Sunday, 28 June 2009

Mindfulness based therapy and Buddhism

When we were young, we rejected the idea of Buddhism as a religion. We saw it as a philosophy or as psychology. But Buddhism is not just psychology. True Buddhism is not used by the ego to further its goals.
- Taiun Jean-Pierre Faure, my Soto Zen teacher (paraphrased)

I've just completed the first programme in my training to become a teacher of Mindfulness Based Cognitive Therapy and Stress Reduction. These techniques are derived from Buddhist vipassana combined with Cognitive Behavioural methods. There are no religious trappings. Some Buddhist teachings are given but the dominant theoretical frameworks are psychological and physiological.

I've been practicing Zen and studying Buddhism for a few years now this puts me in the very interesting position of being able to compare the practices and to compare Buddhist, psychological and physiological paradigms.

The basic model of the difference between therapy and a true spiritual practice is one that I picked up from my psychology tutor.

Spiritual practices differ from therapy in terms of scope. The aim of the latter is for the individual to reach functional normality, while the aim of the former is self-actualisation or enlightenment that goes well beyond normality.
- My undergraduate psychology tutor (paraphrased)

It's quite clear that MBCT teachers see it, not perhaps as Buddhism exactly, but certainly as a practise of what the Buddha taught.

It's the best thing that's happened in Buddhism in 2500 years
- Jon Kabat-Zinn (speaking about the new MBCT '3 minute breathing space' practise, paraphrased)

So, the Buddhists were right. They just didn't know what they were doing. They didn't know about neural pathways - how could they?
- Jini Lavelle, my mindfulness teacher (paraphrased)

There are many similarities - the mindfulness practice called 'choiceless awareness' is virtually indistinuishable from shikantaza zazen. I was expecting the mindfulness to be more goal-orientated perhaps, but both practices emphasise 'being' rather than 'doing'. Sitting in silence with a group of mutually supportive individuals noticing thoughts arise and any reaction to those thoughts and the sensation of air across the skin and the sounds of birds and traffic outside, and with no objective in mind, I could just as easily be at a MBCT sitting as a Zen sitting. And this is the core of both practices. Does it really matter whether the people I'm with came because they wish for enlightenment or inner peace or an end to depression and anxiety? Does it matter whether people bow to a Buddha statue? Surely the fundamental practice is the same and the effect on people's lives is essentially the same?

Similarities

Some techniques involve focussed attention (breath zazen/breath mindfulness)
Other techniques involve open awareness (shikantaza/choiceless awareness)
People encouraged to have upright and dignified posture
Doing discouraged in favour of non-doing or being
Practice continues off the cushion
Compassion seems to naturally appear

Differences

Zen
Sitting on cushions is encouraged
Hands in universal mudra
Eyes half open/lowered
Emphasis on mind-body unity as well mindfulness
Mindfulness/mind-body unity practiced with traditional, ceremonial practices
Moral code given (precepts)
Compassion to self and others encouraged
Bodhisattva concept of practicing for the benefit of others
Original purpose is enlightenment which may fade with time
Theoretical framework is Buddhism or Buddhism with a little psychology
Formal refuge may be taken

Mindfulness
Most people are on chairs
Hands flat or on thighs
Eyes encouraged to be closed
Emphasis on only mindfulness
Mindfulness practiced with ordinary, contemporary practices
No moral code given
Kindness to self encouraged, compassion to others emerges
Awareness of impact of practice on others but no Bodhisattva concept
Original purpose is therapeutic which may fade with time
Theoretical framework is psychology or psychology with a little Buddhism
No formal refuge is taken

As with anything else, Buddhists tend to fall in a range of attitudes from conservative to liberal about matters like this. I tend to see many spiritual and some psycholgical traditions as doing and talking about the same processes and experiences as Buddhism, just with different doctrinal foundations. So this puts me at the liberal end. Others take the teachings very literally and see formal refuge and belief in traditional views of karma and rebirth as essential.

I have no firm conclusions about this. I'd be interested in people's experiences and opinions about it. Can Buddhist practice be seen as psychology? If not, why not?

According to some it cannot - there is no formal refuge in the Buddha. There is no belief in the metaphysical points of doctrine such as literal rebirth (but this is often the case in Western Buddhism anyway especially Zen). Others say there is no goal of enlightenment - yet how much actual difference does having such an aim make? Also, in Soto Zen (according to most instruction at least - I'm not convinced that there is never intentionality at all) goals are abandoned, and in MBCT/SR there is some aim to become free of what could be described in terms of ignorance, greed and desire. In what fundamental sense is this different from the goal of nirvana - which Buddha described as the perfect peace of the state of mind that is free from craving, anger and other afflictive states?

According to my Soto Zen teacher, the reason Zen cannot be described as psychology is that a practise that is used to fulfill the goals of the ego is not a true Zen practice. I can see what he means, however it seems to me that there are problems with this distinction, namely there is no clear point at which a practise is ego-driven and when it is not. All goal-oriented activity is the ego using an activity for it's own purposes. This includes Buddhist spiritual goals. Also whether Soto Zen emphasises non-seeking mind or not, it is not free from 'contamination' by intentionality and thus ego. I have met a number of Soto monks and nuns for who - it seems to me - practice is being used by ego at least to an extent. To insist otherwise is to idealise Soto. Also, the mindfulness of MBCT is a practice of non-doing just as Zen is. So there is no clear distinction at all in this case.

A tendency I've seen in many spiritual practitioners is to seek to raise their own practise by diminishing others. This 'spiritual snobbery' seems to be not uncommon in Buddhism, including Zen, even though 'not having preferences' is supposed to be practised. Many seem to regard their own practise as 'True Buddhism' while the others are engaged in some sort of corrupted practise. Mahayana refer to Theravada as the 'Lesser Vehicle', Theravadans accuse Mahayana as deviating from and corrupting the original words of Shakyamuni Buddha, Soto Zen accuses Rinzai Zen of chasing insight experiences and Rinzai Zen accuses Soto of 'dead sitting' without insight. Non-Buddhist practises are typically even further down in their estimation. Yet there are others who see the wisdom of Buddha as an expression of a more universal wisdom that may be found in all forms of Buddhism, even the words of Rumi, Christ and in every experience of life.

The tentative conclusion I'm coming to is that there is no fundamental difference, rather merely a difference in emphasis and perhaps depth.

I asked my Rinzai teacher about this, any although he didn't answer my question directly (he had no direct experience of mindfulness based approaches) he spoke of Buddhism and therapy not as the same thing but not just by making a value distinction between them either. Drawing on his experience as a psychotherapist, he spoke about them as equally valid and complimentary.

There is an overlap between therapy and Zen, although they are not quite the same. I see Zen as allowing peple to open up their heart and mind and that spaciousness can uncover various complexes and neuroses, although it doesn't address them directly. Psychotherapy or CBT focusses on those specific problems without giving the wider spaciousness that Zen allows. And although that Zen spaciousness doesn't address the problems directly, it can give room for the issues to untangle.
- Genjo Marinello (paraphrased)

To my mind, the place that mindfulness therapy would fit here is in the middle - primarily creating spaciousness but also enhancing understanding and focussed awareness for the specific problems of chronic depression, anxiety, and stress.

22 comments:

  1. Justin - Excellent questions and ideas. In terms of strict psychoanalysis, I think psychology, or in the abnormal sense, psychotherapy is the activity between consular and patient to discuss or illicit an opening, via discussion and other assorted methods into the problems the person faces, ie anxiety/depression/etc. The therapist tries to get the patient to talk through there problems, to see how their 'abnormal' thoughts are causing the problems, and how to talk about how one can change a pattern of thought or behavior to alleviate mental pain.

    What they both do have in common is they both strive for individuals to notice how thoughts arise within themselves and what emotions proceed these thoughts and the affects the emotions have. Cause and Effect of mind in its most basic terms. I see that through the acceptance of Cognitive Behavioral Therapy, psychology is making greater efforts to get to the root of the problems, because of its more scientific basis and rational.

    Forgetting the devotional or religious aspects of Buddhism...

    I see the similarities however, start to fade there between Buddhist teachings and traditional psychotherapy. Buddhism, in a general sense discusses anatta and most psychologist would probably say a stronger sense of self, not weaker one may be more beneficial to the patient. Also, dualistic thought is a very important aspect of Buddhism, while good and bad or right and wrong are used in a totally different way in psychology.

    In a psychological sense, I would have to say my opinion that a practice of mindfulness, and perhaps to an extent insight meditation, without the religious trappings, would be more suitable for many patients seeking help. While I think we all may agree we realize how attachment is one of the great causes of our problems, many people not familiar with Buddhist teachings would not welcome or be able to comprehend this approach. However, the approach or use of ZaZen, silent breath focused exercises in themselves, without a goal of liberation of mind or the teaching of dukkha, anatta or anicca, can be enormously to calming the mind, focusing attention and obtaining some degree of control.

    I would be of the opinion,a Zen like exercise, a practice of walking or daily mindfulness and a limited practice of insight meditation with a guide, but without the Buddhist teachings or religious aspects would definitely be something that could have great potential in psychotherapy for those not open to Buddhism as a philosophy itself.

    The question is will conventional psychology eve embrace the idea of no ego?

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  2. monkmojo sent me here. my therapy is based on mindfulness which is killing me.

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  3. "Buddhism, in a general sense discusses anatta and most psychologist would probably say a stronger sense of self, not weaker one may be more beneficial to the patient."

    This is also Jacques Lacan's core departure from much post-Freudian psychoanalysis, particularly it's American analogue, "Ego Psychology," which taught (with much influence) that the goal of psycho-therapy is the identification of the patient with the therapist's "strong ego." The distinction between normality and liberation beyond normality is relevant here too, because for Lacan and his students Freud's insights pointed away from the ego, like the finger pointing at the moon. To that end, Lacan's insistence on a "return to Freud," another more intimate and concrete engagement with Freud's writing, is not unlike the Zen practice of sitting and returning to the breath.

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  4. Hi Kyle

    "The question is will conventional psychology eve embrace the idea of no ego?"

    Perhaps I'm being a stickler again but my understanding of Anatta is not 'there is no ego', nor even 'there is no self' - if there was no self there would be no issue. Rather it means 'there is no inherent, continuous, separate self' or 'no essence'. And the Buddhist practise is not to remove or destroy the ego but to realise the world through realising the non-essential (empty) nature of self.

    But yes, this may open a whole can of worms for those who don't have a stable sense of self. One of the Humanistic Psychologists (was it Rogers or MAslow?) taught that a well-developed self was required before we could go beyond it. I certainly wouldn't recommend meditation for schizophrenia.

    And I should add, the strong clinical results for MBCT in treating chronic depression should be taken as good news by Buddhists - further scientific validation of the value of Buddhist-style meditation.

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  6. Yes, quite right, a good thing for Buddhism. :-)

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  7. Justin, I am glad to read your more extended thoughts about this. I see how MBSR techniques are similar to meditation practice. Jack Kornfield talks about exactly this most explicitly in his recent book, A Wise Heart, which is all about making psychotherapy and meditation practice complementary. I just become uncomfortable with the idea of Buddhism 'stripped of its religious/cultural trappings,' and the idea of getting to 'the pure essence of Buddhism.' This is mostly because I am a scholar of Buddhist studies. I don't like this idea that it is possible to determine what is 'true' Buddhism and what is cultural. I am happy that MBSR techniques help people who wouldn't meditate otherwise but I am uncomfortable with taking parts of Buddhism and inserting them into a very different context. Buddhism is a whole tradition and system of thought- it is not just meditation or mindfulness techniques.

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  8. Hi Brooke,

    I don't like this idea that it is possible to determine what is 'true' Buddhism and what is cultural.

    Wouldn't that imply that Buddhism stopped being Buddhism the moment that early Nikaya Indian Buddhist culture became Theravada Buddhist culture, Mahayana Buddhist culture, Chinese Buddhist culture, Sri Lankan Buddhist culture, Thai Buddhist culture, Chan Buddhist culture, Tendai Buddhist culture, Pure Land Buddhist culture, Rinzai Zen Buddhist culture, Soto Zen Buddhist culture, Tibetan Vajrayana culture, Nichiren Buddhist culture and so on.

    There are many many Buddhist cultures. Buddhism is not lost because of variations in it's expression. To be limited to conservative imitation to me suggests that the matter is not understood and is merely being parroted.

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  9. In each culture that Buddhism has landed, the culture itself has wrapped itself inside Buddhist teachings, even here in the West. What is the true essence and what isn't is a matter of some debate to come, and I agree Brooke, that the traditions of the multitude of forms Buddhism has taken shouldn't be forgotten and should be continued to be studied with great vigor in all its complexities.

    That said, I think if people are getting good mental health benefits from certain aspects of Buddhist teachings, without carrying forward the culture that it may have come from, I think that in itself is reason enough to do so. I know it is hard to think of Buddhism like a buffet, where one could pick and choose what they like, but I don't think this type of mental health benefit would fall under that understanding. I think that is a separate discussion, but none the less, an extremely important one.

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  10. Wow... the timing!

    http://www.tricycle.com/blog/?p=1263

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  11. Interesting.

    It happens to be derived primarily from Buddhism (combined with some CBT). However, I think it would be misleading to call mindfulness alone 'Buddhism'. Yet personally I don't find the question 'is it Buddhism?' particularly relevant.

    The relevant question is 'does it work?' And evidence indicates the answer to that is 'yes'.

    And to claims that because it is missing certain aspects of Buddhism eg. precepts, this means that it works less well (in some sense), I'd like to see some research done in this area.

    My main motivation for learning this is that I've personally found meditation to be beneficial. I would estimate that 90% of the population might benefit from it. And yet 90% of those are turned off by the religious aspects of Buddhism. I will continue to practice Buddhism myself.

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  12. Justin,
    If the question is whether it will work or not, then what defines if it has worked? What do you see as the end, or result, or best possible outcome?

    I think this might have been our point of misunderstanding, so I am curious to see your answer.

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  13. Good question. And in a sense I think it should stay a question - because what 'works' is determined by the goals of the individual. There is some variation in what the goals of Buddhism is, but the most widely accepted I think is Nirvana, defined as the state of mind that is free from craving, anger and other afflictive states.

    And this end of states of suffering seems to be the goal of Mindfulness therapy too - although not necessarily to the same extent.

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  14. "lesser vehicle" - how RUDE!

    what happened to me, in brief, was that i had not been a meditator, although i had practiced yoga and tai chi, but not buddhist meditation. i was a teacher, life got on top of me, and i had a full physical and mental breakdown (diagnoisis; fibromyalgia). my journey from there was, it so happened that there was a lunch time drop in beginners meditation class at my local buddhist centre, and i felt that meditation might help me, but i found it hard to do on my own. soooo, i went along, and for a good few months didn't talk to anyone. at a certain point, i decided to do the 'breathworks' mindfulness based pain management course, and i continued to benefit from what are, in reality, buddhist techniques for some time before asking to become a mitra. my teacher was also very generous and allowed me to be a 'helper' which means that i have been through the course a good 8 times now, as well as the MCBT for depression course. as well as becoming... a buddhist. i think you would get a real feel for what is the substance of the overlap, and what benefit it can have for people on a whole scale from those who will actually be drawn to buddhism, to those who won't if you volunteer to be a helper on some courses before you set out to teach it.

    at LBC all the courses are taught two handed and mostly by order members. i have done the first part of the breathworks training now, it's based on JKZ's MBSR, but is orientated towards pain and illness. i don't intend to use it 'off the shelf' - the principles of these courses are very solid, and can be adapted. i hope to use it for workplace staff development, bringing in the 'magic' of sangha.

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  15. Thanks for sharing your experiences Elaine.

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  16. My comment was apparently too long, so I posted it on my blog. I address issues brought up by both Kyle and Jamie, as well as continue some of my earlier comment.

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  17. "I certainly wouldn't recommend meditation for schizophrenia."

    Lacan was well aware of the dangers of applying psychoanalysis, which at that point and in general is essentially for neurotics, to those suffering from psychosis, which often enough triggered breaks.

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  18. Joe - I read your post over on your blog, and I have to say I agree with most of it. Maybe traditional psychotherapy could be seen as a work around and a cognitive mindfulness could be seen as a work through. In one we use passive rhetoric to help sooth us and in the other, meditation we confront our minds as they are, in all their turmoil and confusion. I think both perhaps have a place in our society, but I believe there is a better way than the traditional psychoanalysis used. But then again, I'm no psychologist, just an ordinary Buddhist.

    Great writing Joe!

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  19. "Maybe traditional psychotherapy could be seen as a work around and a cognitive mindfulness could be seen as a work through."

    My point is, I guess, that mindfulness-baased cognitive therapy and cognitive therapy in general is still stuck in the "traditional" paradigm. One of the key components of this conservative paradigm is a parsing out of reason and affect, such that we can talk about getting in touch with ones emotions. This is an artifact of fetishized reason, and really the place of high-faluten abstraction. As Freud and later Lacan said, and I think rightly, the only emotion that does not deceive is anxiety

    What I try to bring up is the much more complicated history behind the development of psychology, and psychoanalysis in particular. The seemingly Buddhist objection to psychoanalysis and pop-psychology on the grounds of its abstraction and ego-worship is already something you find in the history of psychoanalysis.

    I think confronting our messy minds gets confused with confronting them and taking them over, as if they were apart from us. This, too, is a soothing technique. What I try to emphasize when I can is that engaging the mind is harder than it sounds, most of all because we must engage this very engagement - there is no neutral set of techniques or poses or chants or teachings that do not require our attention to work. That is to say, there is no one who knows what we have to do in order to be free - no buddha, no bodhisattva, no master, no analyst or therapist - no One.

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  20. My point is, I guess, that mindfulness-baased cognitive therapy and cognitive therapy in general is still stuck in the "traditional" paradigm. One of the key components of this conservative paradigm is a parsing out of reason and affect, such that we can talk about getting in touch with ones emotions. This is an artifact of fetishized reason, and really the place of high-faluten abstraction.

    This is interesting but a bit of an abstraction.

    The reality is that most people's suffering is associated with their being highly identified with thinking and unexamined reactivity. People are blind to their emotions and cognitive habits. Hence the need to become aware of these things. And without the aid of reason it is impossible for those aspects of psychology to see the consequences of the existing conditioning and to find new ways of responding. Cultivating awareness, especially awareness of our reactivity is a 'gate' that allows us to 'become whole' and to make more skillful responses to the world.

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  21. The feedback I've had from Buddhists to the suggestion that mindfulness therapy may not be fundamentally different from Buddhism has been interesting.

    It seemed that the majority certainly wanted to make some sort of clear distinction between them and to make it clear that mindfulness was necessarily in some sense lesser, morally inferior or more superficial. (None of these people had direct experience of mindfulness therapy).

    And yet the basis for this distinction and superior/inferior relationship seemed to be inconsistent.

    According to some, mindfulness therapy has an egotistical goal, while Buddhism has a selfless goal. (I say that it's easy to talk about being selfless).

    Others said that mindfulness includes too much intentionality to be true Buddhism. ( I say that both mindfulness and zazen involve both a practice of 'non-doing' as well as some intentionality).

    Others said that mindfulness lacks the intentionality to become a Buddha. (I say that nirvana is the ending of desire, aversion and delusion and that there are parallel purposes to mindfulness)(I also say that the intentionality of vow-making is not a such a powerful or important practice as meditation and can we really just decide to abandon egotism etc through effort of will?).

    Others said that the belief system of Buddhism made it fundamentally different. (I say it gives the meditation practices a different meaning but this doesn't mean they are acting on us in a different way).

    Others said that mindfulness in itself was not a powerful insight method. (I say it does bring much psychological insight but less profound existential insight perhaps. There may be something to this, but if true it would raise some questions as to the practice of contemporary Soto Zen as well).

    As I say, my provisional assessment is that there is no fundamental difference but the difference is one of depth (and perhaps length) of practice, and emphasis. I'm also now thinking about whether the lack of techniques focusing on existential insight are important (also wondering about this re Soto Zen).

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  22. Maybe "suffering" is actually thinking in action and the Four Truths are describing the structure of reasoning out desires. To be "stuck in thinking is to be nothing but being a hungry ghost or "Beautiful Soul" not being "Human".

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