Meditation And Psychotherapy:
A Review of the Literature
by Greg Bogart, Ph.D.
Originally published in The American Journal of Psychotherapy, 1991 © Greg Bogart, all rights reserved
Are meditation and psychotherapy compatible? While meditation leads to physiological, behavioral, and cognitive changes that may have potential therapeutic benefits, psychoanalytic and Jungian critics claim that meditation is regressive, fosters dissociation, and neglects the unconscious. In contrast, transpersonal theorists contend that, when used with attention to assessing the individual's developmental stage and choice of an appropriate method, meditation may promote inner calm, loving kindness toward oneself and others, access to previously unconscious material, transformative insight into emotional conflicts, and changes in the experience of personal identity.
Jacob Needleman1 has written that increasing numbers of contemporary westerners "no longer know whether they need spiritual or psychological help" (p.110). While therapy is often sought for removing the obstacles that stand in the way of personal happiness, spiritual disciplines like meditation are often pursued by those "yearning for something inexplicably beyond the duties and satisfactions of religious, moral, and social life" (p.113). But might there be some point of meeting between therapy and meditation? Could these two approaches to human growth complement and benefit each other in some way? Could they be integrated and utilized in tandem?
Over the past two decades there has been a growing interest in the potential use of meditative practices in psychotherapy.2,3 This has given rise to a fertile dialogue regarding the confluences and divergences of the traditions of contemplative practice and Western psychotherapy.4-6 Questions have been raised about whether these two methods of human growth are compatible. Might meditation offer access to dimensions of human experience that are largely untouched by Western therapy, and possibly augment or improve the effectiveness of therapy? Does meditation lead to improvements or difficulties in psychological adjustment? How significant are meditation's physiological and cognitive effects? Is meditation fundamentally out of place in the clinical setting, intended to precipitate entirely different kinds of changes in human behavior, personality, and consciousness? Are there dangers in introducing meditation into the therapeutic context? How might these dangers be avoided?
This review of some of the research that has been done to date will focus upon the therapeutic integration of meditative techniques. I will consider theories suggesting that meditation leads to physiological, behavioral, and cognitive changes that have potential therapeutic benefits, as well as suggesting ways in which meditation is more than just a relaxation, behavioral, or cognitive technique. I will then examine some of the problems raised by psychoanalytic and Jungian critiques of meditation. Finally, I will explore the views of several authors associated with the field of transpersonal psychology, Jack Engler, Ken Wilber, Mark Epstein, and Elbert Russell, who have done important work comparing Eastern psychologies (especially Buddhist) and Western views of the self-the individual's conception of being a separate and distinct person with a unique identity-in order to to illuminate how psychotherapy and meditative disciplines might inform and assist one another.
There are many forms of meditation that have been developed and passed on by humanity's religious and spiritual traditions. Many involve some form of withdrawal of attention from the outer world and from customary patterns of perceptual, cognitive, emotional, and motor activity, performed in a state of inner and outer stillness. There are, however, forms of meditation that utilize music, movement, or visual or auditory contemplation of physical objects or processes (i.e., staring at a candle flame, watching or listening to a stream of water or ocean waves). Goleman7 divides meditation into two main categories: concentration methods and insight techniques.
Concentrative meditation fixes the mind on a single object such as the breath or a mantra and attempts to exclude all other thoughts from awareness. This kind of meditation is prescribed in the Yoga Sutras8 and Buddhism9, and has been popularized in the form of "Transcendental Meditation"(TM). Concentration practices suppress ordinary mental functioning, restrict attention to one point, and induce states of absorption characterized by tranquility and bliss.10
Buddhism, however, also introduced the practice of insight meditation (vipassana), the goal of which is insight into the nature of psychic functioning, not the achievement of states of absorption. Vipassana is a training in mindfulness in which attention is focused upon registering feelings, thoughts, and sensations exactly as they occur, without elaboration, preference, selection, comments, censorship, judgment, or interpretation10 (p.21). It is a process of expanding attention to as many mental and physical events as possible, the goal of which is understanding of the impermanent, unsatisfactory, and non-substantial nature of all phenomena. Thus, it is primarily a means of knowing one's mental processes more clearly-for example, by understanding the chain of "mind moments" that lead to suffering-and of learning to shape and control them.
These two kinds of meditation may have very different effects on the practitioner and thus may have very different clinical applications. A comparison of two EEG studies11,12 showed that yogis in meditation are oblivious to the external world, while Zen meditators become keenly attuned to the environment. Thus, different forms of meditation are associated with different patterns of brain activity and different forms of attention. The distinctions between various forms of meditation such as TM sand vipassana are significant because they enable us to recognize that a meditation technique may appropriately be applied in therapy only if it matches the therapeutic goals being sought, for example, stress reduction, working through difficult emotions, or seeking transformative transpersonal experiences.
Finally, in order to speak intelligibly about meditation we must not only make these distinctions between various kinds of meditation, but we must also note that different effects may be associated with different stages of meditative practice; i.e. long-term practitioners may experience different physiological, cognitive, and psychological states and changes than novices.
Why Use Meditation In Psychotherapy?
Deatherage13 studied the effectiveness of meditation techniques as a primary or secondary technique with a variety of psychiatric patients. He conceptualized meditation as a self-treatment regimen (highly efficient for the use of the therapist's time and therefore quite cost-effective) that helps patients know their own mental processes and preoccupations, develop the "observer self," and gain the ability to shape or control their mental processes.
Carpenter14 writes, "Meditation and esoteric traditions have much to offer psychotherapy," and suggests that the efficacy of meditation in therapy is due to a combination of relaxation, cognitive and attentional restructuring, self-observation, and insight. Shapiro & Giber15 discuss two main hypotheses regarding the mechanisms responsible for the therapeutic benefits of meditation: first, the view that meditation brings about a state of relaxation; and secondly, the view that meditation is effective by inducing an altered state of consciousness.
Deikman16 argues that Western psychology has much to learn from the traditions of mystical sciences, which claim that central sources of human suffering originate in ignorance of our true nature, and that achieving enlightenment, or the experience of the "Real Self" alleviates human suffering by removing its basis. Western therapy, he writes, focuses on emotions, thoughts, memories, impulses, images, self-concepts, all of which are contents of consciousness. But Western psychology fails to concern itself with the fact that our core sense of personal existence-what Deikman calls "The observing self"-is located in awareness itself, not in its contents. Thus awareness remains beyond thought and images, memories, and feelings, and cannot be observed, but must be experienced directly. Meditative techniques heighten awareness of the observing self, change customary patterns of perception and thinking(p.33), and change motivation, lessening the intensity of motivations connected with the ego (the "object self"), leading to reduction of symptoms (p.11).
In Deikman's view, "Meditation is an adjunct to therapy, not a replacement for it" (p.143). Therapy is most helpful for persons seeking relief from symptoms interfering with work, intimacy and pleasure (p.174). Therapy ameliorates neurotic self-centeredness, corrects misinterpretations of the world, and teaches new strategies that are more effective in meeting a person's needs. Western therapy focuses on fulfillment of personal desires, the gratification of the object self (p.81). Mysticism questions and uproots craving, and tries to bring about a change in psychological and emotional state or attitude that leads to a diminishment of the problems that are the focus of therapy (p.78). Vassallo17 concurs, writing that by illuminating two basic human dilemmas-clinging and ignorance-Buddhist psychology and meditative practices help people accept reality as it is and decreases their individualistic preoccupation.
Kutz, Borysenko, and Benson18 state that meditation may be a primer for therapy; for observing and categorizing mental events provides insight into how mental schemes are created, giving rise to a greater sense of responsibility and allowing one to step out of conceptual limitations and stereotyped reactions and behaviors. Meditation thus spurs the desire for deeper self-understanding through therapy, and actually leads, in their view, to an intensification of the therapeutic process. Meditation is a form of introspection pursued outside of the therapeutic session, for which patients pay with their own time, not the therapist's time. Thus meditation enhances the quality of therapy by involving patients more deeply in the process of self-exploration and providing abundant material for exploration in therapy sessions. Moreover, therapy and meditation both assume that understanding one's pain and defenses against it can alleviate suffering and promote psychological growth. They argue that combining meditation and therapy is "technically compatible and mutually reinforcing."
Bradwejn, Dowdall, and Iny19 disagreed with these conclusions, writing that the goal of meditation (the realization that the self or ego is illusory) is irreconcilable with the therapeutic goal of facilitating development of a cohesive ego. Corton20 cautioned that before combining therapy and meditation, the developmental levels of patients must be carefully considered. Wolman21 argues that the combination of meditation and therapy is redundant. In contrast, however, Dubs's study22-which used interviews and questionnaire assessments of 30 long-term meditators and identified unresolved anger as a key element in resistance to progress in meditation-suggests that psychological and spiritual growth are linked, perhaps sequentially and developmentally.
Bacher23 suggested that a sequential approach in which psychotherapy precedes meditation is more beneficial than a blended approach. It is important, in his view, to respect the developmental tasks of the person emphasized by existential-humanistic therapy; self identification, emotional contact and expression, ego development, and increase in self-esteem are all necessary before the individual can undertake in a serious way the tasks of meditation: the disidentification from emotional and egoic concerns. Although meditation and therapy perform corollary functions in the enhancement of individual well-being-the intensification of present awareness and lifting of repression-there are major philosophical differences that make separation advisable. Bacher notes that keeping a clear distinction between them maintains the full integrity and power of each to accomplish its stated aims. Meditation teaches the skills of attention and a still mind, a state of inner harmony and a transformation and transcendence of the personal concerns that are the focus of psychotherapy.
Vaughan24 lists the following components common to both therapy and meditation: Telling the truth; releasing negative emotions; the need for effort and consistency; authenticity and trust-avoiding self-deception; integrity and wholeness-accepting all one's experiences and allowing things to be as they are, rather than living in a world of illusion and denial; insight and forgiveness directed toward oneself and others; opening the heart and developing the capacity to give and receive love; awareness and nonjudgmental attention; liberation from limiting self-concepts, from fear and delusion, and from the past and early conditioning.
Kornfield25, a noted psychologist and Buddhist meditation teacher, contends that Western therapy emphasizes analysis, investigation and the adjustment of the personality. Yet it neglects the development of concentration, tranquility, and equanimity, "the cutting power of samadhi, the stillness of the mind in meditation" that can "penetrate the surface of the mind" and "empower the awareness to cut neurotic speed" (p.37). Meditation, in his view, is a means not merely of seeking comfort and stability, but of working with inner turmoil and undergoing a profound transformation that represents the death of the self that is the main focus of attention in psychotherapy. However Kornfield26 also emphasizes that "meditation doesn't do it all." In many areas, he writes, such as grief, communication skills, maturation of relationships, sexuality and intimacy, career and work issues, fears and phobias, and early wounds, Western therapy is quicker and more succesful than meditation.
Odanjnyk27 writes that meditation teaches a focused attention that leads to increased self-awareness of mental and emotional states, mastery over instinctive, compulsive reactions, insight into one's true nature and into reality, exploration of religious themes, images, and feelings, and expansion of ego consciousness into a more universal consciousness.
Brooks and Scarano28 studied the effectiveness of Transcendental Meditation in the treatment of post-Vietnam adjustment, concluding that it is a useful treatment modality. After three months of meditation, treatment subjects showed significant reductions in depression, anxiety, emotional numbness, alcohol consumption, family problems, difficulty in finding a job, insomnia, and other symptoms of posttraumatic stress disorder. Therapy subjects in the same study showed no significant improvement on any measure.
Much of the physiological data on meditation suggests its effectiveness for treating a variety of stress-related, somatically based problems. Many studies have suggested that meditation could be a promising preventive or rehabilitative strategy in treatment of addictions, hypertension, fears, phobias, asthma, insomnia, and stress. Research has also suggested that subjects using meditation change more than control groups in the direction of positive mental health, positive personality change, self-actualization, increased spontaneity self-regard and inner directedness and self-perceived increase in the capacity for intimate contact.29-31 Delmonte32 discussed the relationship between meditation and personality scores, focusing on self-esteem and self-concept, depression, psychosomatic symptomatology, self-actualization, locus of control, and introversion/extroversion. He found no compelling evidence that meditation changes psychometric scores, but found that meditation does seem to be associated with increases in self-actualization and decreases in depression.
Childs33 found that use of TM with juvenile offenders was associated with self-actualization, decreased anxiety and drug use, and improvements in behavior and interpersonal relationships. Dice34 noted that TM promoted improvement of self-concept and internal locus of control. Lesh35 has shown that meditation may increase therapists' accurate empathy and openness to their own inner experience. And Keefe36 believes that meditation leads to greater awareness of feelings, enhanced interpersonal perception, and increased present-centeredness, thereby strengthening therapists' effectiveness. Goleman37 contends that meditation is applicable as a means of deconditioning in cases of general or diffuse anxiety but not in treatment of specific fears. In his view, responses of meditators to stressful situations may be more adaptive, due to the increased ability to let go of stress rather than remain chronically stressed or anxious after the stressful situation has passed.7
However, the view that meditation leads to anxiety reduction is a point of contention for some. Many of the findings cited above have been contested on methodological grounds by Smith.2 Boswell & Murray38 contend that
self-report and behavioral measures of anxiety are no more reduced after meditation than after appropriate controls.... The results uniformly fail to support the contention that meditation is an effective method for reducing anxiety.
Delmonte39-using measures of blood lactate, blood flow, hormone levels, plasma phenylalanine, and neurotransmitter metabolites-concluded that there is no compelling evidence that meditation is associated with special state or trait effects at a biochemical level.
The Relaxation Model
Many of the clinical benefits claimed for meditation are attributed to the physiological state of relaxation associated with meditation. Studies have found that meditation leads to significant decreases in oxygen consumption, carbon dioxide elimination, respiration rate, cardiac output, heart rate, arterial lactate concentration, respiratory quotient, blood pressure, arterial gases, and body temperature.40-50 Meditation is also associated with increases in skin resistance and in slow alpha brain waves and a decrease of beta waves.40 All of these physiological correlates of meditation yield a portrait of a condition of relaxed wakefulness. This has given rise to the view that meditation is basically a relaxation technique, one which allows a calm witnessing of thoughts and reduces somatic symptoms, fears, and phobias through desensitization and reduction of anxiety.
The relaxation model of meditation's therapeutic effectiveness is usually associated with the theory of reciprocal inhibition. Wolpe51 hypothesized that a phobic reaction would extinguish if it could symbolically occur in the presence of an incompatible response, such as relaxation. This is the foundation of modern behavioral self-control strategies, which will be compared with meditation below.
The Reciprocal Inhibition Model
Goleman's7 study of Buddhist Abhidharma psychology and meditation identified the principle of reciprocal inhibition as central to the efficacy of meditation. Abhidharma teachings describe the flow of "mind moments," the constant flux of mental states. Mental states are said to be composed of a set of properties of mental factors, which are differentiated into pure, wholesome, healthy factors, and impure, unwholesome, and unhealthy mental properties. Delusion-perceptual cloudiness or misperception of objects-is the primary unhealthy factor, which gives rise to the unhealthy cognitive factors of perplexity, shamelessness, remorselessness, and to the unhealthy affective factors of agitation, worry, contraction, torpor, greed, avarice, envy, and aversion. These are counteracted by the factors present in healthy states, which are seen as antagonistic to unhealthy states. The most important of these are mindfulness and insight (clear perception of the object as it really is), which suppress the fundamental unhealthy factor of delusion. These lead to the development of modesty, discretion, rectitude, confidence, nonattachment, nonaversion, impartiality, composure, buoyancy, pliancy, efficiency, proficiency, compassion, loving-kindness, and altruistic joy. According to Goleman, "The key principle in the Abhidharma program for achieving mental health is the reciprocal inhibition of unhealthy mental factors by healthy ones."
While Goleman's summary of the Abdhidharma perspective is quite illuminating, the theory of reciprocal inhibition upon which it is based is not immune to criticism. Shapiro & Giber15 raise questions regarding the reciprocal inhibition explanation of systematic desensitization of anxiety, saying that this effect may also be due to attention shifts and cognitive refocusing.52,53 Boals54 writes that the reciprocal inhibition theory ignores some of the complexities of the relationship between anxiety and performance, for example the fact that insufficient levels of arousal may detract from optimal performance as much as excessive anxiety does. Moreover, the hypothesis that meditation leads to global desensitization of anxiety associated with an individual's thoughts37 may be unfounded; the relaxation provided by meditation may not be sufficient to achieve desensitization to negative or disturbing thoughts and images that may emerge in the course of meditation.
Furthermore, according to Boals, meditation may not reduce the anxiety associated with symptoms like drug use by substituting relaxation for it; instead it may work by substituting an alternative way by which people can reach an altered state of consciousness (ASC). Thus, while meditation may be associated with a decrease in the use of drugs or alcohol, for example, anxiety reduction may not be the best explanation for this reduction. There is some evidence suggesting that people may ingest substances not to reduce anxiety but to produce an ASC that is positively reinforcing.
Klajner, Hartman, and Sobell55 write that previous research on the use of relaxation methods (such as meditation) for treatment of drug and alcohol abuse have been premised upon the assumption that substance use is causally linked to anxiety and that anxiety can be reduced by relaxation training. However, evidence suggests that such precipitating anxiety is limited to interpersonal stress situations involving diminished perceived personal control over the stressor, and that alcohol and other drugs are often consumed for their euphoric rather than tranquilizing effects. Thus, empirical support for the efficacy of relaxation training or meditation as a treatment for substance abuse is equivocal. Even in cases of demonstrated effectiveness, they write, increased perceived control is a more plausible explanation than decreased anxiety.
Critiques of the Relaxation Model
In addition to these important questions regarding anxiety-reduction and reciprocal inhibition, there are a number of other reasons to reconsider the view of meditation as primarily a relaxation, anxiety-reducing strategy. Boals54 writes that the relaxation model of meditation has allowed meditation to become more familiar, acceptable, and accessible to the scientific community and to the public at large, and has led to fruitful study of the uses of meditation in a variety of settings. Nevertheless, this view of meditation may have outlived its usefulness. The relaxation model does not provide us with an adequate understanding of the negative consequences sometimes associated with meditation, which can only be explained as symptoms of unstressing (the organism's attempt to normalize itself by eliminating old stresses), a resistance to relaxation, or an eruption of depression that is ordinarily masked by activity.
Furthermore, the relaxation model leads some to believe that meditation is no different from other relaxation techniques.56-59 Benson57, for example, has postulated that meditation, Zen, Yoga, and relaxation techniques-such as autogenic training, hypnosis, progressive relaxation as well as and certain forms of prayer-elicit a uniform "relaxation response," which only requires a quiet environment, a mental device for focusing attention, a passive solitude, and a comfortable position. Delmonte60 would seem to confirm this finding, showing that both mantra meditation and hypnosis involve focused and selective attention, reduced exteroceptive and proprioceptive sensory input, passive volition, a receptive attitude, a relaxed posture, and monotonous, rhythmic vocal or subvocal repetition. Both states involve increased drowsiness, a shift toward right brain hemisphere activity and parasympathetic nervous system dominance, increased hypnogogic reverie, regressive mentation, and suggestibility. Both are altered states of consciousness that have in common similar induction procedures, and many state effects.
While the view of a unitary relaxation phenomenon demystifies meditation, Boals writes, it is inaccurate for a number of important reasons. First, although Benson postulates the relaxation response as a unitary phenomenon, it is difficult to define relaxation precisely. Sleep and TM, for example, are both relaxing, yet they are associated with very different states of consciousness.40,61,62 Moreover, many activities that are considered relaxing are quite active and involve states of physiological arousal. Second, some meditation techniques produce different effects on different subjects or in the same subject on different occasions.63-66 Third, the relaxation model tells us nothing about the process of meditation as it is subjectively experienced. Fourth, there are quantitative and qualitative differences between various relaxation techniques. I will return below to this point, which is important because failure to distinguish between various methods obfuscates the potential uses of different techniques in alleviating particular kinds of human suffering.
Fifth, as noted earlier, meditation is not a unitary phenomenon: different types of meditation produce widely varying outcomes. For example, Zen meditators grappling with a koan or vipassana meditators confronting the naked truth of mental processes may become at least temporarily quite anxious or agitated. Similarly, meditation in the tradition of kundalini yoga67 may bring about spontaneous motor activity, emotional release, or other forms of psychophysiological arousal. Thus, some forms of meditation do not result in states of relaxation.
Sixth, the mechanisms used to explain the relaxation response may not be valid. For example, rhythm is said to be a central factor used to induce states of meditation; yet some rhythms are arousing rather than relaxing, and many meditation methods do not use rhythm at all (e.g., staring at a candle flame). For all of these reasons, we must conclude that although there is some evidence that meditation does lead to a state of relaxation and does seem to be associated with a reduction of anxiety, the relaxation model is not by itself an adequate explanation of the therapeutic efficacy of meditation.
Meditation From A Cognitive Perspective
Boals54 and Deikman16 prefer a cognitive explanation of meditation, viewing it as a process of deliberately altering attention, involving a change of focus from the external world to the inner world, from stimulus variety to stimulus uniformity, from the active mode of consciousness-characterized by focal attention, control, task orientation, manipulation of the environment-to the receptive mode-characterized by diffuse attention and letting go. Goleman7 also characterizes meditation as the "self-regulation and retraining of attentional habits," through deliberate deconditioning of habitual patterns patterns of perception, cognition, and response.
The cognitive changes resulting from meditation can perhaps best be understood using Deikman's68 concept of the "deautomatization" of consciousness, brought about by "reinvesting actions and percepts with attention." Deautomatization implies a shift toward a form of perceptual and cognitive organization which some people might consider primitive because it is one preceding the analytic, abstract, intellectual mode. However this mode of perceptual organization could also be viewed as more vivid, sensuous, syncretic, animated, and dedifferentiated with respect to distinctions between self and object, between objects, and between sense modalities. Deikman69 calls deautomatization a process of "cutting away false cognitive certainties," leading to mystical experiences and unusual modes of perception. Many experiences of altered or mystical states, he believes, can be understood in terms of "perceptual expansion," the "awareness of new dimensions of the total stimulus array," through which aspects of reality previously unavailable enter awareness. Such experiences are "trans-sensate phenomena," experiences that go beyond customary pathways, ideas, and memories, and "are the result of the operation of a new perceptual capacity responsive to dimensions of the stimulus array previously ignored or blocked from awareness."
According to Goleman7, meditation induces the experience of flow characteristic of all intrinsically rewarding activities.70,71 The flow experience is characterized by (a) the merging of action and awareness in sustained, non-distractible concentration on the task at hand, (b) the focusing of attention on a limited stimulus field, excluding intruding stimuli from awareness in a pure inwardness devoid of concern with outcome, (c) self-forgetfulness with heightened awareness of function and body states, (d) skills adequate to meet the environmental demand, (e) clarity regarding situational cues and appropriate response. Flow arises when there is optimal fit between one's capability and the demands of the moment.7
Meditation produces a change in internal state that maximizes the possibility for flow experiences while lessening the need to control the environment. Meditation thus leads to "perceptual sharpening and increased ability to attend to a target environmental stimulus while ignoring irrelevant stimuli." Flow is associated with a sense of the intrinsic rewards of activity and an absence of anxiety and boredom. The flow state that may result from meditation is associated with clarity of perception, alertness, equanimity, pliancy, efficiency, skill in action, and pleasure in action for its own sake.
Another useful cognitive model is found in Delmonte's72 constructivist approach to meditation based on George Kelly's73 Personal Construct Theory (PCT). According to Kelly, there are two fundamental realities, the reality beyond human perception (similar to Kant's "noumenon"), and our interpretations or constructions of this primary reality (Kant's "phenomenon"), which are constantly updated in the light of new evidence. Both PCT and Eastern psychologies such as Buddhism agree that normal human understanding involves use of dualistic constructions to make sense of a unitary reality. Buddhism emphasizes the need to see through the illusion of duality through meditation, to recognize the transparency of our construct system, and to experience a greater sense of unity; whereas PCT emphasizes the practical value of dualistic construing and the importance of elaborating ever more effective personal construct systems to more accurately predict events.
Meditation involves two main "cognitive sets," Delmonte writes, constriction and dilation. In constriction, attention acts to exclude or curtail construing by reducing the number of elements to be dealt with to a minimum. Dilation uses suspension of habitual construing while broadening the perceptual field to include more elements, using a more comprehensive organization of the construct system. Thus, in mindfulness meditation one observes the contents of consciousness in a neutral fashion while suspending habitual construing. The stimulus repetition of meditation leads to a condition of "no thought" due to stimulus habituation and inhibition of the construct system. As habitual construing is temporarily blocked, spatial and temporal distortions of awareness may result, or a regression to a preverbal form of sense-making (e.g. sexual arousal, hate, fear, love, anger, changed body size). Delmonte notes that meditation often brings about modification of brain hemispheric laterality, such that advanced stages of meditation inhibit or transcend the functions associated with both left and right hemispheres, a finding that is at odds with those who view meditation as primarily a relaxation response associated with increases in right-hemisphere functioning.
According to Delmonte, the suspension of habitual, logical-verbal construing in meditation frees us of our usual defensive constructions, allowing consciousness to move in new directions. Here Delmonte makes a crucial differentiation between "ascendence," a movement up to a higher, more abstract level within one's personal construct system; "descendence," in which awareness moves down from cognitive to preverbal or somatic construal, an adaptive regression to unconscious levels of awareness in which repressed emotional material can come into consciousness and be cathartically released; and "transcendence," in which one experiences no thought, the feeling of unity or bliss, in which the meditator transcends the bipolarity of contrual and thereby recovers the preverbal awareness of the essential unity of reality.
Thus, Delmonte's model suggests that the process of attentional retraining involved in meditation can be beneficial in three distinctive ways: It can be applied in a pragmatic way to change human behavior by augmenting and improving our personal construct systems (ascendence); to facilitate the accessing of unconscious material, previously inaccesible from within our construct system (descendence); and to bring about altered states of consciousness in which one experiences, at least temporarily, the free space of reality beyond and prior to our construct systems. Let us examine how meditation could be utilized therapeutically in each of these ways.
Meditation and Behavioral Self-management Techniques
Through attentional training, meditation brings about a shift toward self-observation and thus may be useful for facilitating behavioral changes.54,74 Herein may lie one of meditation's most important forms of clinical utility. Deikman16 writes that the increase in scope and clarity of the observing self which meditation encourages leads directly to freedom from habitual patterns of perception and response (p.98). As the motivations of the object self subside and cease to dominate perception and as the observing self is extracted from the contents of consciousness, one begins to disidentify with automatic sequences of thought, emotion, and fantasy (p.107). The observing self redirects the intensity of affect, obsessive thinking,automatic response patterns, and thus provides the opportunity for modification, mastery, and control of behavior.
Goleman7 has noted that therapy is treatment for specific symptoms, while meditation is not. Biofeedback or behavioral therapy may be more effective for self-control and relearning of adaptive responses to stress or for treatment of specific psychopathology. Conversely, meditation is useful for providing a general pattern of stress response less likely to trigger overlearned, maladaptive responses. Meditation, he writes, may function as a stress therapy, facilitating more rapid recovery from the psychological and physiological coping processes mobilized in stress situations, allowing more alert anticipations to threat cues, and more effective recovery.
Shapiro and Zifferblatt75 compared Zen meditation with Western behavioral self-control strategies. In addition to relaxation and refocusing of attention, meditation involves self-observation and desensitization to thoughts, fears, and worries. Attending to the breath in a state of relaxed attention becomes a competing response that desensitizes thoughts and images, and permits increased receptivity to other thoughts, affects, or fantasies. (This refers to the emergence into awareness of previously unconscious material, a topic to which I will return below.)
Methods of behavioral self-change are also based on awareness: self-observation, self-monitoring, and analysis of the elements of the environment that are controlling one's behavior. Self-control techniques also use monitoring of thoughts, feelings, physiological reactions, and somatic complaints; examination of antecedents, initiating stimuli, and consequences of behaviors; and recognition of the frequency, duration, intensity of the behavior itself.
In Zen meditation on the breath, no attempt is made to plot data charts or employ systematic and written evaluation of data. In contrast, behavioral self-observation focuses on the specific problem area observed, the behavior to be changed or altered, and utilizes the labelling, evaluation, recording, and charting of data for the purpose of discrimination, and self-management. Shapiro and Zifferblatt do not seem to be aware that other forms of meditation such as Vipassana do employ discrimination, labelling, and recording of all contents and movements of consciousness.
Shapiro and Zifferblatt contend that meditation can promote behavioral self-control skills by teaching one to unstress and empty the mind of thoughts and images, and by increasing alertness to stress situations, thus facilitating performance of behavioral self-observation. Moreover, meditation gives practice in noting when attention wanders from a task, therefore placing the person in a better position to interrupt a maladaptive behavioral sequence. Zen meditation also does not involve cultivation of particular positive images or thoughts, as do active behavioral programming methods for stress and tension management, which use fear arousal as a discriminative stimulus for active relaxation, positive imagery, and self-instructions to cope with the stressful situation. Nevertheless, meditation does allow one to step back from fears and worries, and to observe them in a detached, relaxed way. Thus it alters subsequent self-observation by making the problem seem less intense and by giving a feeling of strength and control.
Meditation And The Unconscious: Psychoanalytic and Buddhist Perspectives
Meditation may indeed have some usefulness in facilitating the self-observation and behavioral changes sought in some forms of psychotherapy. But to view meditation solely in this manner is to limit our understanding of its potential to promote other important therapeutic goals, for example, the recognition of unconscious conflicts that may be at the root of behavioral problems. In this regard, let us recall Delmonte's observation that meditation can also bring about "descendence" of consciousness, thus increasing access to the unconscious. Goleman7 also noted that meditation allows formerly painful material to surface. Thus there is some reason to think that meditation might be compatible with psychodynamically oriented psychotherapies focusing on uncovering and working through unconscious material.
Kutz et al.18 write that meditation leads to greater cognitive flexibility, which allows one to perceive connections between sets of psychological contents that were hitherto separate and unrelated. In this manner, they contend, meditation loosens defenses and allows the emergence of repressed material. Both meditation and free association involve self-observation, although one is usually discouraged from trying to interpret the meaning of free associations during meditation. Meditation-related free associations are usually available to memory and, like dreams, can be brought into therapy and understood by examining their origin and meaning.
The view that meditation may be a useful means of uncovering unconscious material is not shared by some within the psychoanalytic tradition who view meditation as regressive or pathological. Freud76 considered all forms of religious experiences as attempts to return to the most primitive stages of ego development, a "restoration of limitless narcissism" (p.19), used as a defense against the fears of separateness. Alexander77 called meditation a "libidinal, narcissistic turning of the urge for knowing inward, a sort of artificial schizophrenia with complete withdrawal of libidinal interest from the outside world" (p.130). Masson and Hanly78 contend that the urge to get beyond the ego which is the goal of mysticism represents a regression to an earlier, undifferentiated state of primary narcissism, often associated with "an influx of megalomania," and characterized by "the withdrawal of interest from the natural world." Lazarus79 noted psychiatric problems precipitated by TM. He concluded that TM can be effective when it is used properly by informed practioners, but that when used indiscriminately it can lead to depression and depersonalization, heightened anxiety and tension, agitation, restlessness, or feelings of failure or ineptitude if the promised results do not occur. These findings suggest that the very openness to the unconscious that meditation provides may also contribute to the negative experiences sometimes found among meditators.
Several writers sympathetic to both meditation and the psychoanalytic perspective have attempted to clarify the psychoanalytic understanding of meditation. Shafii80 conceptualizes meditation as a temporary and controlled regression to the preverbal level or "somatosymbiotic phase" of the mother-child relationship, a regression that rekindles unresolved issues from the developmental phase in which the individual develops a sense of basic trust (i.e. experiences and learns to rely on the continuity and sameness of outer providers and of oneself). Frustrations of basic trust due to breaches in the child's protective shielding give rise to "cumulative trauma," and the consequent maladaptive defense mechanisms studied by psychoanalysis. Meditation, Shafii says, returns the individual to the earliest fixation points and permits reexperiencing of traumas of the separation-individuation phase on a non-verbal level. Meditation, in Shafii's81 view, is a state of "active passivity" and "creative quiescence" that has some similarities with the "psychoanalytic situation": utilization of a special body posture, limited cathexis of visual perception and increased cathexis of internal perception, enhanced free association of thoughts and fantasies. However, while psychoanalysis emphasizes verbalization of free associated thoughts, feelings, and fantasies, in meditation one experiences and witnesses these silently.
Epstein and Lieff82 emphasize that meditation may be used in both adaptive and regressive ways. They stress that some meditators need a therapeutic framework in which to work out the unresolved unconscious issues which may emerge in the form of an upsurge of fantasies, daydreams, precognitve mental processes, or visual, auditory, or somatic aberrations during meditation. They also note that many of the phenomena that often occur during advanced stages of meditation-such as visions of bright lights, feelings of joy and rapture, tranquility, lucid percpetions, feelings of love and devotion, kundalini experiences, etc.-must not be interpreted simply as pathological symptoms. To do so would be an example of what Wilber83,84 has called the "pre-trans fallacy," that is
a confusing of pre-rational structures with trans-rational structures simply because they are both non-rational.... It is particularly common to reduce samadhi into autistic, symbiotic, or narcissistic ocean states.84 (p.146)
Wilber83,84 has delineated the stages of development comprising what he believes is the full spectrum of human development, from pre-personal to personal to transpersonal stages of consciousness. He emphasizes that we must not equate transpersonal experiences with the pre-egoic states with which they have some structual similarities. According to Wilber84, meditation is not a way of digging into lower and respressed structures of the submerged unconscious, but rather a way of facilitating emergent growth and development of higher structures of consciousness. Thus, meditation is a progression in transcendence of the ego, not a simple regression in the service of the ego. At the same time, derepression of unconscious material ("the shadow") may occur in meditation, as meditation disrupts the exclusive identification with the present level of development.
Engler10, who is both a psychiatrist and a teacher of Buddhist meditation, has written perhaps the most lucid assessment of the problems of using meditation in a clinical setting, one which addresses many of the concerns raised by psychoanalytic critics. In his view, both Buddhist psychology and psychoanalytic ego psychology and object relations theory define the ego (what Buddhists call "personality belief") as an internalized image that is constructed out of experience with the object world and which appears to have the qualities of consistency, sameness, and continuity. According to object relations theory, the major cause of psychopathology is the lack of a sense of self, caused by failures in establishing a cohesive, integrated self, resulting in an inability to feel real. In contrast, Buddhist psychology says that the deepest psychopathological problem is the presence of a self, the "clinging to personal existence." That is, identity and object constancy are seen by Buddhist psychology as the root of mental suffering. Thus, whereas therapy devotes itself to regrowing a sense of self, Buddhist meditation is focused upon seeing through the illusory construction of the self. Engler questions whether or not these two goals are mutually exclusive and suggests that one might be a precursor of the other, concluding, "You have to be somebody before you can be nobody" (p.17).
Engler has noted the tendency for Western students of meditation to become fixated on a psychodynamic level of experience-dominated by primary process thinking and unrealistic fantasies, daydreams, imagery, memories, derepression of conflictual material, incessant thinking and emotional lability; and their tendency to develop strong mirroring and idealizing transferences to meditation teachers, reflecting a need for acceptance by or merger with a source of idealized strength and calmness, or characterized by oscillation between idealization and devaluation. Engler attributes these problems to the inability to develop adequate concentration, the tendency to become absorbed in contents of awareness rather than the process of awareness; and the tendency to confuse meditation with therapy and to analyze mental content instead of observing it.
However, a more fundamental problem is that meditation may be effective only for persons who have achieved an adequate level of personality organization, and may be deleterious for persons with personality disorders. In Engler's view, many Western students of meditation have prior vulnerability and disturbances in the sense of identity and self-esteem, as well as a tendency to try to use Buddhism as a shortcut solution to age-appropriate developmental problems of identity formation. Thus, such persons often misunderstand the Buddhist "anatta" doctrine that there is no enduring self to justify premature abandonment of essential psychosocial tasks. Engler believes that such students have not achieved the level of personality development necessary to practice meditation, and demonstrate structural deficit pathologies. Many, in his view, are near the borderline level of development, characterized by identity diffusion, failure of integration, split object-relations units, fluid boundaries between self and world, feelings of inner emptiness and of not having a self, and an inability to form or sustain stable, satisfying relationships (p.30). Such persons are attracted to the anatta doctrine because it explains, rationalizes, or legitimates a lack of self-integration. Moreover, borderlines are often attracted to the ideal of enlightenment, which is cathected as the acme of personal omnipotence and perfection. This represents for them a purified state of invulnerable self-sufficiency from which all defilements, fetters, and badness have been expelled, leading in many cases to a feeling of being superior to others.
Buddhist psychology has little to say about the level of self-pathology with structural deficits stemming from faulty early object-relations development because Buddhism does not describe in detail the early stages in the development of the self (p.34). Moreover, Engler believes that Buddhist meditation practices will only be effective when the practitioner has a relatively intact, coherent, and integrated sense of self, without which there is danger that feelings of emptiness or not feeling inwardly cohesive or integrated may be mistaken for sunyata (voidness) or selflessness.
Like therapy, vipassana meditation is an uncovering technique, characterized by neutrality, removal of censorship; observation and abstinence from gratification of wishes, impulses, or desires, and discouragement of abreaction, catharsis, or acting out; and a therapeutic split in the ego, in which one becomes a witness to one's experience. All of these elements presuppose a normal, neurotic level of functioning. In Engler's view, those with poorly defined and weakly integrated representations of self and others cannot tolerate uncovering techniques or the painful affects which emerge (p.36). Thus insight techniques like vipassana run the risk of further fragmenting an already vulnerable sense of self.
The vipassana guidelines of attention to all thoughts, feelings, and sensations without selection or discrimination create an unstructured situation intrapsychically. However, the goal of treatment of borderline conditions is to build structure (not to uncover repression), and thus to facilitate integration of contradictory self-images, object images, and affects into a stable sense of self able to maintain constant relationships with objects even in the face of disappointment, frustration, and loss. Such treatment addresses the developmental deficits deriving from early relationships-through a dyadic relationship, not through introspective activities like meditation (p.38). Engler emphasizes that mere self-observation of contradictory ego states is not enough to integrate dissociated aspects of the self, objects, and affects. What is required is confrontation and interpersonal exposure of split object- relations units as they occur within the transference. Thus, Engler writes, "Meditation is designed for a different type of problem and a different level of ego structure" (p.39).
Because a cohesive and integrated self is necessary to practice uncovering techniques like vipassana, meditation is not a viable or possible remedy for autistic, psychopathic, schizophrenic, borderline or narcissistic conditions. Concentration techniques, however, may be useful in lowering chronic stress and anxiety, and for inducing greater internal locus of control. In Engler's view, meditation and psychotherapy aimed at egoic strengthening are mutually exclusive; for at a given time, one should either strive to attain a coherent self, or to attain liberation from it (p.48). Engler warns that bypassing the developmental tasks of identity formation and object constancy through the misguided attempt to annihilate the ego has pathological consequences.
Nonetheless, despite these potential drawbacks of meditation, Engler contends that Buddhism has much to teach Western psychology, especially in its radical view of the construction of stable and enduring constructs of self and others as the source of suffering. From the Buddhist perspective, in contrast to that of most Western psychologists, identity and object constancy represent a point of fixation or arrest, and coherency of the self is a position achieved in order to be transcended (p.47). Therefore what we consider normality is, in the Buddhist view, a state of arrested development.
Epstein85 disagrees with Engler's contention that meditation is only an appropriate therapeutic intervention for those already possessing a "fully developed personality." Epstein concedes that some people attracted to meditation have pre-oedipal issues and narcissistic pathologies, but argues that Buddhist meditation may play an effective role in the resolution of infantile, narcissistic conflicts. Mahler86 found that narcissistic residues persist throughout the life-cycle, centering around memories of the blissful symbiotic union of the child and mother-a time in which all needs were immediately satisfied and the self was not yet differentiated. According to psychoanalytic theory, the infant's experience of undifferentiated fusion with the mother gives rise to two psychic structures: the ego ideal and the ideal ego. The ego ideal is that toward which the ego strives, what it yearns to become, and into which it desires to merge, as well as the ego's memory of the perfection in which it was once contained. The ideal ego is an idealized image the ego has of itself, especially centered around the belief in the ego's solidity, permanence, and perfection; thus it is an image of the ego's remembered state of perfection, a self-image distorted by idealization, sustained by the ego's denial of its imperfections.
In borderline, narcissistic and neurotic disorders, the ideal ego is strong and the ego ideal is weak. Only with maturation does the ego ideal begin to eclipse the ideal ego. Psychoanalytic theorists view meditation as a narcissistic attempt to merge the ego and the ego ideal to reachieve fusion with a primary object. Thus, in this view, meditation is believed to strengthen the ego ideal and neglect the ideal ego.
Epstein contends that Buddhist meditation can bring about restructuring of both the ego ideal and the ideal ego. From a Buddhist perspective, the experiences of terror that sometimes occur during meditation are the result of insight into the impermanent, insubstantial, unsatisfactory nature of the self and ordinary experience, leading to a sense of fragmentation, anxiety, and fear. Western psychologists are concerned that these experiences could unbalance those with inadequate personality structure. Buddhist psychologists, however, emphasize that equilibrium can be maintained through the stabilizing effects of concentration-which promotes unity of ego and ego ideal by encouraging fixity of mind on a single object, allowing the ego to dissolve into the object in bliss and contentment quite evocative of the infantile narcisistic state. The experiences of terror sometimes resulting from insight practices, however, do not satisfy the yearning for perfection and do not evoke grandeur, elation, or omnipotence. Instead they challenge the grasp of the ideal ego, exposing ego as groundless, impermanent, and empty, and overcome the denials that support the wishful image of the self.
Theravadin Buddhism also postulates an ideal personality-the Arhat, who represents the fruition of meditative practice, and the experience of nirvana, in which reality is perceived without distortion. The promise of nirvana may thus speak to a primitive yearning. In this manner, the ego ideal is strengthened while the ideal ego is diminished, reversing the relative intensities of these two that are thought to characterize immature personality organization. Buddhism emphasizes the precise balance of concentration and insight, a balance between an exalted, equilibrated, boundless state with one that stresses knowledge of the insubstantiality of the self. Concentration practices strengthen the ego ideal, leading to a sense of cohesion, stability, and serenity thst can relieve feelings of emptiness or isolation. Yet if the ego ideal is strengthened without insight into the nature of the ideal ego, the experience of concentration may lead to a sense of self importance or specialness that can increase the hold of the ideal ego. Conversely, when the ideal ego is examined without adequate support from the ego ideal one may become anxious and afraid, leading to morbid preoccupation with emptiness, loss of enthusiasm for living, and an overly serious attitude about oneself and one's spiritual calling. Another danger is that of superimposing a new image of the ideal ego onto the preexisting one, "cloaking the ideal ego in vestments of emptiness, egolessness, and non-attachment."
To understand the therapeutic benefits of meditation, it is important to avoid the pre-trans fallacy83,84 by distinguishing between experiences that may sound similar yet have very different meanings in the therapeutic and meditative contexts, respectively-for example, equating the states of emptiness that sometimes arise in the course of meditation with the pathological forms of emptiness described by psychoanalysis. Epstein87 writes that while the experience of emptiness is a subject common to both Western and Buddhist psychologies, these two traditions understand emptiness in fundamentally different ways. Western psychologists have described pathological forms of emptiness characterized by numbness, despair and incompleteness, identity diffusion, existential meaninglessness, and depersonalized states in which one aspect of the self is repudiated. As we have seen, some critics of meditation78,79 contend that it may intensify these forms of emptiness. According to Epstein, emptiness of these kinds are characterized as 1) a deficiency, an internalized remnant of emotional sustenance not given in childhood; 2) a defense-a more tolerable substitute for virulent rage or self-hatred; 3) a distortion of the development of a sense of self, in which one is unable to integrate diverse, conflicting self and object representations; and 4) a manifestation of inner conflict over idealized aspirations of the self, resulting when unconscious, idealized images of the self are not matched by actual experience, producing a sense of unreality or estrangement.
In contrast, the emptiness arising from Buddhist meditation is characterized by clarity, unimpededness, and openness, an experience that destroys the idea of a substantially existing, persisting, individual nature, as well as the substantiality of "outer" phenomena. Western psychologists observe that succumbing to the inevitable gap between actual and idealized experiences of the self leads to disavowing the actual self through a numbing sense of hollowness or unreality. Buddhist psychology focuses upon uncovering the distorting idealizations that are at their root groundless, based on archaic, infantile fantasy. Meditators confronted by a sense of emptiness must not mistake this for Buddhist emptiness, Epstein writes, but must explore it and expose their beliefs in its concrete nature. Epstein argues that meditation can help the observing ego attend to whatever conflicting self or object images that arise without clinging or condemnation, thereby decreasing pathological emptiness. Thus Epstein concludes that while there are potential complications of using meditation as a therapeutic method, it may have a role in transforming narcissism, feelings of emptiness, and other forms of psychological suffering. Moreover, according to Epstein, where absorption and insight balance precisely and the voidness of the self is discerned, meditation can move beyond all residues of the ego ideal and of narcissism into the experience of enlightenment.
The writings of Engler, Wilber, and Epstein represent a new synthesis of the insights of psychoanalytic theory and Buddhist psychology. Each of them suggests that the question of whether meditation should be used in therapy requires a careful assessment of the patient's character structure and the way in which this may be affected by meditation.
The Jungian Critique of Meditation
C.G. Jung88, while considerably more open to religious or spiritual experiences than many psychoanalytic theoreticians, consistently advised Westerners against the use of Eastern meditation techniques. Westerners do not need more control and more power over themselves and over nature, he writes; we need to return to our own nature, not systems and methods to control or repress the natural man. Before Westerners can safely practice Yoga or meditation, Jung says, we must first know our own unconscious nature. Jung believes that psychotherapy is a more appropriate form of introversion for Westerners, one which permits the making conscious of unconscious components of the self. No discipline ought to be imposed on the unconscious, Jung emphasizes, for this would reinforce the "cramping" effect of consciousness. Instead, everything must be done to help the unconscious mind reach the conscious mind and free it of its rigidity. Thus Jung prescribes active imagination, in which one switches off consciousness and allows unconscious contents to unfold (pp.533-37).
Jung frequently cited the danger of being overwhelmed by the unconscious through improper use of Eastern psychotechnologies. He was particularly wary of the possibility of being thrust into an uncontrollable psychotic decompensation, or of becoming "inflated" as a result of identification with archetypal material emerging from the unconscious. In his view89, these pitfalls can be avoided by cultivating the ability to consciously understand this unconscious material with a critical intelligence (pp.224, 232-34).
Hillman90 contends that spiritual disciplines have a fundamentally different purpose than psychotherapy, being oriented toward "peaks," ascent toward pneumatic experience, or timeless and impersonal spirit, and often encouraging a turning away from nature, from community, from sleep and dreams, from personal and ancestral history, and from polytheistic complexity. Psychotherapy, in his view, is more a work of the soul than of the spirit, of depth as opposed to height, of "vales" rather than peaks. Therapy is "a digging in the ruins" of our personal history, fantasies, and emotional complexities as revealed by imagery emerging from the unconscious.
Jung and Hillman suggest the importance of finding value and meaning in the imaginal contents of the unconscious mind. In their view, many forms of meditation involve disidentification from the contents of consciousness, including the unconscious material that may emerge. It is important to recognize, however, that while their comments may apply to concentration methods, they may be inaccurate with respect to vipassana meditation, in which one must actively face and grapple with one's unconscious conflicts rather than transcend them. Nevertheless, one argument against the use of meditation in psychotherapy is that it may encourage a detached or negative attitude toward the contents of the unconscious, which are so significant in most forms of depth or insight psychotherapy.
Balancing Psychological and Spiritual Development
Jungian and psychoanalytic critiques suggest that using meditation in the context of therapy is no substitute for the exploration of psychological-emotional issues stemming from the individual's personal history that are the focus of most psychotherapies. Thus to be effective therapeutically, meditation would have to be pursued with an attitude of psychological sensitivity that does not pursue expanded states of consciousness as a form of "spiritual bypassing"91 of emotional, interpersonal, or intrapsychic conflicts.
Russell92 has attempted to define a model for a balanced approach to psychological and spiritual development. Russell searched the literature of Hindu Yoga and Theravadin, Abhidharma, and Vajrayana Buddhism and found that while these systems have great insight into conscious experiences and states of mind, they do not demonstrate any understanding of the unconscious, emotional conflicts, the existence of defensive mechanisms, or the operation of emotions like anxiety, anger or guilt operating outside of awareness. Nor do they acknowledge the effect of childhood trauma and parental treatment on the adult personality. While Eastern psychologies may occasionally refer to unconscious contents, they invariably view these as an intrusion and an obstacle to meditation that must be removed-for example, through concentration techniques for suppressing the unconscious.
Russell believes that therapy and meditation differ significantly with respect to their aims, their experiential areas, and their techniques. Meditation is not a method to alleviate psychopathology, Russell states, and "in recent years the expectation that meditation would be an effective psychotherapy has largely been reversed." Meditation helps one achieve higher states of consciousness, but is not focused on resolving emotional problems. Therapy, however, aims at exploration of the unconscious, rather than the higher states of consciousness sought in meditation. Welwood91 summed up this view when he wrote that the aim of psychotherapy is self-integration, while the aim of meditation is self-transcendence.
Meditation and therapy are also concerned with quite different aspects of consciousness. Therapy attempts to bring unconscious material into consciousness where it is explored, analyzed, interpreted, or expresssed, while concentrative forms of meditation seek a state of pure consciousness without content. In addition, therapy generally uses uncovering techniques designed to elicit unconscious material and bring it into awareness, where it is actively engaged through free association, interpretation, and analysis of transference. Only in cases of severe psychopathology (in which structure building and the development of adequate personal defenses are necessary and desirable treatment goals) does therapy employ covering techniques. Eastern spiritual disciplines do not examine unconscious material closely, and often use covering methods to eliminate obstacles to attainment of higher states of consciousness. For example, Theravadin Buddhism uses precribed behaviors and concentration meditation directed toward particular themes to reduce emotions and desires that interfere with meditation. Concentrative meditation does not attend to emerging unconscious material, but rather utilizes selective inattention toward it. Moreover, although a technique like vipassana can be viewed as an uncovering method in that unconscious material does arise, this material is dealt with differently than in Western therapy. As Welwood91 noted, in meditation feelings and emotions are not viewed as having any special importance, whereas in psychotherapy they are. In support of Russell's argument, however, let us note that although vipassana does stress examination of the nature of emotions, this is not the case in most forms of meditation.
Despite these observations, Russell believes that because meditation doesn't necessarily block unconscious material, there is not a complete opposition between meditation and therapy. He argues that spirituality and psychology are both concerned with enlarging the area of consciousness, either by bringing unconscious material into consciousness, or by exploring higher states of consciousness. These two approaches to expanded consciousness can be but are not necessariy explored simultaneously. Increased access to unconscious material does not always lead to an increase of higher states of consciousness. Alternatively, higher states of consciousness could occur without increased awareness of unconscious material. However it is also possible to increase awareness in both directions concurrently. Moreover, solving personal problems through awareness of unconscious material may improve meditation. Conversely, meditation may sensitize a person to the inner world and thereby increase openness to emergence of unconscious material in therapy. Russell concludes, therefore, that therapy and meditation are not related in a linear sense, as Wilber's and Engler's developmental models seem to suggest, but can act synergistically to promote human growth. Thus Russell is in agreement with Epstein that meditation can be used therapeutically both to promote the personal healing customarily sought in therapy and the expansion of consciousness sought in contemplative contexts.
Meditation and Altered States of Consciousness
As we have seen, meditation involves voluntary redirection of attention, a training in the self-control of attention that has some resemblance to other methods used in the behavioral sciences. However, this retraining of attention may lead not only to a physiological condition of deep relaxation, to increased skill in behavioral self-observation, to deepened access to the unconscious, but also to non ordinary states of consciousness. By alteration of the level and variety of sensory input (either through sensory reduction or sensory overload)54, the brain's information-processing capacities are affected, perception is "deautomatized," and the "flow" experience arises, characterized by perceptual expansion and sharpening.
In some cases, meditation may lead to what Delmonte72 and Noble93 have called "transcendence," the experience of going beyond one's habitual perceptions or conceptions of self and world, culminating in peak experiences such as samadhi, satori, or enlightenment.
According to Noble83-summarizing the views of James94-such powerful thrusts into higher consciousness are characterized by ineffability (i.e., cannot be described accurately in words); a "noetic" quality of heightened clarity and understanding of reality; transiency; passivity; perception of the unity and interconnectedness of existence; and positive affect. Noble writes that spiritual disciplines like meditation have as their primary objective an openness to, and preparation for, the experience of transcendence. While such experiences may cause disruption of personal equilibrium in their aftermath (e.g., periods of withdrawal, isolation, confusion, self-doubt), Noble also notes evidence suggesting that, "Transcendence is significantly more productive of psychological health than pathology."
Noble reviews studies showing that subjects who have had peak experiences are less authoritarian and dogmatic, and more assertive, imaginative, self-sufficient, and relaxed.95 Wuthnow96 showed that peak experiences were positively associated with "introspective, self-aware, and self-assured personalities" (p.73) and with a greater sense of meaningfulness and purposefulness in life. Other studies97 have shown that people having intense spiritual experiences are more likely to report a high level of psychological well-being. Noble also reviews evidence suggesting that
[T]he tendency to report such experience increased significantly with overall gain in psychological maturity scores. This finding is consistent with Hood's98 suggestion that "only a strong ego can be relinquished non-pathologically" (Hood, p.69) and that to have a transcendent experience, one must have developed the requisite psychological strength to withstand it. Clearly, transcendence can present percipients with a total existential shift in which their experience of self and of the world, their orientation in space and time, their emotional attitudes and cognitive styles, and perhaps even their entire personalities undergo a profound change.93
Noble's findings suggest
that a further reason to use meditation in psychotherapy is to precipitate such
experiences of transcendence, and the "existential shifts" that these
Deikman16 has also noted that meditation produces major alterations in perception of personal identity or definition of the self. He emphasizes the value of meditation as a means of realizing the transiency of all mind content, and bringing about a decreased preoccupation with one's personal problems and suffering (p.142). Parry and Jones99 write that meditation facilitates the recognition that "belief in the reality of a separate self, rather than enhancing well-being, actually leads to suffering" (p.177). Walley100 writes that meditation practice provides an antidote to "self-grasping" and "the self-cherishing attitude" which, according to Buddhist teachings, cloud the inherent purity, warmth, openess, and intelligence that are the qualities of our natural state of mind (p.196).
These writers suggest that meditation may offer a fundamentally different approach to mental health than that used by most psychotherapists. Whereas therapy traditionally focuses on the individual's problems and attempts to construct a more healthy self-image, a meditatively informed therapy would promote realization of the transiency and insubstantiality of all identity constructs as well as the cultivation of equanimity, compassion, and friendliness toward oneself and others5 (p.49). The extent to which such realizations of "no-self" and consequent turning of attention away from the problems of the personal self is in line with the goals of psychotherapy, and exactly how these would affect the course and outcome of psychotherapy remains to be determined through further empirical and phenomenological studies.
Meditation is a multidimensional phenomenon that may be useful in a clinical setting in a variety of ways. First, meditation is associated with states of physiological relaxation that can be utilized to alleviate stress, anxiety, and other physical symptoms. Secondly, meditation brings about cognitive shifts that can be applied to behavioral self-observation and management, and to understanding limiting or self-destructive cognitive patterns.
Meditation may also permit deepened access to the unconscious. However, meditation by itself may not be an effective means of reflecting upon and giving meaning to the previously submerged material that may come to consciousness. Here the interpretive schemas developed by psychoanalytic, Jungian, and other psychodynamic theorists may prove more useful. Conversely, meditation techniques like Vipassana focus attention on the manner in which unconscious conflicts are being processed and recreated in the mind on a moment-to-moment basis. Thus, vipassana offers the possibility of not just understanding such conflicts conceptually, but of actually penetrating and gradually dismantling them through meditative insight.
I have noted the importance of assessing the developmental stage of the individual before prescribing meditation as an adjunct to therapy, and in choosing an appropriate method. While some, such as Engler, argue that meditation may intensify prior deficits in self-structure in ways that may be deleterious, others, e.g., Epstein, contend that meditation can actually help resolve structural personality disorders commonly treated by therapists.
Our discussion has suggested that meditation may offer the possibility of development beyond what most therapy can offer, but proceeds more effectively when certain egoic issues such as self-esteem, livelihood, and intimacy and sexuality have been at least to some extent resolved.10,16,84 Therapy may be a more effective means of developing ego strength and exploring unconscious conflicts, relationships issues, and so forth, especially when a preoccupation with these concerns is a cause of sufficient anxiety that focused meditation may not be possible.26,90 Here Bacher's23 contention that a sequential approach to the use of meditation in therapy may be most fitting appears to be supported.
I believe that meditation can make a significant contribution to the deep transformation of personality sought in psychotherapy. Nevertheless, Western therapists will need to experiment to learn how these methods can be most useful to them. For the therapeutic effects of different meditation techniques may vary greatly. Concentration methods may allow the patient to feel inner balance, calm, and a ground of being that transcends the continuous flux of thoughts and emotions, and that inspires confidence. Vipassana meditation may promote transformative insight into maladaptive patterns of mental and emotional activity. But all of these methods have the capacity, as Deatherage suggested, to help make the patient more self-reliant and less preoccupied with transference to the therapist. Meditation can in some cases be useful in promoting social adjustment, behavioral change, ego development, and so forth by generating a mindfulness and inner peace that leads to greater efficiency in work, openness to feelings, and satisfaction in daily life. Moreover, meditation can enable the patient to view emotions with dispassion, acceptance, and loving kindness, to transmute neurosis into a spiritual path, and to taste an inner freedom "beyond any identity structure" (101). I think that the use of meditation mainly makes sense in a therapy that deliberately understands itself as contemplative or transpersonal; for meditation's ultimate goal is to evoke the higher potentials of consciousness, and experiences of a spaciousness beyond the cognitive structures and constructs of the self that conventional psychotherapy seeks merely to modify.
This essay has explored research to date concerning the efficacy of introducing meditation into the therapeutic setting. I have presented the views of proponents and critics of the relaxation model of meditation and of theories describing the cognitive changes brought about by meditation-for example, Deikman's theory of the deautomatization of consciousness and Delmonte's view that meditation may be utilized to bring about "ascendence," "descendence," and "transcendence." After summarizing psychoanalytic and Jungian arguments against meditation, the writings of several transpersonal psychologists have been cited to demonstrate the differences in how psychotherapy and meditative disciplines conceptualize personal identity, work with unconscious material, and view the experience of emptiness.
I conclude that the question of whether meditation should be used in therapy can be answered only by considering what therapeutic goals are being sought in a particular instance and whether or not meditation can reasonably be expected to facilitate achievement of those goals. Meditation may, in some cases, be compatible with, and effective in promoting the aims of psychotherapy-for example, cognitive and behavioral change, or access to the deep regions of the personal unconscious. In other cases, it may be strongly contraindicated, especially when the therapeutic goal is to strengthen ego boundaries, release powerful emotions, or work through complex relational dynamics, ends which may be more effectively reached through standard psychotherapeutic methods than through meditation. Meditation may be of great value, however, through its capacity to awaken altered states of consciousness that may profoundly reorient an individual's identity, emotional attitude, and sense of wellbeing and purpose in life.
The author would like to acknowledge the assistance of Donald Rothberg, Ph.D.
in the preparation of this article.
For more information about the work of Greg Bogart, Ph.D.
Visit the web site: pweb.jps.net/~gbogart/index.html