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Buddhadharma : Spring 2009
buddhadharma: the practitioner’s quarterly SPRING 2 0 09 32 collective healing and awakening—methods that don’t come from the spiritual traditions themselves. And as the number of spiritual, psychological, medical, and other healing practices continues to multiply, this becomes an increasingly perplex- ing—and ever-more relevant—question. We need a significant and disciplined evaluation of how best to combine dharma and diverse therapeutic disciplines, including the most con- troversial of all therapies: medication. In fact, such an evaluation has already begun. It’s in its early stages, but it is indeed underway. Psychotherapy and Meditation When Buddhism first came to the West, many teachers and practitioners initially dismissed psychotherapy as superficial, unnecessary, and possibly counterproductive. As time went on, more and more students faced crises or simply felt their spiritual practice was not dealing with deeper problems that were hindering their development. Psychotherapy’s relation- ship to spiritual practice started to undergo a reevaluation, and the two disciplines began to intermingle a bit more. Among the first to bridge the divide between therapy and spiritual practice was Jack Kornfield, who is both a meditation teacher and psychologist. In 1993, he wrote an article called “Even the Best Meditators Have Old Wounds to Heal: Combining Meditation and Psychotherapy,” which was published in the book Paths Beyond Ego: The Transpersonal Vision. In it he argued: For most people, meditation practice doesn’t “do it all.” At best, it’s one important piece of a complex path of opening and awakening... There are many areas of growth (grief and other unfinished business, communica- tion and maturing of relationships, sexuality and inti- macy, career and work issues, certain fears and phobias, early wounds, and more) where good Western therapy is on the whole much quicker and more successful than meditation... Does this mean we should trade meditation for psychotherapy? Not at all... What is required is the courage to face the totality of what arises. Only then can we find the deep healing we seek—for ourselves and for our planet. Controversial in their time, Kornfield’s ideas have now gained wide acceptance. In fact, meditation and psychother- apy are being integrated in many different contexts, as therapy clients and patients are offered meditation and meditators are offered therapy. Research has convinced therapists of the value of meditation for a host of psychological and psychosomatic difficulties. In fact, many therapists and meditation teachers now agree that meditation and psychotherapy can be mutu- ally facilitating. Meditators seem to progress more quickly in therapy, while psychotherapy can improve the effectiveness of their meditation. In addition, combination therapies that integrate medita- tion and psychotherapy are proliferating, and often prove more effective than either application alone. The original inspiration was Jon Kabat-Zinn’s widely used “mindfulness- based stress reduction” (MBSR). Originally designed to treat chronic pain, MBSR has since proved helpful with a diverse array of psychological and psychosomatic difficulties. Exam- ples of disorders that have responded well to MBSR range from anxiety, aggression, stress, and eating disorders on the psychological side to asthma, angina, and high blood pressure on the somatic side. Several recent combinations merge Buddhist mindfulness with specific psychotherapies. These include, for example, “mindfulness-based cognitive therapy” for depression, “mind- fulness-based sleep management” for insomnia, and “mindful- ness-based relationship therapy” for enhancing relationships. Research affirms the effectiveness of each of these approaches. More broad-based combination treatments—such as transper- sonal and integral therapies—incorporate multiple psychologi- cal, spiritual, and somatic strategies. In short, the integration of contemplative and conventional therapies is proceeding rapidly, and the results are promising. Combining meditation and psychotherapy makes sense if we appreciate how they work in complementary ways. For the most part, meditation focuses primarily on developing capacities such as concentration and awareness, whereas psychotherapy focuses primarily on changing the objects of awareness, such as emotions and beliefs. Of course, there are also significant overlaps, but this complementarity suggests