Manjushri pick up his bundle and head back to town, everything had changed but nothing was altered.
PT: Many people believe it's healthy to just express your emotions: do whatever you need to do to get them out. What's your take on this?
EPSTEIN: The Buddhist approach is that you can't empty out feelings by acting them out. You don't necessarily make things better by expressing everything; you might actually inflame the situation. Instead, it's helpful to learn how to be with what you're feeling before choosing whether to act it out. Recognizing an emotion as it happens is what I have learned from both Buddhist meditation and from any own experiences in therapy.
PT: What sort of Buddhist meditation do you practice?
EPSTEIN: From the age of twenty-one, I've practiced a form of Buddhist meditation rooted in Southeast Asia and called Vipassana. This kind of meditation emphasizes a practice of what's called bare attention. You just watch your mind. You give impartial attention to your thoughts and your emotions without judging them. When I sat down and began my work as a therapist, I automatically went into this state of mind that I had cultivated in meditation.
PT: When you started meditating, what was your experience?
EPSTEIN: I had a lot of held-back anger. And one of the emotional lessons I had to learn was to understand my right to be angry. I had to learn how to feel it and then learn to make use of the energy rather than just being spiteful or turning it in against myself or anyone else.
PT: It seems like the biggest obstacle of facing difficult emotions is that people are afraid of what they're going to feel.
EPSTEIN: Or of what they're going to find. But you can face this fear bit by bit, by biting off really small amounts. When you meditate or have a therapy session, it's rare that the feeling come surging up like some volcano that overwhelms you. It's much more usual that you'll have just enough frustration or fear about "what's going to happen after I exhale on this breath before I can draw in the next breath." Meditation provides little tiny opportunities for getting to know you own fear.
PT: In your book Going to Pieces Without Falling Apart, you discuss your long meditation retreats. To really learn to tolerate emotions, do you think you need to go off on retreats?
EPSTEIN: I think to really understand the potential or the power of meditation, it's very, very useful to go off on a retreat for a period of time. You can definitely experience some things that you won't experience sitting and meditating at home for half an hour.
PT: Like what?
EPSTEIN: The first thing you discover is how you're thinking all the time. There's this internal chatter that's just going, thinking the same thoughts, one after another, over and over and over again, always commenting on what's going on and getting in the way of a more direct experience of life. If you can patiently sit for an hour or walk for a half hour, eat your meals slowly, not talk, try to pay attention as best you can to what you're doing, your mind starts to get quieter. There are little windows in which the chatter is not going all the time. And then you really start to have a different experience of the world because of the veil of your own thoughts has been parted. For the uninitiated, it's like trying to talk about sex before you've experience it. You can only describe little whiffs of it.
PT: And what happened to you when you started to meditate? How did you change?
EPSTEIN: Early on in my meditation practice, I had a few experiences of being filled with happiness and relieved of any sense of burden. Then, I spent an extraordinary amount of time trying to recapture that feeling in meditation. I kept judging my experience, pulling myself away from it ever so slightly, comparing it to that blissful moment that I had last time, and in a subtle but pervasive way, I was perpetuating my own happiness. Then I realized that the real lesson from meditation was not about the bliss. It was the same lesson that the child psychiatrist D.W. Winnicott was talking about when he wrote that the mother's responsibility is to fail the child adequately. You're inevitably going to be disappointed by life, or by people whom you love, or by meditation, but the point is to learn how to bear that disappointment and not to hide behind it, but to come back with the love. For me, meditation look away the fear of getting attached to the world while knowing how fleeting it all is.
PT: How people will disappoint us, leave, die...
EPSTEIN: That's right. And meditation, ultimately, is about surrender to that process, and the joy that comes out of completely immersing yourself in this changing world. Sometimes, to learn how to completely immerse yourself into this world, you have to renounce to it, you have pull yourself back and practice just with your own mind. The point of that retreat is to free you up enough to engage more with the world. And at its best, that has to be the aim of psychotherapy. You let someone become attached to you in a real way and then let them leave.
PT: As the psychiatrist Jean Baker Miller said about how we don't grow into independence or autonomy, we grow into relationship.
EPSTEIN: Instead of heading toward separation and individuation, we're growing towards love and death. And to successfully engage in either of those realms requires this ability to quiet yourself and give yourself over the process. I feel enriched by having been clued into that early in my life.
From the book Going to Pieces without Falling Apart by Mark Epstein, M.D. Copyright [C] 1998 by Mark Epstein. Published by arrangement with Broadway Books, a division of Bantam Doubleday Dell Publishing Group, Inc., New York, New York. All rights reserved.
Copyright 1998 Sussex Publishers, Inc.
Copyright 2000 Gale Group