This article on the interplay between meditation and psychotherapy was published in the Summer 2017 edition of Buddhadharma magazine. You can also read it here at Lion's Roar.
What Meditation Can't Cure
by Debra Flics
Many Westerners, when they come to dharma practice, come looking for psychological healing--but this is not what meditation was designed to do. As meditation has become mainstream, it has been marketed as a way to address physical and emotional ailments as well as a way to improve performance at work, reduce stress, and rewire the brain. I've been a psychotherapist for nearly twenty-five years, working with meditators and non-meditators alike; I have also taught meditation in the Theravada tradition to students who could clearly benefit from therapy. I've see firsthand the benefit of combining the two. I've also seen the pitfalls of thinking that meditation can resolve early psychological wounds--as powerful as meditation is, that kind of healing is not its purview. For that, we have psychotherapy. And when psychotherapy is undertaken in tandem with a meditation practice, it can be a powerful mix.
In a 1989 article titled "Even the Best Meditators Have Old Wounds to Heal," Jack Kornfield wrote, "For most people, meditation practice doesn't do it all." At best, it's one important piece of a complex path of opening and awakening." Back then, the idea that meditation cannot resolve all psychological difficulty was discounted in meditation circles. But with more research and anecdotal evidence, it has gained wider and wider acceptance. By 2009, in a Buddhadharma article titled "Medicate or Meditate?" Roger Walsh, Robin Bitner, Bruce Victor, and Lorena Hillman wrote, "It seems clear that the question of whether meditation and psychotherapy can enhance one another has been decided: many people benefit from combining them, and this has been observed by clinicians and demonstrated by research. When old traumas, pains, and patterns recycle endlessly, or make spiritual practice seem overwhelming and hopeless, the best answer may not be simply the classic one of more practice. Instead, psychotherapy may be called for."
I practice contemporary psychoanalysis, which means that when I work with a client, we aim to deeply transform faulty emotional patterning that was formed in childhood. As this is done, I also reflect and encourage the client's authentic self-expression. For example, someone may have learned early on that it is dangerous to get mad, as it could jeopardize a parent's love. This may leave him in a situation where he is taken advantage of because he does not have access to his legitimate anger. In therapy, we would not only discover the cause of the difficulty with anger but also encourage the practicing of it, especially at times when the client might be angry with me. By my staying steady and accepting his feeling, the client gains a living experience of being able to be angry with someone who does not retaliate or withdraw, who accepts his concerns. These types of exchanges assist the client in developing a healthy, authentic, and vital sense of self.
This aspect of psychological development was not necessary for the Buddha, and the healing of these types of wounds was not included in the Buddha's prescription to end suffering.
As the popular story of the Buddha tells us, Siddhartha's father shielded him from the sufferings of the world by keeping him behind the palace walls. This worked until he was twenty-nine and became curious about what was going on outside. Four times he embarked on a journey with his charioteer. In three of these journeys, he encountered someone--a very old person, a very sick person, and a corpse--who lifted the veil from his eyes, and he realized the inescapable fact of existential suffering. On his fourth outing, Siddhartha encountered an ascetic, one who had renounced the material world in order to live the holy life and be freed from suffering. This last encounter pointed the Buddha-to-be in the direction he would take to achieve final liberation.
Unlike many of us, Siddhartha was raised with absolute care, safety, love, respect, nurturance, and admiration. Although his mother died shortly after he was born, which perhaps made him more sensitive to existential suffering when he was exposed to it as an adult, he had developed what is called a secure attachment with his aunt, meaning he had safely bonded to his caregiver. According to developmental psychology, this attachment is necessary in order for a child to grow into an adult with a healthy and stable sense of self.
Siddhartha emerged from his childhood strong and confident--so much so that he was able to respond to the appearance of the four divine messengers and take immediate action. After his initial shock, he did not become overwhelmed or dissociated; he did not go into denial. He was determined and set upon a course of action to be free. In short, he was psychologically whole.
Siddhartha's quest was not a struggle to develop a sense of self within conventional reality. We can now see that his quest was in fact meant to move his consciousness beyond conventional reality, to overcome existential suffering by realizing the deathless. The practices that he left for us reflect his ultimate goal. We can see his strong and healthy sense of self when he was able to listen to his own internal promptings, leave everything that he had known and move ahead without doubt. We can also see it later on in his journey when, after spending a number of years with yogis who were engaged in the practice of austerities, he realized practices such as fasting and self-flagellation were not going to solve the problem of old age, sickness, and death, and he went his own way once again. All along his journey, the Buddha had his low moments but did not give up. He did not become depressed, anxious, withdrawn, traumatized, or codependent. His sense of self was clearly healthy and intact.
When I practice psychotherapy, I encounter people who have been exposed to suffering very early in life--before their minds can comprehend what is happening, when their bodies are still growing and vulnerable, and at a time when, for their optimal physical, emotional and psychological development, they should be shielded from suffering. They may have experienced challenging family dynamics that include abuse, emotional neglect, and lack of nurturance. They may have parents who themselves were not parented and turn to their children to meet their emotional needs. Beyond the family, the culture itself presents us with violence, trauma, and systemic racism. Many people are far outside the palace walls.
Children raised in this way may be unable to hear, let alone follow, their inner guidance, and be unable to act from love and wisdom. This can develop further into addictions, depression, anxiety, post-traumatic stress disorder, and other ailments. So many of us in Western culture wonder who we are, how we fit in, and what our purpose is; we struggle with a negative sense of self as we try to manage the impact of difficult early experiences. In short, we arrive at the doorway of spiritual practice with a very different emotional and psychological landscape than that of the Buddha-to-be. When we begin practice, we are struggling to overcome personal suffering that prevents us from fully living within the relative, not yet at the point of grappling with existential suffering in order to realize the absolute.
Is meditation helpful for us then? If it can't fully heal psychological suffering, does it offer us anything positive? Does it have any healing aspects? The answer is a definite yes. Even if the Buddha did not come to meditation to heal, meditation does offer some respite from psychological afflictions.
When we meditate and develop our concentration through awareness of the breath, it frees us, even if only temporarily, from the thoughts and feelings that have been bombarding us. For some of us, it may be the first time we see that we are not what our thoughts say about us. We see that thoughts arise unbidden, are conditioned by family, teachers, and culture, and do not require us to identify with them. We come to see that we don't have to be taken away by every thought form and state of mind; we learn that we can make choices in the service of our well-being. We see the mental ride that we are about to take, and we ask ourselves if it is a ride worth taking. As we begin to act from awareness rather than identification with thought, we behave more skillfully toward ourselves and others. We learn ways to take care of ourselves, develop compassion, and practice with love.
During longer periods of retreat and silence, the difficult psychological states that have been buried in our psyches may rise to the surface in order to be felt, witnessed, and released. As the practice deepens, meditation allows us to move beyond discursive thought and to feel these experiences directly. In these instances, we are freed from old paradigms and ways of feeling about ourselves. This directly overlaps with what can happen in a good therapeutic relationship.
However, we may leave the silence and stillness of retreat and once again find it difficult to concentrate and access deeper levels of patterning. There are clear reasons for this. Traditionally, difficulty concentrating has been attributed to the five hindrances--greed, aversion, sloth and torpor, restlessness, and doubt--all states of mind that prohibit deeper states of concentration. For some people, these mind states may be composed of those early psychological wounds that we are carrying with us. For example, what a meditation teacher may call aversion, a psychotherapist may see as self-hatred. What a meditation teacher may see as sloth, a psychotherapist may recognize as depression. What a meditation teacher may see as restlessness, a psychotherapist may see as anxiety or PTSD. Because these mind states may be composed of very difficult, even traumatic, experiences that occurred before we were developmentally able to contend with them, just naming them as hindrances and feeling their energetic components is often not enough.
A psychotherapist would see the problem of not being able to access deeper patterning not as a problem in establishing concentration but instead as psychological defenses. Defenses are just what they sound like--they defend the self from experiencing painful and often overwhelming feelings and memories. Defenses are unconscious; they happen automatically and without our consent. We may experience a sour mood, a feeling of emptiness, difficult behavioral patterns, a lack of clarity, anxiety, depression, phobias, and more--all without knowing the experiences, beliefs, and feelings that lie at the root of these mind states. Conversely, if the defenses break down, we can find ourselves flooded by painful emotions and sometimes unable to function.
Rather than seeing these mind states as hindrances to deeper concentration, a psychotherapist would see them as experiences that are crying out to be healed; in the safe, confidential space of the relationship between therapist and client, then, the approach would be to explore these experiences. The defenses are seen as a starting point. In a shared exploration, the therapist points out and interprets the defenses so they gradually lose their hold. As trust is built, the material that lies beyond the defenses can emerge and be processed. In optimal circumstances, the difficult emotions and experiences that have previously been unconscious emerge slowly and safely so the client can integrate them without becoming overwhelmed. As these patterns unravel, the psychotherapist not only lends emotional support and encouragement but also serves as a new model of how to respond to difficulty.
Here's an example of how a psychotherapist might help transform psychological pattering. When a client begins to feel vulnerable, she may hear a harsh voice inside calling herself stupid or weak. With exploration, we may discover that that voice is exactly how the parent treated the client when she was a vulnerable child. That voice maintains the status quo; it keeps the vulnerable feelings at bay. The client calls herself weak or needy and tries to beat back these feelings with harshness and self-blame. But the harsh voice is serving a protective function, as the vulnerable feelings would have overwhelmed the child without a soothing parent to help her with them. The psychotherapist interprets the defensive nature of this harsh voice and points out that it no longer serves the client to suppress her vulnerable feelings. The vulnerable child can be invited to express herself, and the psychotherapist can respond with care and compassion. Instead of the model of harshness that was taken in from the parent, a new accepting stance is taken in, and the client learns how to treat herself with kindness.
In this way, a secure attachment is formed to the therapist. This is what Siddhartha already possessed when he began his quest for freedom; it is essential for the development of a healthy sense of self. When this does not occur in childhood, it leaves us lacking. Where do adults go to meet unmet dependency needs, needs for mirroring of their authentic selves, encouragement of their true strivings, safety, and empathy? Where can adults to to finally grow up?
Psychotherapy conducted from a developmental perspective--meaning therapy that takes into account the need for a secure attachment composed of safety, empathy, mirroring, nurturance of the client's authentic strivings and the deleterious effects of this not being offered in an optimal way during childhood--offers a developmental re-do. Clinicians will encourage and support the development of clients' deepest yearnings, their true interests, and the expression of their gifts. As they are expressed and find an outlet in the world, these aspects of self that were frozen in childhood begin to grow again. Developmentally attuned psychotherapy, therefore, is not just a working through of old patterns and belief systems but also a second chance at becoming the true and authentic person that we were meant to be. The inner child that we've all heard so much about does not have to remain a child, frozen in time forever. With commitment and resolve, the client can become an emotionally mature adult. For all of its power, this is something that a solitary meditation practice cannot provide.
Meditation can, however, support the therapeutic process. As painful thoughts and feelings emerge in treatment, a meditator will initially be more likely than a non-meditator to understand that thoughts and feelings are internal phenomena that do not have to be acted on. This is a crucial step in ending problematic behavior and growing in consciousness. This skill, in combination with the internalization of the psychotherapist's caring presence, can deeply change the way that a person responds to thoughts and relationships. Also, understanding and deeply seeing the impermanence of mental phenomena can allow a meditator in therapy to experience distressing thoughts and emotions with less fear and a growing trust that they will pass. Awareness is strengthened in meditation to the point where we have watched mind states come and go; we are less likely to resist their arising as we know that this will delay their passing. Not only that, but when we understand the selfless and conditioned nature of phenomena, it fosters the awareness that thoughts can be emotionally true without being concretely true--a crucial distinction for inner work. There is a great deal of difference between believing that I am a terrible person and understanding that I feel like a terrible person because of how I was treated in the past.
As meditators, we understand in a deep way that the discursive mind is conditioned and not who we are in our essence. We become more sensitive and can feel the energetic difference between the chattering mind and the internal voice of wisdom. We know that we have buddhanature--a powerful internal guidance system, beyond the thinking mind, that points us toward wisdom and love.
Having opened to and healed many of our wounds in psychotherapy, we no longer use our defenses to shield us from our pain; without this armor against suffering, we become more responsive to the world around us. Now when we meditate, we see more clearly. We go deeper. We have internalized the psychotherapist's compassionate presence in the face of our own suffering, and as a result, we can better express compassion toward ourselves and others. We have matured. We are less caught in our own fear and pain and able to turn toward the suffering of others with an open heart. We are more of a clear channel for our inner guidance; like the Buddha, we can follow the inner promptings of our life journey and potential.
With our karmic patterns modified and transformed, our spiritual practice deepens. Having studied the self, we forget the self and can see the world through a less personal lens. We can move deeper in our meditation practice, and, like the Buddha on his outings from the palace, experience the truths of old age, sickness, and death. We experience insights into the three characteristics: suffering, impermanence, and selflessness. We recognize the folly of relying on the conditioned realm to bring lasting happiness and satisfaction. At the same time, we deepen our commitment to develop the heart, to refrain from bringing any more suffering to our self and others, and to cultivate compassion for all beings.
Like the Buddha, we may then be inspired to move even further, to leave our preoccupation with the familiar self and find what lasts beyond the conditioned realm. We may ask what is true beyond the sufferings and desires of the personal self, beyond our history and circumstance, beyond life and death. Less saddled with the baggage of personal suffering, we go forth.