A role of Buddhism in Postmodern Psychotherapy
Buddhism liberates, offers a glimpse into the absolute, a sense of transcendence in the realization of fundamental emptiness, realization of the emptiness of the present moment, the emptiness of existence and mind, psychotherapy gives one skills to unlock the mind, to diagnose the symptoms, unearth their causes and to heal them.
Buddhism's "suffering" (duhkha) manifests itself as psychological, or psychiatric "dis-ease", or symptoms, symptoms which are individual, private, mine, yours, even if the same ones in many, if not all of us.
Life is full of suffering because of a fundamental lack, not only a perception of a lack, but the actual lack of our absence.
If the absence is lacking, then there is suffering. Of course there are moments of great joy, love, ecstasy, in fact there is the entire spectrum of human emotions arising from just being alive and human, but the lack of your absence - which is nothing but your life - is the source of your suffering. Our very existence originates from the lack of absence, so there is that actual experience of not being absent, of the lack, of not not-being there, and that lack, life itself, is causing suffering.
That fundamental suffering manifests itself as psychiatric and psychological symptoms so well described in the DSM system of psychopathology. Depression, suicide, panic attacks, anxiety, perversions, addictions, violence, psychosis, hundreds of other. They are real, they exist, we all do suffer in some way. And that suffering and symptoms is where Buddhism and psychotherapy meet. They both address the same aspect of life and being. One might say, that therapy then moves on to devise a system of healing, systems of alleviating of the suffering, of reducing, decreasing, eliminating or controlling the symptoms. Hundreds of systems have evolved to do just that - the major ones being psychoanalysis and psychoanalytic/psychodynamic therapy, cognitive behavior therapy, and psychopharmacology.
Buddhism and postmodern psychotherapy are similar to the extent they both attempt to understand the Mind and find a way to alleviate human suffering.
In Buddhism, the essence of the Mind (sunyata) and the ubiquity of suffering (duhkha) are, arguably, best described by the Mahayana doctrines of Emptiness and Interdependent Origination and by the Four Noble Truths, while the Eightfold Path (sila, samadhi, prajna) charts the general path towards personal liberation (Nirvana, Enlightenment).
Correspondingly, postmodern psychotherapy combines cognitive psychology and psychoanalytic theory to describe how minds work and borrows from the DSM system of classification of psychiatric symptoms to catalogue diverse manifestations of individual suffering (anxiety, depression, psychosis, personality disorders, etc.)
Duhkha, the first of the Four Noble Truths and the Buddhist term for any form of dis-ease, pain and suffering corresponds to the inherent conflictedness of our lives and the inescapable presence of psychological symptoms addressed in any psychotherapy.
To understand the potential role of Buddhism in postmodern psychotherapy on has to understand why people suffer.
And we do not mean the physical pain, although, it may actually be involved, we really mean the psychological pain, despair, anguish, anxiety, depression, psychosis, alienation, self-destructive behavior, aggression, suicide, etc. There are many ways in which people suffer, and the pain takes on infinite and infinitely subtle manifestations so well depicted in art and so often seen in clinical practice. But is suffering limited to people only? Everybody would agree that all animals experience physical pain, but how about the "mental" pain -depression, loss, anxiety? And what about other forms of life? Is suffering contingent on having a mind? Consciousness? Self? Do plants and trees suffer? And how about inanimate object? Can we imagine a river or a mountain suffering? Do industrial or human waste dumped into delicately balanced ecosystems of our land creates a form of suffering? If it destroys life and living organisms, pollutes water and soil, poisons and sickens people who live there - does it create some sort of universal suffering?
What are the boundaries of suffering - when her child is in pain, the mother suffers, somehow child's and mother's pain are connected or maybe even really just being one, even if we can't see it as long as we function within the more narrow sense of our individuality restricted to inside of our skin? Do we suffer when others suffers? And what empathy really is? Is it resonating with the other or is it experiencing the same state, emotional, physical or psychological?
And what about a farmer, a rancher who can't sleep at night when his land or his cattle is destroyed by a natural or man made disaster? Individual pain is never just individual, it transcends, it permeates all those who are sensitive enough to experience it.
Buddhism asserts that all duhkha results from some form of desire, including the desire for existence and the desire for non-existence. Similarily, postmodern theory places psychological symptoms in the realm of Desire and Lack (wish, instinct, drive, motive, need, deficit, deprivation, etc.), fundamental precursors of any individual self, identity and behavior.
Buddhism does not elaborate on the "how" of how symptoms develop, why depression and not anxiety, why obsessive rituals and not panic attacks. In Buddhism, all suffering is one suffering, the suffering of the Universe. And the Buddhist Eightfold Path is presented as a way out. Right understanding, right speech, right action, right life - what on the surface of it appears a uniform prescription for all, is, in its actual implementation, completely individualized. It is always, ultimately, my right speech, my right understanding, my action, my suffering, my life, and this is where psychotherapy and Buddhism overlap. It is a person attempting to change him/herself and anything that pertains to changing mind, speech or behavior is, by definition, a realm of psychology. The same thing looked at from two different perspectives.
Not only two perspectives but two different methods. And it is the methods where Buddhism and psychotherapy begin to diverge. Psychotherapy is codified in the psychoanalytic and the cognitive paradigms, psychopharmacology, inpatient crisis interventions, the entire "mental health" industry as we know it. Buddhism is different, with its meditation at the core, teacher / student matrix of interactions, its monasticism, Sangha, precepts, vows, mind-to-mind-transmission, Buddhism approaches a person completely differently.
And there is the outcome, the end, or is there? What is the prescriptive outcome of Buddhist practice? The art of happiness? Compassion? Boddhisatva's realized and actualized enlightenment? And what is the outcome of psychotherapy? At bare minimum, alleviation of symptoms, a lack of diagnosable mental disorder. Happiness? Health? Adjustment? Insight? Freud's "ability to play, work and love"?
It is easy to see that there are similarities and differences here. Capacity for happiness and insight overlap for Buddhism and psychotherapy, enlightenment is clearly not even addressed in therapy, usually relegated, and rightly so, to the realm of religion. But what is "enlightenment" in Buddhism? Maybe it exists in psychology under different names? Mystical experience, peak experience? "Flow" in the "zone"? From James and Maslow to contemporary post- modernists, there has always been a great interest in the transcendental in psychology. Freud and Jung grappled with it. Is compassion similar to empathy? Altruism? What is health, happiness, compassion?
This area needs more clarification of those basic terms to sort through it, but just looking at it, it appears that even in the outcome, there are great similarities, or at least similar concepts which may, or may not, actually denote similar realities.
So, in summary, it looks that in Buddhism and psychotherapy the nature of "the problem" is similar - suffering manifesting itself in psychological and psychiatric symptoms. The solutions are very different - psychotherapy vs. Buddhist practice; the outcomes may actually be more similar than not when the terminology and concepts are clarified.
And, fundamentally, there is only one soul, one mind, to treat and to save. Some say that we do not need to divide it into different conceptual fields of practice and treatment. There is only one person in front of a therapist or a Buddhist teacher. A person who seems to need some sort of help or liberation. So when we sit in front of each other, it is yet another Mysterium of a healing dialogue, because, somehow, words heal your suffering and my alienation from you. And, as we talk, as you reveal yourself even more to me, I don't know if I am being Buddhist or just therapeutic. Actually, I forget myself in your story. What is psychotherapy anyway? Somehow people have realized that speaking heals, brings things out, to focus, focus of the mind, two minds. You and me, leaning over your illness, your pain, touching it with words, touching it with attention, feelings and our imagination, ourselves touched, as we discover the new and the old buried under the skin of our minds.
Your words flow, language flows, and we change the direction, telling, retelling, listening, hearing, till the pain dissolves. Even if life does not have a rewind button, we can change the past in the present of our dialogue. Living without a possibility of return is living in the Real, but there can also be the Imaginary transformed by the Symbolic ..
And there is the lack, the lack of absence, the lack of emptiness, your life, and there is the emptiness of the lack .a possibility for healing and liberation.
.....only the Mind itself can end the endless chain of suffering karma....
The inter-subjective of one's "dis-ease" can be transformed in at least one of the following four ways:
" direct intervention in the neurochemical functioning of the brain e.g. psychotropic medications, mind-altering substances, nutrition, foods
" indirect intervention in the functioning of the nervous system, e.g. meditation, yoga, sports, sex, socialization, changes in life style
" direct change of the external context - any action / behavior altering one's actual life situation / life style, e.g. initiating or ending a relationship, job change, geographical re-location, resolution / removal of actual stressors
" direct transformation of the subjective experience via psychotherapy (insight, re-framing, new understanding, new knowledge, working through, etc)
" The purpose of the initial consultation is to articulate the reason(s) for the visit and to formulate it in the language of postmodern psychotherapy.
" A full initial psychodynamic formulation and a complete DSM-IV-TR diagnosis are usually arrived at and discussed within the first 1-3 visits.
" Additional tests and consults are often suggested to clarify the diagnosis.
" The use of medications is discussed and recommended if indicated.
" Treatment options and fees are discussed and the decision whether to enter a treatment contract is made.
" All necessary referrals are made to assure continuity of care.
" Individual psychotherapy sessions 1 - 5 times per week, 50 min or longer, if needed.
" Individual study - a list of selected books, articles, films, poetry, art work and music are assigned for individual study. Online resources are made available.
" Mindfulness training - Buddhist meditation is encouraged, 30 - 60 min daily. Work with a Buddhist meditation teacher is strongly recommended. Meditation instruction in all major Buddhist traditions and ongoing support are provided.
" Group psychotherapy - recommended, if indicated.
" Individual assignments - activities, research and other tasks may be prescribed based on the ongoing psychodynamic formulation.
" All treatment is provided by a Licensed Ph.D. Psychologist or a Board Certified Psychiatrist
" Treatment may be completed within a few sessions or remain open-ended, as needed.