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With Buddha in Mind, mindfulness based psychotherapy in practice.

Soon after I started my first analysis I painted a triptych of three selves that I had become particularly aware of. The first I painted naturalistically – an image of myself as others saw me – a young man at that time. The second I painted in reds, oranges and browns. A devilish man with little horns and a wicked glint in his eyes, a self I knew too well. The last, however, was unfamiliar and very painful to admit. In dull blues and greys a third man emerged, small, crushed and very sad. He was the pain I had only just realised was inside of me. An image of my own unacknowledged suffering.

This should not have been such a surprise given my interest in Buddhism. Two and a half thousand years ago the Buddha was approached by a woman, Kisa Gotami, whose son had just died, asking that he be brought back to life. The Buddha replied that she must gather a mustard seed from every house that had not known death but as she travelled from house to house she quickly found that everyone without exception had lost, “a child, husband, parent or friend”. Finally at twilight she sat sadly by the side of the road and realised that as the lights in the valley twinkled on and off, so all life comes and goes, and that no one is free of the grief and anguish this causes. The Buddha, an expert on suffering, had known that her experience was universal – not one of us escapes the suffering of loss.

As counsellors, psychotherapists and analysts we too have people who bring their suffering to us in the hope that we can find a way to help them feel better. If I think about my own clinical practice I have been brought the experiences of:

Being valueless being lost within an imaginal world being with an absence of feeling being expected to be clever being with abusive alcoholic and violent parents being with self destructive unexpressed rage being the renegade child being the victim of sexual abuse being made always wrong and humiliated being crushed being abandoned being terrified of emotional vulnerability being fearful of emotional expression being ignored, emotionally undernourished and shamed being in fear of fathers unpredictable moods being special being annihilated by ones own goodness.

Buddhism tells us that the Buddha before he became enlightened, as the nobleman Siddartha, had his own wake up call when he first became conscious of suffering. Discovering his intoxicating pleasures were merely distractions he went out onto the streets and saw all around him illness, old age and something now mostly hidden from us – death. This deeply disturbed him – he thought if this happened to other people it would surely happen to him also. He too would know insecurity, being sick, being infirm and dying.

The Buddha’s response to his shocking discovery was to become immediately curious. Rather than retreating back into what had become a meaningless life, he looked even closer at the unhappiness he saw all around him and tried to understand its different expressions and where these each came from. Early Buddhism says that the fruit of this investigation was taught by the Buddha during his first discourse in which he talks about taking a realistic look at what is happening and finding ways to embrace what we find happily. He starts by describing suffering as an inseparable element of human experience and he sees this as falling into three distinct categories. The first he called the suffering of suffering. The unavoidable and universal suffering that comes from the round of biological life. Having children, finding we are ageing, physical and psychological ill health, old age, decrepitude and death. The second he called the suffering of change. Seeing that the whole of existence was ephemeral and transitory it followed that life was inevitably going to frustrate and distress us as we grasped ineffectually onto precious things that we were losing while being compelled to accept what was unwanted as it were forced upon us. That our wanting and not wanting, so deeply part of our human psyche, nonetheless was in direct conflict with an ever changing universe over which we had no control. The last he called the suffering of conditioned existence. This is both the most profound and also easily missed. It describes a low grade, all pervading dissatisfaction that comes from things never being quite right, never measuring up or fulfilling our expectations, always leaving us wanting something more or different. Here think of shopping and how quickly the pleasure of a purchase decays. Sigmund Freud may have put his finger on it when he said that the ego is the seat of anxiety. That there is something just about being a person that creates a deep uneasiness and uncertainty. We could also see this as the suffering that arises from not knowing who we are.

The Buddha’s word which we translate here as suffering is dukkha, and as we have seen, it is rich in its variety and spread of meaning. Originally it referred to an ill fitting axle hole on a cart which gave a bumpy ride and by extension it ranges between the pervasive unsatisfactoriness of everything that mars our happiness, the feeling that nothing is quite right even if it is superficially okay, to experiences of anxiety, stress, anguish, deep despair and emotional chaos. It also includes the rubbing uneasiness that there is something more, the discomfort and perhaps longing of an unanswered spiritual hunger. This last can also build into yet another category of suffering, the awareness of the suffering of others.

This makes me think of C. G. Jung who said that he had found that in a long analysis the suffering of the broader world came to replace the suffering of the individual. That after we had gone through our own pain, the pain of the world and how to be with that, moved to the forefront. Pema Chödrön, a wonderfully compassionate American Buddhist nun says much the same thing. That as we open our hearts we begin to feel the pain of the world around us. A pain which if anything is more difficult than our own because it seems there is nothing we can do to really help it.

I think many of us will have felt this – it is hard not to when we have daily news updates on the unimaginable suffering others feel around us. As I write this now I am aware that whenever I have spoken of this shared suffering previously there has always been natural disasters, accidents or wars providing examples where a not very arduous aeroplane flight will put me amongst people who have experienced grandparents, mothers and fathers, aunts and uncles, brothers and sisters, cousins, friends, children and tiny babies all having their homes and sometimes their lives snatched away. Dispossessed, violated, killed. In the face of such suffering I observe myself escaping defensively into distraction, into indifference, looking at the next news item. An earthquake, nuclear leaks, the disruption in the middle east and then the football results.

The Buddha as health professional

Some of us may find all this focusing on suffering a source of suffering itself. That it is depressing and frihtening to confront what hurts us and others. I can identify with this, I too find it very hard to listen consistently to the news, a catalogue of ever continuing suffering, so much of it brought upon ourselves. The Buddha in his time was also criticised for focusing on suffering. His answer to this criticism – and we as counsellors and psychotherapists may borrow it – was to describe three types of doctors. The first is a reckless optimist. Called to the patient he declares there is nothing wrong. The second is a defeated pessimist. Called to the patient he says the patient is indeed ill but there is nothing that may be done. The third is a realist. Called to the patient he sees there is a problem but he also can see its cause, knows it cure and the medicine it will take to bring the cure about. This cause, cure and medicine is what we shall next look at. Do not despair, there is hope!

The Cause

If suffering is the illness then what is it that makes us susceptible to it? The Buddha’s diagnosis of the cause of suffering was not something social or political outside of us but a personal and insatiable ‘craving’ driven by a deep spiritual ignorance – tanha. Christina Feldman, an accomplished insight meditation teacher, gets to the heart of this for me when she says that suffering arises in the gap between how things are and how we want them to be. It is our craving that is the problem ultimately, not really the circumstance. Buddhism, with its love of lists, spells this out systematically. What causes suffering is our craving for sensual pleasure, craving for existence and craving for non-existence. The first, craving for sensual pleasures, is clear – it is endlessly being driven to seek pleasurable sensory (and I would add psychological) experiences while pushing away and defending against anything that we feel is unpleasant, repugnant or threatening. This style of craving is particularly displayed in addiction. Then the darker side of its nature is fully revealed – a nightmarish compulsion that is without any hope of full or lasting satisfaction. Thinking about this I am reminded of Freud’s rather bleak belief that there is something inside of each of us that he called the ‘it’, that is an insatiable appetite that simply wants what it wants. An unreflective mouth that gobbles everything up yet never knows enough. That experience of wandering around our house wanting something without knowing what. Buying more superfluous stuff off the internet, turning on the TV when there is nothing on, looking in the fridge when it is empty.

The second and third forms of craving for existence and non-existence take us deep into the psychoanalytic territory of the formation of the self. How we are addicted to maintaining a sense of personal identity having continuity, stability and agency. Capable of prevailing against and dominating ourselves, those around us and the world we all inhabit. And how, paradoxically, this self also yearns for rest, oblivion, to feel nothing, to dissociate and be free of the conflicting emotions and tormenting thoughts that consist much of its experience. Again severity reveals its interior. These two cravings show themselves particularly in the existential crises that psychoanalysis has come to recognise as narcissism – a pandemic psychological disorder in our western world. Narcissism is the hurt we feel when we do not know who we are. The beautiful young man Narcissus lends his name to the disorder. In the Greek myth the nymph Echo dies from the grief of unrequited love because Narcissus cannot love anyone but himself. The god Nemesis, as a punishment for this, causes Narcissus to fall in love with his own beautiful image reflected in a pool. At the waters edge, captivated by his own face he remains trapped until he too pines away and dies.

When wounded narcissistically we may present to the world a highly successful mask, an accomplished and pleasing persona. Tough, generous, charming and seductive. But beneath this, barely acknowledged by ourselves and greatly feared, is another set of emotions, equally distorted by grandiosity, where we feel desperately impoverished, shame soaked, depressed, worthless and inferior. Longing for a love we might come to know ourselves through, while being incapable of receiving or giving it. Acknowledging the emotions behind our mask is extraordinarily painful because it feels humiliating, even annihilating, and the vulnerability this threatens is the very thing we most want to avoid.

Here is an example of a narcissistic wound in someone attracted to Buddhism. Carl had been interested in spirituality since his early teens. He had read many books about meditation and transpersonal psychology. He also took lots of hallucinogenic drugs and believed that the meditative states of non ordinary consciousness he had read about he had experientially achieved. Now, inhabiting what he believed to be an exalted state, he tried to join a spiritual group under the guidance of a teacher. This experience however brought some problems. Firstly his relationships with the other students was made difficult by his need for them to recognise his spiritual superiority, cloaked in a persona of caring and seeming detachment. Several of the younger women within the group had been seduced by this and then had been badly hurt by his inability to appropriately meet their emotional needs. Secondly his relationship with the teacher was marred by a deep ambivalence on his part. Initially he had listened attentively, keen to be seen as a central and important student, but once the teacher recognised his presence and began to invite him into a student teacher relationship, he immediately drew back feeling angry and defensive. Carl was incapable of the relationship that the spiritual teaching demanded. While he wanted the teacher to acknowledge his spiritual insights, stolen through drugs, he was not prepared to actually undergo any real initiation that entailed a surrender of his narcissistic self.

Carl’s story closely mirrors the Narcissus myth. Driven by a mixture of omnipotence and escapism, he is drawn into searching for a relationship with something other and perhaps greater than himself. However he does not yet have the ability to love – presently he can neither give nor surrender, and so incapable of relationship, he ends up as he always has been, alone. His legitimate psychological needs for the existence of a healthy, robust ego is sabotaged by his narcissistic craving for acknowledgment of his empty grandiose persona. Fearful of intimacy he retreats, still armoured against his vulnerability. Ultimately the issue of narcissism is one of identity. The story offers one last twist that strangely links its insight to that of the Buddha. The reflection that Narcissus becomes mesmerised by is actually nothing but an illusion. While it appears that Narcissus looks at himself there is really no one there. This strangely mirrors Buddhism’s insight that suggests that behind all our experiences there is no experiencer – no person who is having the experience. All there is is the experience itself and part of it is the feeling of a continuing yet illusionary self that it happens to.

Buddhism links this absence of an discrete and lasting self to its understanding of shūnyatā, the emptiness or absence of an enduring and separate self that is discovered under close analysis. The insight meditation teacher Joseph Goldstein says that one way of understanding emptiness is to think of it as an absence of self-centeredness. This reveals a deeper understanding of narcissism. Narcissism is more than believing the universe revolves around us. Rather it is the mistaken belief that there is an enduring self around which the universe revolves. The craving for pleasurable experiences, existence and non-existence, creates suffering because it grasps for a control that is impossible to achieve by a self that was never really there. A self that is no more than a fearful contraction that we can not let go of. Observation confirms the value of this insight. All of us experiences flow states – listening to music, arts, sports – without having to be aware of our sense of self while engaged in them. When we stop fearfully grasping at our deep desire for a brittle identity, things become more spacious, easier, more nourishing – and fun.

The Cure

What are our images of “cure” in psychotherapy? Freud offers ‘ordinary unhappiness’ instead of a neurotic unhappiness. Something more manageable and less unrelated to the consensus reality. Jung offers ‘individuation’, an image of psychological wholeness which includes all those parts of the self repressed. A kind of superman who has a life full of meaning. Object Relations therapists value object relations – the ability to become related to another, to love and be loved. Humanistic psychotherapy wants us to realise our human potential. To express a full spectrum of emotional experience. Buddhism imagines something more which it calls nirvāṇa, the irreversible burning away of craving which brings all suffering to an end forever.

My own feeling on this is that the goals different modalities of analysis, psychotherapy and counselling offer are all ideal states. Complex narratives that easily obscure where we actually are and who we actually are in this present moment. Do any of us really ever learn how to express our self fully, love sanely, become whole, let alone become enlightened? In practice are we all not more muddled, subscribing to an ideal which, while we never make it experientially real, none the less acts as a valuable light on a horizon we may never reach?

Buddhism is certainly also prone to such idealism. What could be more idealistic than the goal to bring all suffering to an end forever? But it also has another face, a more close to the ground one that simply invites us to stay with ‘what simply is’, consciously, mindfully. Not to rush on along the path wishing to be what we are not. Seeing in such rushing a subtle form of self abuse. A non-acceptance of who we are, a narcissistic grasping at being more. That the rushing, grasping relationship to ideals, to narratives – including Buddhist ones – is in itself a source of suffering.

In contrast it values something plainer and simpler. It’s cure consists of being able to stay with our experience fully, without needing the protection of defensive closure. This is not the same as Freud’s ordinary unhappiness because it is the source of real happiness. It is not Jung’s individuation – the creation of individual meaning is much less important here than the finding of a genuinely kind quality of awareness. And it is not just about human love or emotional expression in any ordinary sense because while it values these qualities it also mindfully discriminates their often hidden, obscure and feral motivations.

The Buddha’s cure, though a narrative itself, is something that begins where we are, with who we are, in the emotions we have. It is the ability to be with our self without fear and to dissolve the grasping of our narcissism so that we dare to experience our sameness with the world around us. That we are all changing, that we all suffer when we protectively contract around the idea of who we are and that inside of each of us is a limitless expanse of compassionate well being – our Buddha Nature. Knowing this, directly, nakedly, right here and now is the Buddha’s cure. A cure psychotherapy can comfortably share in.

The Medicine

The Buddha’s medicine which effects this cure comes in three parts: an ethical relationship with our self and the world, meditation and the cultivation of wisdom. In my experience as a psychotherapist, while it may be necessary to be wary of spiritual ideals – particularly when they threaten to invade the consulting room – we need not fear this medicine as its therapeutic qualities are immediately apparent and are widely applicable within and without an explicitly Buddhist context. Let’s look at each of them.


Buddhist ethics are governed by the belief that all our thoughts and actions have repercussions and therefore it is important to create good causes and this is best done by wishing to do good and actively avoiding doing harm. From this comes two central values: unconditional friendliness and compassion. Maitrī and karuṇā. D.W. Winnicott says something similar when he speaks of the ‘facilitating environment’ – we flourish in an atmosphere of kindness and generosity and we may exemplify and encourage this in our psychotherapeutic practice. This becomes particularly pertinent when we begin to see clearly the depth of our self criticism, self rejection and sometimes self-loathing.

Here is an example. Jane was menopausal. Each night she awoke overheated and bombarded with self critical thoughts which left her shattered and with no sense of her very real qualities and talents. At times her thinking was plainly paranoid and quite unrelated to reality. However she was also a practitioner of mindfulness and she found that frequently her practice – done in the early morning hours next to her sleeping husband – enabled her to disidentify with what she recognised as the internalised voice of her viciously critical father and find a place of rest. Although this was difficult to achieve and not always possible, it gradually became clear that this period in her life represented an initiatory threshold and that Jane was meeting her own destructive self each night when she descended towards sleep. Her ability to allow herself to stay with and experience the fullness of her nocturnal struggles was the fruit of her mindfulness and the care and kindness she brought to the struggle – not making herself wrong or bad for having it – was the expression of the unconditional friendliness and compassion she could – mostly – extend to herself.

Jane’s story in principle I have come across again and again. It seems that a common component in much of the suffering that comes into the consulting room is self criticism and loathing. A young woman arrives and tells me of a life time of depression, loneliness and self recrimination. Why does she blame herself? She blames herself for having her depressive moods and thoughts. It is not enough to be bleak and leaden she is wrong and stupid as well. She says to herself “You are a fuck wit, a looser.” The Buddhist notion of unconditional friendliness, maitrī, fiercely challenges this. It asks we bring an intelligent kindness to our woundedness because only once a wound is accepted can the process of healing begin. Further more, as the contemplative psychotherapist John Welwood points out, a psychotherapy that is always pushing for change is in itself subtly doing further harm if it is colluding with the abusive inner voice of the patient that says to be loved I must be different.

As Henry James said: “There are three important things in the world. The first is kindness. The second is kindness. And the third is kindness.” I believe a psychotherapy that can embrace this authentically, and not as mere sentiment, is an ethical psychotherapy.

Mindfulness Meditation

Mindfulness is to be consciously aware of what is happening inside of us and around us from moment to moment. This conscious awareness stays close to the sensory facts of the situation and tries not to become distracted by thoughts about what we are aware of. If I choose to focus my mindfulness on the sounds around me I just hear the sounds and come back from thinking about the wind and how much damage its blowing is doing to my garden. If I choose my breath I just stay with the sensations within each breath, intentionally adding nothing more and when I do, non-judgementally returning to the breath. If I choose my emotions – a common choice in psychotherapy – I just stay with the felt sense of the emotion located within my body – I don’t immediately go off into the history of the emotion nor speculation where it might lead.

In mindfulness based psychotherapy kindness and curiosity are central. Mindfulness does not observe with a cold eye dispassionately but more with a gentle interest. What ever it finds is entirely accepted, what is important is the awareness. This mindful position is always the position of the therapist and, when appropriate, also the position of the one who sits in the opposite chair. Nina Coltart, a psychoanalyst and Buddhist describes her experience of this:

As regards my own practice, and how Buddhism has affected my clinical work with patients, one of the earliest things I noticed was the deepening of attention. I’d written a paper on attention in my first book, where I refer to “bare attention,” which is a very Buddhist phrase. Bare attention has a sort of purity about it. It’s not a cluttered concept. It’s that you simply become better, as any good analyst knows, at concentrating more and more directly, more purely, on what’s going on in a session. You come to concentrate more and more fully on this person who is with you, here and now, and on what it is they experience with you: to the point that many sessions become similar to meditations. When this happens, I usually don’t say very much, but am very, very closely attending to the patient, with my thought processes in suspension, moving toward what Bion called “O”: a state which I see as being “unthought-out,” involving a quality of intuitive apperception of another person’s evolving truth.

To this I would add that I have found the work of Eugene Gendlin and his technique of Focusing invaluable. It provides a bridge between the reflective work of psychotherapy and the being present with what arises as it arises – the experience of being mindful. Focusing invites us to be present with our emotional experience in our body, the felt sense. To find words, phrases or images that express the felt sense and remain attentive to any changes without attachment to change. Making paramount the ability to ‘stay with’ rather than descend into long stories ‘about’ what is felt.

Another example: Ted described his life long fear of depression. He had realised that whenever he had a leaden feeling in his guts and limbs and a sense of hopelessness and not caring, he would jump up immediately and engage himself in an activity. When he started practising mindfulness he became aware of this defensive manoeuvre and instead decided to simply remain mindfully present with the basic feeling. Quite a brave thing to do given his aversion to this particular fear. Doing this it became plain to him that the basic feeling, leaden guts and legs, feelings of hopelessness and lethargy, generated secondary emotions of fear and alarm, causing him to do anything but stay with his actual experience. In time his ability to reverse this process grew. Initially he began to consciously notice the depression and his defensive avoidance of it when it occurred. Then gradually he was able to stay present with the feelings and allow himself to have them without any desire to articulate them, change them or understand them in any way. Just leaving what was, as it was, a sensation and a feeling, and remaining present with it until it finally passed of its own accord.

Staying with rather than stories about.


Talking about wisdom in psychotherapy is difficult. I observe in my self a shying away, a fear that I may get too inflated and fall into the fascism of ideals, of the unhelpful narratives, that we looked at above. However in Buddhism wisdom is equated with knowing how things really are, not just how they appear, and the way to do this is – again – simply being present with what is happening without adding any of our own ‘stuff’ to the experience. The ongoing act of mindfulness already described. Something that some forms of psychotherapy specifically concerned with trauma are beginning to recognise as extremely valuable.

Where Buddhism and psychotherapy do not meet is on how deep this process can go. At its worst psychotherapy is often satisfied with a general understanding of how wounded patterns of being were created, somehow trusting that once we have a rational view of our neurosis that will be enough. In my experience such knowledge is never enough, it has no ability to actually be conscious of the thoughts and emotions that arise out of the patterns of hurt, complexes, as they occur and therefore is all too prone to either further acting out or repression. Personally I neither believe in nor trust those who think they have had a full analysis and now know what is theirs and what is their patients. My observation of myself and others over twenty five years of clinical practice is that our identification with our wounding is very deep, perhaps so deep it colours the whole personality, and therefor we are always acting out of it one way or another.

The Buddhist take on this is to see the personality and all its woundedness as a narrative, a story of who we are, that we tell ourself all the time. A story we defend when any threat to it comes near. Most analysts, psychotherapists and counsellors will recognise a particularly obvious manifestation of this in the patients or clients that steadfastly cling to their material, actively resisting change. Their fear is probably of the unknown that would emerge if they were to let go. However it is the Buddhist belief that we are all doing this all the time – its just that most of us do it less obviously. Thus in a mindfulness based psychotherapy the narrative is less important than an awareness of how the narrative is used. The belief that being with our experience openly is more important than knowing how we became so closed. Of course to be human is to spin our own tale and the meaning that comes from this is an important element in keeping happy and sane. However the narrative can be and is frequently used defensively – a closed story about who we are, what we like and don’t like and how far we can travel. Becoming aware of our narrative, not just its content, its story lines, but also how we use it to defend our self against the fullness of our experience is central to the work.

A post note. On Friday I asked someone I have been working with for long time what wisdom had arisen from their practice of receiving and giving psychotherapy, and their involvement with Buddhism. The first response was to laugh – what wisdom! – and then they reflected more seriously and came up with the following. Firstly the realisation that they were not alone in their madness. That all of us suffer in our own way with our own stuff. This discovery was an enormous relief. Then that telling our story to another person really helps. Relationships, intimacy, are made much better, deeper, richer. More authentic. Then everything changes, however bad, this too will pass and finally that the story of myself is made up of thoughts, emotions and body sensations which on close examination are not as solid, not as non-negotiable, as they initially seem – it really is a story and the realisation of this brings immense and unexpected freedom.

19 July 2009

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