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04 22nd, 2010| 
BUDDHIST PSYCHOTHERAPY AND COUNSELLING
[Peter Eastman]
[This study has been modelled on the chapter format in
Corsini & Wedding CURRENT PSYCHOTHERAPIES [various editions] and
Prochaska & Norcross SYSTEMS OF PSYCHOTHERAPY: A Transtheoretical Analysis [various editions]. This is a work in progress, and several sections have yet to be completed, let alone carefully edited. Reading lists and references to follow.
Criticism and comments [email] greatly appreciated.]
Overview
Buddhist psychotherapy – as a preliminary step to Buddhist counselling – is entirely focussed on the issue of ultimate human fulfilment. It seeks first to clarify how best to identify this fulfilment, and then how best to set about achieving it. This has nothing to do with worldly success, whether financial or social, because Buddhism views ultimate fulfilment as a metaphysical issue, and never as a matter of wealth, fame, or status. More surprisingly, perhaps, Buddhist psychotherapy is not much concerned with achieving happiness either; at least, not happiness as it is normally understood, and pursued.
Psychotherapy is, to a greater or lesser degree, beholden to the medical model of psychology. As the old joke would have it, the clue is in the name: certain mental states are labelled as pathological, and this means they call for therapy, or some sort of medical cure. Psychotherapy is not about the search for insight, it is about the curing of illness.
As a philosophical approach to life, Buddhism is not blind to psychological distress. It does not seek to pretend that certain states of mind do not exist, or to deny that certain psychological responses can be overwhelming. Psychological distress – whatever the cause – is an everyday fact, plain for all to see. But where Buddhism departs from both the medical model of psychological health – and the popular conception of happiness as the greatest good – is that it does not accord the psyche ultimate worth, and it looks to re-evaluate our whole approach to psychological well-being. Buddhism seeks to bring about, through greater understanding, a different perspective on life. And it hopes that, in reaching a new perspective, a good number of psychological problems will resolve themselves along the way.
Basic concepts & assumptions
Buddhist psychotherapy is basically a coming together of the idea of western psychotherapy, and a Buddhist philosophical perspective. This has not been a straightforward process, and in many instances the marriage of the two traditions has been deeply disappointing, owing to the pervasiveness of New Age thinking, and the almost complete absence of competent Buddhist missionaries. As found in popular culture, Buddhist psychotherapy consists of faddist techniques and practices which rely either on the channelling of hypothesized forces, or on the cultivation of artificial states of mind; and the intellectual context in which all this takes place is simple-minded, reverential, and quite demeaning. It amounts to the reintroduction, by the backdoor, of witchdoctery and shamanism, and it goes against the principles of clear thinking and scientific commonsense. This is not to disparage magic and mystification out of hand, because everything has its place, but simply to say that the forms of New Age Buddhist psychotherapy currently being promoted in popular culture have no connection to the kind of theoretical framework being outlined here.
Buddhism begins with a quest. It is an inner, metaphysical search to find out the ultimate meaning and purpose of the human condition. It is not a religion, or a system of beliefs, or a practice. It is simply an approach to the ultimate problems of life and existence. The Buddha himself made this abundantly clear, as did a number of important Buddhist teachers, especially in the Chan and Zen traditions. The idea was that each and every person should struggle to discover, for themselves, by themselves, and without recourse to faith, belief or tradition, exactly what the situation was, in clear sight, with regard to their own ultimate being. There should be no intermediaries, and no outside interference. The quest should be a radical self-searching, as if one were the only person alive in the universe, with no-one to turn to. Nothing should come between the seeker and the naked facts of their existence.
Psychotherapy has emerged out of modern western scientific thinking, and it very much reflects a materialist and secularist worldview as to human destiny. It pictures the human being as no more than an advanced animal, subject to somewhat mysterious but ultimately rather primitive psychological forces. If we exclude psychotherapies that have an expressly religious bias, all other psychotherapies subscribe to the belief that the here-and-now is all there is, and that the world as we know it is the only destination worth considering, and that happiness, pleasure and well-being are the legitimate, as well as the ultimate, goals of human striving. In this view, psychological distress is undesirable, and is of limited value, and ought therefore to be eliminated. Psychotherapy strives to return the distressed individual back into ordinary life, where they can take up the search for happiness, alongside their fellows. Some psychotherapeutic systems treat patients as mere pieces of machinery, to be dealt with by specific technique; with others are less reductive, and rely on gentler forms of persuasion.
Of course Buddhism accepts the reality of psychological distress, and of course it also wishes to return the individual to some kind of functioning normality, but it does not accept the currently prevailing narrative of the human condition. Buddhism seeks somehow to engender, in the individual, a spirit of inquiry, not only about their immediate condition, and their psychological makeup, but also about their ultimate metaphysical destiny, and their meaning and purpose as incarnate beings. And it hopes that, in doing so, the individual will come to see that, in a quest for greater understanding and insight, psychological distress is not only valuable, it is also essential. Such a perspective has nothing to do with masochism, or stoicism, or any kind of bizarre delight in suffering for its own sake; it is instead a simple recognition of the need for negativity for any meaningful psychological environment. And it is this unique perspective which is the distinctive contribution Buddhism is able to make to psychotherapeutic practice.
Other systems
Buddhist psychotherapy differs markedly from other systems in that its objective is to increase psychological and metaphysical understanding, not simply to relieve distress. At its furthest point, Buddhism itself aims at complete and final metaphysical enlightenment, but this is an incredibly lofty goal, and no one should waste too much time speculating what kind of an experience it could be. It is the holy grail of the Buddhist quest, the elusive endpoint to which everyone should aspire, but it is the questing journey which is important, not imaginings about features of the destination. In a very real way, enlightenment can be treated as a mere hypothesis, or perhaps even as a helpful fiction, designed to push you forward into the realms of metaphysical investigation. Buddhists can afford to be casual about their ultimate goal, because whether or not such a state can be attained doesn’t change anything about the questing journey itself, and the importance of metaphysical investigation as a means of advancing one’s understanding.
In terms of simple practice, Buddhist psychotherapy would begin by creating a context which would share many of the features of person-centred therapy. Concepts such as congruence, unconditional positive regard, and empathy are key to the basic Buddhist psychotherapeutic encounter, in that the therapist wants the client to understand that they are being fully accepted, and fully appreciated, as the human beings that they are, whatever their past, and whatever their future. More than any of the other ‘talking cures’, person-centred therapy has done sterling work in laying bare the conditions necessary for the initial therapist-client encounter, as well as guidance as to how to open dialogue.
But as soon as the therapist-client dialogue has moved beyond introductory phrases and become a substantial discussion, and a meeting of minds has been established, Buddhist psychotherapy parts company with other psychotherapies. The topic under scrutiny may well be the distress that the client is going through, but the analysis is concerned not with simply alleviating that distress, but rather with gaining an insight into the client’s personality as a whole; their motivation, their likes and dislikes, their history, their vision of themselves. Psychoanalytic notions of the unconscious are relevant here, especially insofar as there is a discrepancy between illusion and reality, and while Buddhism would dispute Freudian and Jungian notions as to the specific character and content of the unconscious, it has much to learn from their descriptions of the dynamics of unconscious motivation, hidden conflicts, repressed emotions, and the like. In other words, Buddhism accepts the form, while rejecting aspects of the content.
It many cases, Buddhist psychotherapy is prepared to adopt key concepts of various schools of psychotherapy, insofar as they identify and describe important features of human life. This may seem mercenary or parasitic, but Buddhism takes a flexible approach to psychological narrative, and is always trying to improve on the tools it has at its disposal. Existentialism, for example, is metaphysically deficient, and has nothing to say directly about the quest for metaphysical knowledge, but it offers a powerful and cogent account of the stark choices facing adult human beings in western society. In a therapeutic situation, it would be perfectly valid to characterise mundane decision-making in existential terms, and to have the client view their choices in this way. But it is only the pragmatic use of a certain narrative to illumine a certain situation, because the wider purpose lies elsewhere.
Buddhist psychotherapy rejects, for the most part, those schools of thought which are reductionist, and which deliberately reduce psychotherapy to a matter of technique. This would apply to cognitive and behavioural therapies – and all the variants thereof – as well as to techniques such as hypnotherapy. This criticism has nothing to do with a sentimental attachment to human subjectivity, or with a rejection of the idea of reductionism per se; rather it has to do with the fact that, when analysing a client’s lived world in all its complexity, one is dealing with an existential totality, and not with particulars, either as instances of behaviour, or as patterns of thought. The therapist engages with a client’s lived world with a view to influencing – or changing – the client’s self-narrative in its totality, and not merely in some specific aspect of that totality. It may seem unnecessary to have to spell all this out, but reductionism has been a consistent feature of popular psychology for nearly a century, and has now taken on a recognisable cycle in the public arena: Every few years a new psychotherapeutic technique emerges from one institute or another, is then proclaimed enthusiastically in the media, and is portrayed as representing a whole new approach to dealing with mental problems. Buddhist psychotherapy does not address issues such as correcting bad habits, or improving performance; it is concerned only with what is known as the ‘big picture’, and in viewing that picture from a distinctly philosophical perspective.
HISTORY
Precursors
Buddhist psychotherapy traces its origins – in very general terms – to Buddhism itself. Buddhism started out – in India some 2,500 years ago – as the attempt to formalise a metaphysical quest, but it very quickly turned into a religion, and became a rigid system of beliefs and teachings, instead of an unencumbered and open-ended metaphysical searching. The tension between ossified teachings and the quest for radical self knowledge will doubtless cloud Buddhism for the rest of its days, but Buddhism was never meant to be handicapped by the dead weight of tradition.
As part of their mapping of the mind, many Buddhist philosophers have, over the centuries, produced detailed phenomenological descriptions of human psychology, and the resulting studies form part of Buddhist literature. But they cannot be read as psychotherapeutic documents, because they are directed at a different audience, and their context and frames of reference make them difficult to adapt to modern thinking.
Buddhism has been periodically reinvigorated by teachers who have returned it to its original purpose, and dispensed with any suffocating heritage. This was especially true of the Chan schools of Chinese Buddhism, and certain schools of Japanese Zen, where Buddhism was radicalised, and shorn of as much unnecessary material as possible, and turned into a startling self-questioning. Though unfortunately brief, these flowerings of essential Buddhism have been of immense value in allowing Buddhism to be redefined for a modern audience; and adapted to modern thinking, with its taste for urgency, and directness.
Beginnings
Psychotherapy as a concept is entirely of the modern era. It has its origins in psychoanalysis, at the beginning of the 20th century, but it really only came into its own – as a form of psychological counselling – in the 1950s, with an explosion of new schools, and the idea itself becoming part of the wider public consciousness, first in America, and later in the rest of the western world.
Buddhism, as an eastern teaching, was similarly introduced into popular consciousness over the last century. Although Zen had a brief flowering in the 1950s on the back of the Beat movement, Buddhism has, generally speaking, been unable to compete for public affection with yoga and Hinduism, and is usually understood to be just another eastern cult, albeit one with a somewhat austere, shaven-headed, flavour. This marginalisation of Buddhism is very instructive in its own right, both from the point of a demonstration of the lack of competent Buddhist missionary work, as well as an indication of Buddhism’s poor understanding of itself. It also explains the widespread degradation of Buddhist ideas, and the way they have so easily been turned into items of ubiquitous but specious nonsense. Misunderstandings are frequent, and so many key concepts – emptiness, non-self, experiential immediacy – have simply been hollowed out, and reduced to mere labels, which are then applied to whatever appears to be most appropriate. Buddhism has allowed itself to become a distinctive species of yoga, characterised by its own idiosyncratic vocabulary, yet no more demanding of its adherents than any other Hindu school. Following one school or another basically becomes a matter of personal preference, as the various teachings are so shallow as to be meaningless. Some meditation, some oriental obsequiousness, some book titles, a vocabulary. For their part, Hindu gurus feel free to use Buddhist terminology whenever it suits their purpose, and Buddhist realisations are equated with mystical states.
The degradation of Buddhism in popular culture means that it is important to distinguish between Buddhism as a religious flavour, and Buddhism as a metaphysical quest. Religious Buddhism, as it has been filtered through popular culture, is almost entirely fatuous, and counterproductive, and empty-headed, and would have no credibility at all were it not for the persistent need it fulfils in New Agers. Notions of ‘mindfulness’, and ‘no-self’, and ‘emptiness’ as relevant to therapy are absurd, as these are representations of advanced metaphysical realisation, not everyday concepts waiting to be put to good use. There may be some very limited applicability, for example, for basic meditational techniques to specific cases, but meditation is hardly something you would recommend to someone in distress; commonsense would tell you that it would likely make matters worse. And on the other end of the scale, there are a whole raft of tantric-based body therapies – also surprisingly keen to describe themselves as Buddhist – which dabble with force fields, energy-centres, and different types of psychic power. There is nothing wrong with wanting to research mysterious forces, or to take psychic energy seriously, but there is everything wrong in thinking that occult energies are easily harnessed for psychotherapeutic purposes, or that a certificate from a validated institute somehow proves you can do it. Buddhism ought to be centred on metaphysical realisation, and insight, and advancing the capacity for understanding, not on the channelling magical forces.
Current Status
If we put the New Agery to one side, we are left with Buddhism as a philosophical perspective, and as an open-ended approach to metaphysical inquiry. Other than the application of carefully considered commonsense, Buddhism has nothing revolutionary to offer by way of psychotherapeutic technique; nothing at all. Its strengths lie elsewhere, in putting the individual on to a new path, and into a new outlook; one aimed at moving beyond a life dedicated to superficial pleasure and happiness. If this seems a strange prospect, it is because the western mindset is so wholly fixated on pleasure and happiness that it has lost the flexibility to envisage any other existence.
But if Buddhism has nothing to offer psychotherapy by way of revolutionary technique, it has much to offer by way of insight. Insight has to be nurtured slowly, within a calm and unsensational environment – and entirely dependent upon the active commitment of the client – and then allowed to work its own authentic brand of healing. Anything less than this is not going to work.
As has been outlined above, Buddhist psychotherapy is currently in the grip of New Agery, and at the time of writing, almost all the supposedly distinctively Buddhistic therapies on offer are products of mistaken understanding and poor judgement. They are basically faddish, and insubstantial, and in time will fall by the wayside. As far as this study is concerned, Buddhist psychotherapy has yet to be adequately defined and given content, and the greater part of our task here is to address this problem.
PERSONALITY
Theory of Personality
Personality is the central notion in psychotherapy, because personality is seen as bringing together all the psychological aspects of the individual self, in a single, accessible package. Personality is both the public face of the individual, as well as their psychodynamic totality. In western society, personality has become the furthest level of human development, insofar as popular culture revolves around concepts of likeability and attractiveness, and celebrity – a public endorsement of the two – attracts far more interest than does achievement. Personality is understood to be that aspect of your individuality with which you engage with other people, so it is of the utmost importance that one’s personality is – by consensual standards – fully developed, fully functioning and, in our culture, fully exploitable. This is not the same as being fully congenial, as some celebrities are celebrated for their unashamed selfishness and nastiness.
An excellent example of a personality theory designed for a secular, modernised society, is that outlined by Carl Rogers in his Client-Centered Therapy [1951]. In a nineteen point series of propositions, Rogers presents what amounts to a theory of human psychological evolution, a phenomenology of experience, and an implicit philosophy of life. According to his theory, the individual responds and interacts – with varying degrees of success – with its environment, while attempting to satisfy its needs. Psychological maladjustment occurs when certain experiences are denied adequate integration with the individual self, whereas psychological adjustment occurs when such experiences are integrated at what Rogers describes as a ’symbolic’ level. This is just one psychotherapeutic theory amongst many, but it has the advantage of portraying personality and psychotherapy in curiously flat, secular terms, and with the very minimum of anything resembling colour. Human psychology is presented as a somewhat uncomplicated affair – a series of straightforward challenges – and the whole environment seems more than a little dull. Life is presented as a very uncomplicated process, observable and graspable, and not one which would call for any measure of existential agonising, or soul searching. Psychotherapy becomes simply a matter of a therapist helping the client to resolve particular difficulties, so that the client can be full functional.
Our current popular culture – early 21st century – portrays human life as a series of dazzling public events set against a background of dull but necessary routine. Humans are divided into two categories: celebrities, and the audience. People strive to become celebrities, some on the basis of their talents, others on the basis of their presentability, or on some feature of themselves which will hold public attention for a time. Personality is seen as one’s ability to function as a public figure, whether on a small scale as a good neighbour or, more grandly, as an object of media attention. In this vision, the traditional stages of life, such as education, marriage, family, and work, have no particular meaning if they do not afford one opportunities to present oneself to the public gaze, and no-one much cares about the details, provided the spectacle is sufficiently entertaining. We are living through what may well be the most fantastically superficial era in human history, but no less marvellous for that. It is as if Andy Warhol were in charge of the universe; who knows when the world will ever witness an incredible environment like this again ?
Suffice to say, from an intellectual point of view, we are not living through an era when deep thought counts for much. The ‘life of the mind’ has been reduced to the ‘dynamics of sensation’, and, in the struggle to promote fashionable ideas, many important distinctions have either vanished, or never been fully understood in the first place. And it is against this background that Buddhism is attempting to establish itself as a meaningful undertaking.
As has been mentioned earlier, Buddhist philosophy – as relevant to psychotherapy – does not regard human personality as either the starting point or the endpoint of counselling. It is happy to make use of a Rogerian context for the initial setting, as a way of approaching the client with an open commitment to dialogue, but the process itself is not directed at simply returning the client to the world from which they emerged, even as a better integrated, happier, human being. This would amount to a dereliction of duty. Buddhist psychotherapy is concerned, at least at an intellectual level, to try to find some way in which the individual can respond to the profounder questions of life and existence, to give their life a deeper meaning, and to enable them to be able to begin to appreciate the spiritual realm. This is not the same as treating the client as a potential convert, and using psychotherapy as an evangelical subterfuge, because there is no organisation to join, or merchandise to be sold; this is about assisting the individual on a metaphysical quest for self-knowledge.
In this view, psychological distress – whatever the cause – would be analysed for its diagnostic and illustrative value. It is important to stress that Buddhist psychotherapy can only begin in a more or less ordinary setting, outside the scope of severe mental illness and psychiatry, and situations where the client is under medication, or being treated by some other medical system. Buddhist psychotherapy is not in competition with psychiatry, and it is not applicable to crises and instances of breakdown. It needs relative calm in which to unfold.
Buddhist psychotherapy does not advance a ‘theory of personality’ as such. The reasons for this are complex. To begin with, a phenomenology of the human condition, such as might be found in one of the various Buddhist traditions, is really only useful to someone familiar with both the perspective of that particular tradition, as well as its mindset. In other words, Buddhist phenomenologies cannot be taken out of context, and employed in various disciplines as if they were standard templates. You need to know what the original purpose of the description was, and the precise meanings of the various terms employed. It won’t do simply to lift ideas from one context and apply them to another, because to do so will distort their meaning.
Secondly, Buddhist psychotherapy is not primarily focussed on the psyche, or soul, of the human being, but rather on their existential condition in its totality. Psychological life is not viewed as an end it itself, but rather as one facet of the human condition, albeit a compelling and powerful one. Psychological life is best understood according to its own dictates, and according to its own internal logic; and this in turn means that psychological distress is best resolved by combining commonsense with simple therapeutic procedures known to work on the basis of past practice.
All of which means that Buddhist psychotherapy is largely parasitic when it comes to a theory of personality, or when it comes to psychodynamic theory in general. As far as theoretical frameworks are concerned, therapists should be happy to pick and choose, to modify, and to abandon when necessary. Human psychology is ever changing, ever mysterious, ever surprising. It may function according to certain very basic principles – attraction and repulsion, tension and release – but these principles are so obvious and uninformative as to be intellectually worthless. Even a simple concept like ‘desire’ is so multifaceted and elusive that it slips through the fingers as soon as you try to pin it down. If psychological theory is to be relevant, it has to remain flexible, and able to adapt to changing environments. There are always going to be new patterns of thought, and new ways of responding to life, and psychology will constantly have to refresh itself in the light of new observations.
Key Concepts
Despite the fact that Buddhist psychotherapy does not offer a radically transformative theory of personality, there are a handful of key concepts which are crucial to any accurate understanding of the human condition.
The Psyche, or Soul
This is properly the object of psychology: it is the human capacity to experience through emotions and feelings. The term ‘psyche’ or ’soul’ is not often used outside theological or occult discourses, where it is thought of as a distinct entity, almost like an organ of the body. But for our purposes here, it does not much matter how the soul or psyche is conceived, because we are referring to exactly the same capacity, and it is useful to blur the distinction between the various discourses, in order to demonstrate this single referent.
In human terms, the soul has always been granted priority; it has always been seen as that part of one’s experience worth saving, if death were in some way to damage one’s experiencing. Religion deals with salvation of the soul; depth psychology deals with the psyche; popular culture refers to the capacity to experience profound emotions as the functioning of one’s ’soul’. These capacities, or these dimensions to one’s existence, are all of a piece: they are all psychological experiencing.
The Intellect
The intellect is our analytical capacity, in its various forms: mathematical, philosophical, commonsensical. It is our mental ability to abstract and break down our experience into discrete ideas, which we can then form judgements about. The intellect relies heavily on memory for its operation, but it can be trained to respond to material presented to it in an infinite variety of ways.
The Understanding
The ‘understanding’ as a reified concept, is properly a capacity of the intellect, but only when directed at the broader picture, or at a vision of one’s life as a whole. The ‘understanding’ is the capacity of the intellect to look at life as a whole, and to then attempt to come to appropriate judgements as to how to proceed, and how to behave. Everyday intellect deals with what it has in front of it: calculations, situations, memories, dialogue; but the understanding often has to try and project what it knows into the future, and envisage an outcome. This is hazardous, and difficult, and the reason why people’s lives are often in a mess. The understanding does the best it can, but three quarters of the information it needs for its judgements is often not available at the time.
Spirit
This is the most difficult aspect of the human condition to define, because it is essentially outside of normal human perception. It is not to be confused with spiritualism, or ghostly manifestations, or the unseen. It is basically that which is driving the human being to try to answer the big questions of life and existence; and it amounts to an almost imperceptible sense that something is not quite right with existence, and that something still remains to be sorted out, or realised, or brought out into the open. Something still has to click.
The Body
Before psychotherapy can begin, it is essential to make sure that whatever is causing psychological distress, does not have an organic origin. Psychotherapy can only be meaningful if it takes place well outside the remit of psychiatry and what is normally understood to be medical science. Physical diseases are always reflected in one’s state of mind, and it is important that psychology ought to be addressing psychological issues, and not physical ones. Reductionism aside, the psyche is more than enough of a problem on its own terms, without one having to worry about vitamin deficiencies, viruses, and all the other variants of physical illness.
And while Buddhist psychotherapy would certainly advise taking care of the body, and trying to keep it in peak condition, therapy itself is seen in terms of mental processes, conceptual perspectives and philosophical reasoning. There is no physical dimension to Buddhist therapy, and no use for the idea of the body as an energy centre, or force field, or chakra vehicle, as is popular with yoga-based theories. No one who has investigated the subject can doubt the astonishing abilities afforded bodies trained according to the dictates of Tai Ji Quan, or Kung Fu – or any physical discipline for that matter – but even the best trained body in the world will not grant you a sliver of insight in the realm of the understanding. Understanding begins within the realm of the understanding, not with changes to ethereal currents within the body.
An Evolutionary Process
In a general terms, the process of psychotherapy is best to be understood as an evolutionary progression; that is to say, the process unfolds over time, with gradual, or incremental changes taking place, dependent upon the development of the client’s understanding, which in turn is dependent upon the client’s commitment to the task. This is not to be confused with Darwinian evolution, even if Darwinism has considerable narrative applicability when it comes to trying to grasp how mental changes and developments occur; it does no violence to the subject to picture the understanding as struggling against a hostile environment, and as strengthening itself through adaptation.
Insight
The key to psychotherapeutic progress is of course the cultivation of insight, but it is important to identify the precise nature of the insight required. When it comes to diagnostics, insight is required at every level, from the physical, to the emotional and psychological, but in Buddhist terms serious therapeutic progress can only take place when insight occurs at the level of the understanding. And the understanding has to be that of the client, seeing, as it were, the facts of the situation for themselves, and not as the result of indoctrination – overt or subtle – by the therapist.
Motivation and Commitment
For psychotherapy to have any chance of a successful outcome, the client has to be independently motivated. Unfortunately the medical model of psychotherapy encourages passivity and submissiveness, and both these responses are counterproductive when it comes to self-understanding. The client has to want to learn, and this requires a certain measure of respectful acceptance on their part, but only as a preliminary step to their active engagement in their own metaphysical self-exploration.
PSYCHOTHERAPY
Theory and Process of Psychotherapy
Buddhist psychotherapy takes place in two stages:
(1) addressing the immediate problem, ie whatever brought the client to the therapist to begin with, and
(2) making a start on the Buddhist quest.
Section (1): Addressing the immediate problem
Initial Setting
The process begins with the arrival of the client, who should then be met in an ordinary, non-medical setting. Clinics are all very well, in terms of logistics and convenience, but rooms with medical furniture give off completely the wrong impression, and can unintentionally poison the atmosphere. While clients should certainly be reassured that they are being properly taken care of, they should not be lead into thinking that they have stumbled into a branch of medical science, and that they are going to be treated as pseudo-patients. While it cannot be denied that a certain amount of medical posturing can work wonders with certain clients, this is not the preferred route of the Buddhist psychotherapist, who is trying to encourage and support self-reliance in a client. The correct setting for such a therapeutic encounter is a quiet, reasonably tidy room – in a private house or in a suitable public building – and preferably decorated with books and pictures and other indications of an intelligent and educated engagement with the world at large.
A session normally lasts from 60 to 90 minutes. It is possible for one-to-one sessions to go on for longer, for as long as 120 minutes, but this would depend on whether or not client and therapist found such an intensive session worth having. It can sometimes be the case early in a series of sessions, if a client feels it important to give a lengthy and detailed account of a subject. Longer sessions would have to be arranged in advance, as initial diagnostic sessions will only last for an hour. Normally 60 minutes is enough, given that the therapist has to prepare for other clients, as well as write up notes.
Dialogue, and Diagnostics
It is not feasible in this context to go into a detailed discussion of diagnostic technique, other than to describe the process in broad outline. The session begins with the therapist inviting the client to explain what they would like to talk about, and then gently but deliberately guiding the discussion to make sure the key topics are adequately covered.
Some psychotherapeutic systems, especially those psychoanalytically-based, allow, or at least pretend to allow, the client to set the agenda, with very little overt intervention by the therapist. The client is expected to maintain a confessional flow. This leads to very peculiar, stilted, Pinteresque exchanges, dotted with uncomfortable pauses, and the client left feeling that the therapist’s lack of a response is in fact symptomatic of the client’s own inadequacies, not the other way round. The client then feels compelled to fill the silences, and they do this by snatching at whatever relevant ideas happen to be passing, and presenting them as if they were an essential part of their overall evidence. Much speculative nonsense is added to what might otherwise be a reasonably taut narrative. Free association has its place, but nothing is going to be lost by guiding a discussion forward, and avoiding useless digressions.
The point being made here is that Buddhist psychotherapy consists of an exchange of information, and dialogue is not restricted to the client unloading the contents of their thought processes. The therapist is at liberty to contribute their own thoughts and feelings to the discussion, and to illustrate their examples as best they can, either with incidents from their own lives, or from those of their friends and acquaintances. This can be done within reason, and without the therapist turning the sessions into mutual disclosure.
The therapist should also outline to the client key aspects of the theoretical framework in which they operating. In other words, the therapist should give the client a good idea as to what is expected of them, how long the process is likely to take, and what the outcome might be. This information should always be presented in a positive light, and with the client’s active agreement, yet there is no need to think of a positive gloss as a form of subterfuge, because it represents an expression of intent, not the twisting of facts. Also, an open discussion of the process they are engaged in dispels any notion that the client is being treated as a patient, and as someone on the receiving end of an authoritative body of knowledge. Buddhist psychotherapy is not a meeting of equals, but the therapist should encourage the client to feel actively involved in all aspects of the process.
Borrowing some concepts from client-centred therapy, a Buddhist psychotherapist would necessarily want to establish, between themselves and the client, the following conditions:
Empathy and a basic positive regard
A Buddhist psychotherapist – or any Buddhist, for that matter – is interested in the human condition, in all its aspects, and especially in the way in which the human condition encounters the world. This grants them a natural and unenforced empathy with anyone in a difficult situation, accompanied by a simple desire to want to help. There is no need to call up special thoughts, or to adopt a particular frame of mind, when it comes to empathy for a fellow human being in distress. It is a very strange idea to want to induce such a state artificially, and one can only wonder what the results would be; presumably something like encountering a deeply unsympathetic teacher forced to teach.
Positive regard for another is a more complicated state, and can only be unconditional in a very weak sense. One always feel positive towards another person in an initial encounter, but one’s positivity varies over time, depending on factors generated by the therapeutic process. Clients can be provocative, and deliberately confrontational, and it would be absurd not to respond to such changes in the mood and dynamics of a professional encounter. This does not mean that professional restraint is ever abandoned, or that one gives in to strong feelings, but it does mean that ‘unconditional positive regard’ is a very blunt conceptual tool, and does not do justice to the wide range of possible responses one can have, over the course of time, to any particular client.
Implied Therapeutic Conditions:
1) the therapist and the client have agreed to start a process of therapeutic encounters, under professional conditions
2) the client is in a state of psychological distress, or turmoil, or uncertainty, and wants to resolve the situation
3) the client is motivated to improve their situation: they are prepared to learn from the encounter with the therapist, and prepared to translate what they learn into action
4) the therapist is committed to seeing the client resolve their immediate difficulty, and in enhancing the client’s ability to gain a wider insight and understanding into their existence, with the hope that the client will put their new knowledge into action.
Mechanisms of Psychotherapy
In the psychotherapeutic session itself, there are three features worth highlighting; two over which the therapist has some control, and one which is almost entirely in the hands of the client.
1) The conversational mechanisms; manners, politeness, interactive skills
2) the gaining of insight
3) application of insight gained into the life of the client.
Something needs to be said about interactive or interpersonal skills, because although they are a vital feature of therapy, they cannot be formalised, or turned into some kind of routine. This is a vast subject in itself, but we can only touch on it here. Interpersonal skills cannot really be taught, either in a classroom or in role-playing, but paradoxically they can be learned, or absorbed, in time. Ones learns by constant observation, and by imitation, and by trial and error. One learns by feeling one’s way, over the years, in real life situations, and then by fine tuning one’s inner judgement until any sense of acting or artifice falls away, and one becomes the person one wants to be. One learns by making a conscious decision to improve one’s conversational skills, and then trying to find ways of doing so. Interpersonal skills are not self-evident, nor are they easy to attain. Many people whose specific job it is to deal with others have no idea how poorly they perform, and even if they did, might not be able to change themselves. We should not forget that there is an entire industry devoted to producing salespeople of one sort or another, employing manipulative techniques, and wholly centred on a kind of seductive bullying. Salesmanship can work as a technique in limited situations, but it could never become a default position for dealing with people . And on the other end of the scale, there are those with amazingly friendly manners who are unable to put such talents to good use. Finding the right balance between friendliness and authority is a special skill; and therapists have to work out for themselves how they are going to manage it.
Section (2): Making a start on the Buddhist Quest
When it comes to the gaining of insight, we move into even more complex territory. Insight is of course the central pillar of Buddhist psychotherapy and counselling. And it is all very well to have ‘the gaining of insight’ as a therapeutic objective, but it is not a realisation which can be achieved by technique, or by mere determination. To begin with, the therapist has to have a high degree of psycho-diagnostic skill, in order to be able to grasp the essence of the client’s difficulty, and then translate that into a meaningful resolution. Beyond that, the therapist has to try to find ways of awakening the client to the Buddhist narrative; in other words, of actualising the quest for metaphysical knowledge within the client’s own particular circumstances. This cannot be seen as a mere missionary exercise, converting someone to a way of thinking other than that which they would have chosen for themselves – it has to be an authentic development within the client’s own frame of reference.
How can this be achieved ? In the most basic terms, by having the client explore their own innermost psychological responses, though not with a view to gaining mastery over them, or defusing them, but rather with a view to understanding them, and gaining insight into their workings, and purpose. Presented in the right way, it would be a fascinating and rewarding exploration on its own terms, and it puts the client in the position of taking an active philosophical interest not only in their own existence, but also in that of others, because this type of knowledge becomes more appealing the more you discuss it with others, and the more you read about it. Once again, there is no need to introduce artificial feelings of a connectedness for others; the connection will come about automatically, as the result of a committed exploration of the building blocks of existence.
Therapeutic Boundaries
Buddhist psychotherapy is entirely dependent on its ability to generate insight in the mind of the client. It has no other rationale, no other mechanisms, and certainly no other hidden tricks. And the insight it needs to generate is of a particular order, and a particular quality, and is not to be confused with the type of insight prized by psychoanalysis. Buddhist psychotherapeutic insight is based in an exploration of the client’s own state of being, in the client’s own metaphysical actuality, as they see it themselves, unmediated by theory, or tradition, or say-so. The client has to have the ability to take a long, cold, hard, look at themselves – as the being that they are – and to see how their mind, and their psyche, and their personality manifests itself, and performs, and tries to fulfil itself. Somewhere in the process of metaphysical self-exploration, and intellectual self-objectification, aided by an experienced therapist over a period of time, insight ought to start to appear, and make itself felt and, slowly but surely, transform the situation the client finds themselves in, so that the client feels a greater sense of adequacy, and connectedness, as well as a greater sense of purpose. They may not feel happier, or more euphoric, but they should feel more advanced, more developed, more evolved, and, dare one say it, more grownup.
If insight does not arise, then all the talking – all the preparation – has been in vain. There is no way round this, and nowhere to hide. It is an inescapable conclusion. Insight cannot be generated by technique, or by magic, or mantras, or force fields, or ethereal currents. It has to be generated by mental effort, and by mental application, and by careful observation. And the effort and application have to be appropriate to the task, and absolutely accurate, and not distorted by flights of fancy. Objective self-exploration cannot come about through an intermediary, such as a book, or a teaching, or the words of a guru: it has to be direct, plain, and unequivocal; otherwise one is simply twisting one’s observations to match other people’s ideas. It is possible to study one’s body by using a textbook of anatomy, but it is not possible to study one’s own mind by using a book that someone else has written about their mind; the potential for misapprehension and distortion are too great, as is the tendency for a kind of insidious mental laziness, whereby endorsing what someone else has said becomes easier than looking and observing for oneself. This is the great danger inherent within the Buddhist tradition, because Buddhist followers fill their minds with other people’s discoveries, instead of discovering things for themselves.
All this is simply to say that, if the capacity for insight is not there, then Buddhist psychotherapy is not possible. Some schools of thought try threats and inducements to get people to come round to their way of thinking but, from a Buddhist perspective, besides being questionable, it would be completely counterproductive.
APPLICABILITY:
Types of problems
Buddhist psychotherapy would not normally make use of any kind of formal diagnostic tests, or institutionalised psychological evaluations. As it is only applicable in situations well clear of anything psychiatric, there is no need for specialised diagnostic techniques. Psychiatric screening would take place in the initial telephone call, as would inquiries as to the client’s treatment by other professionals, and any use of medication. Therapeutic and counselling sessions can only go ahead once these issues have been dealt with, and it is clear that the client is not psychiatrically disturbed, under someone else’s treatment, or taking medication.
Normally, a client would consider psychotherapy or counselling in order to come to terms with a specific situation. This situation might be urgent and traumatic, such as bereavement, or divorce, or it might represent a more generalised dissatisfaction, such as the desire to change a career, or to move to a different country, or to reassess a lifestyle. Whatever the case, the client will already have decided that the resources they have at their disposal – such as discussions with family and friends – are not sufficient for their needs, and that they are going to have to seek more specialist assistance. But as has been indicated earlier, the kind of counselling offered by Buddhist psychotherapy has unfortunately been tarnished by the medical model, which means that clients have to deal with an unnecessary medical dimension to their problem, instead of being able to see counselling as simply a form of specialised professional advice. Hopefully, over the years to come, life counselling will be divorced from medicine, and it will be viewed as an intelligent choice rather than a sign of weakness.
The therapist simply invites the client to unburden themselves, so that the immediate problem can be investigated and discussed. The therapist creates an environment of unhurried deliberation, imbued with a sense of calm, and strength of purpose. The client understands that they can relax, and feel reassured, even though – as the therapist will try to make clear – there is not going to be any quick fix, and that serious progress will necessarily be hard won. This is not designed to put people off, but to demonstrate to them that they are being appreciated as complex adult human beings and not as ciphers of pop culture. And it should also be made clear that, even if progress is going to be slow and painstaking, this does not mean that therapeutic sessions need continue indefinitely; they play an important role at the beginning, but later on can be treated more as occasional discussions, with varying lengths of time between one meeting and the next.
When it comes to methods for dealing with the client’s immediate problem, the rationale is fairly straightforward: the therapist is looking to frame the problem in such a way that the client feels relieved of at least a part of the burden. This is all about talking through a problem; re-describing it, re-contextualising it; finding new perspectives on it; looking for hidden positive aspects to it. It is mistaken to assume that a problem can be ‘talked away’, or even in a weaker sense ‘talked out’, but it can be made less intense by carefully thinking it through from all angles. This is where the therapist’s age and experience play a crucial role, in being able to supply authentic detail from their own life.
An important distinction needs to be drawn here between the type of ‘talking cure’ achieved in Buddhist psychotherapy, and that which takes place in psychoanalysis, or any similar schools. The distinction is one of both form and content. In Buddhist psychotherapy, discussion is aimed at arriving at an objective metaphysical perception of the client’s condition as a human being, so that the client can see for themselves what their existence amounts to, and what they can do for themselves if they want to change it. This is a grand way of saying that Buddhist psychotherapy wants to illumine a situation, rather than manipulate it. Psychoanalysis, on the other hand, looks for evidence to confirm a pre-existing theory, and then offers a psychological solution which only makes sense if you accept the psychoanalytic worldview in the first place. Also psychoanalytic therapy makes great play of catharsis, and the consequent recalibration of psychological equilibrium. There is no need for this in Buddhist psychotherapy, as confessional catharsis is not accorded any special value. The client can hold on to their secrets – unless they’re desperate not to – because it is psychological insight which is of interest in Buddhism, not varieties of intense experience.
And out of the therapeutic discussions, the therapist will be encouraging the client to take charge of their own inner life, not in order to dominate and control it, but rather as an interested observer, committed to exploring the processes that make up our existence.
[Further sections to follow]
Evaluation
Treatment
CASE STUDIES
Criticisms
SUMMARY
The Future of Buddhist Psychotherapy
