Implications at the practical level
As mentioned before, the dialogue and integration between Buddhist and western psychology has been started for a rather long period of time. Many psychotherapeutic approaches have been developed and put into practice. Generally speaking, the approaches can be divided into two major groups: one is developed on the basis of western traditions by western scholars/practitioners such as Morita Therapy, Zen Therapy, Mindfulness-Based Stress Reduction Program (MBSRP) and 3’S approach. The other group of approaches has been developed by Buddhist monks and teachers who are trained in traditional Buddhist culture such as Contemplative Psychotherapy, Core Process Psychotherapy and Naikan Therapy. We also note that some approaches such as Zen Therapy and Contemplative Psychotherapy which emphasize on Buddhist philosophy and practice such as practicing mediation, developing non-dualistic relationship, realizing “non-self” nature and cultivating loving-kindness. Some approaches, on the other hand, tend to be “technical eclecticism”. MBSRP is one of the examples, which only stresses on practicing mindfulness and meditation skills, which is de-contextualized from Buddhist culture and philosophy. Nowadays, the joint venture between Buddhism and psychotherapy is an inevitable trend, therefore, it is also worthy to discuss the implications at the practical level. Our discussion will be based on Prof. Karunadasa’s discussion framework on the meaning of suffering. In fact, his framework is also corresponding to the major components of a psychotherapeutic intervention: acknowledging the problem, understanding the problem, developing the coping strategies and the roles of the involved parties (client and therapist). Moreover, our discussion will also be supplemented with a case illustration. I choose this case because its central theme is in line with our rationale to suffering – perceiving suffering (Stan’s pain and anger) as a potential for the “breaking through.” For that reason, I will briefly introduce the case background information before starting our discussion.
The client, Stan, married with children, is a plumbing contractor who had found himself suffered from lung cancer three months ago. His ability to work and daily activities had been greatly diminished by the physical pain and the short-windedness. His emotional reaction to his sickness, like most of other people, is totally despaired, frustrated and angry. Accordingly, he has connected with the weekend workshop for some years and indicated a deep spiritual tendency – I think this arrangement is especially important for Stan who can be more receptive to the Buddhist ideas in the counseling process and has a positive response to the “Who ma I?” technique of self-investigation.
First of all, when acknowledging suffering, as a reality of life, has positive function in leading a noble and satisfying life, psychotherapist would have to understand and coach his client to realize that suffering is nothing more than an invitation to advance our intellectual, psychological or emotional maturity. We do not fight or flight, but try to constructively make use of it with a fearless attitude. As what Stephen believed: Stan’s pain and anger may be a potential for some kind of “breakthrough”: so we would better start where the suffering is!
Secondly, we know that suffering is dependent origination in nature, which can be ceased. With this understanding, psychotherapist will bear in mind that what he does is not just to fix the given problem or the symptom. There is another way which can assist the client in adopting a total different perceptive towards suffering, just like the case of Stan. Moreover, in line with the twelve-link formula, the concrete application of the principle of Dependent Origination suggests that “ignorance” is the root of suffering which refers to an “attachment to the false notion of self”. So, psychotherapist is recommended to be aware of the use of sympathy, empathy or other concepts and techniques which may reinforce the self-procession in the helping process. Positively, sympathy and empathy can contribute in developing a good working rapport. On the other hand, from the Buddhist perspective, they will also intensify and reify the sense of self for grasping. Suffering, as a psychological and mental experience, will then be carried on by developing the idea: there is “me” who is suffering. However, it does not mean we are necessarily cruel to our clients, we just suggest psychotherapist developing non-dualistic and non-hierarchical working relationship, in the Buddhist term, compassion. And be mindfully and carefully used those concepts and techniques. For example, as reflected from the whole transcript, Stephen never communicated Stan with a sense of empathy or any statement that he felt sorry about his situation, but he tried to guide Stan to dig into the suffering so as to find out the true nature of self.
Moreover, being inspired by the principle of Dependent Origination – with the arising of A, B arises; with the cessation of A, B ceases, we suggest psychotherapist does not only focus on working with the manifestation of suffering such as the symptoms though they are also very important but also on the conditions leads to suffering. Take Stan’s case, his affliction and suffering are obviously originated from his lung cancer, so we can work on the manifestations of suffering by using Panadol to alleviate his pain and Prozac or some kind of techniques to regulate his mood. However, his pain and emotional fluctuation may also be conditioned by the ideas of unfairness, loneliness and fear. Therefore, in Stan’s case, the conditions which supported the existence of suffering, other than the physical dimension, were the above mentioned psychological and mental constructs. To work on these constructs is the primary concern of psychotherapy. Nevertheless, according to the Buddhist perspective, there is another way out because the major condition supports suffering is induced by the ignorance and the attachment to the notion of self. So Stephen gave up exploring the concepts of fear, fairness and loneliness but directly taking the Buddhist way – to unveil the nature of self together with Stan. Additionally, people are also recommended to work on the constructive side by cultivating good conditions such as Loving-kindness (Metta), Compassion (Karuna), Sympathetic Joy (Mudita), Equanimity (Upekkha), rather than only working on the destructive side, the manifestations of suffering. Therefore, one can cultivate good conditions to lead a noble and satisfying life by practicing the Noble Eightfold Paths. In this sense, Stan was coached to develop his Right View and Right Thought.
Thirdly, Buddhism rejects any interpretation of suffering because interpretation implies an attempt of rationalization which will result in avoidance, acceptance, stagnation or provoking of secondary emotion and will also direct client to focus on suffering. Interpretation will focus on its meaning and content while mindful practice is rather process-oriented. All reactions created by interpretation prevent client from developing mindful practice. Psychotherapist is thus recommended to focus on helping the client to mindfully experience his reactions to the suffering such as to observe the reactions of the five skandhas with fearless and non-judgmental attitudes by going through a dialectical process. I will term the elements of the dialectical process as the knocking, coaching, exploring, investigating and educating if we take the point of view from the psychotherapist. On the other hand, the elements as observing, describing, acknowledging and accepting will be added if we view from the client’s side. In Stan’s case, Stephen coached Stan to go through the dialectical process step by step. Here are some of the episodes which elaborated from psychotherapist’s side:
The first element we talk about is knocking which denotes psychotherapist trying to assist the client in developing the alternative views on their suffering/situation. The suggestions may be some strange ideas which the client may reject. Therefore, psychotherapist will present as an invitation and non-intrusive attitude by using the wordings such as maybe and perhaps, just like knocking on the door. However, client’s right of not opening the door should be respected:
Stephen: “Maybe it isn’t the illness that is the cause of your suffering, maybe the cancer is just putting you in touch with your holding to old ways of being in the world. Perhaps it is your self-image, no longer constantly able to be reconstructed, that is causing your suffering.”
The second element is exploring which denotes a comparatively breath and shallow searching involved in the process of thinking and reasoning. Psychotherapist also guides the client to be observing and acknowledging his discovery during the process. To the certain extent, the function in this part is similar to the Right Mindfulness:
Stephen: “Well, Stan, when you say ‘I am,’ to whom does that refer?”
Stan: “Well, I guess I mean Stan, the owner of a plumbing business, the father of my children, the protector of my family . . . some poor asshole dying of cancer.”
Stephen: “What is this sense of ‘I am’ that is behind all the outward appearance? You know, when you say, ‘I am this’ or ‘I am that,’ there is always something to lose and somehow it is never the whole truth…”
Thirdly, Investigating denotes a searching process attended to a particular focus at a given moment. The focus will be as a concept, an emotion, an object or a particular part of our body. It is a narrow and deeper exploration without emphasizing on the cognitive knowing. It is similar to the Right Concentration:
Stephen: “Perhaps you might want to take some time to investigate these states of mind like willingness, fear, frustration, doubt. See what their nature is and see who is experiencing these states…Investigate, ask yourself, ‘Who is willing? Who is frustrated?’ …”
Stephen: “What I am suggesting to you is that you begin to investigate who it is that is experiencing all this. The way that you do it is to ask, ‘Who am I?’ Don’t fight the experience, explore it. Don’t fight the mind…”
Fourthly, Coaching denotes psychotherapist trying to deliver a direction or a task who will suggest the client to attend to. Here, Stephen coached Stan to think, listen and watch as follows:
Stephen: “Perhaps instead of getting lost in the fear, you may be able to get some space around your predicament. Is there even some satisfactory answer, some ‘me’ that is always the same? Is the ‘me’ of the forty-five-year-old fellow who is dying the same ‘me’ as when you were six?”
Stephen: “Can you just listen to the voices? Can you just begin to watch the different personas rise and pass away in the hallway of change? One voice constantly replacing the other. A moment of frustration, a moment of fear, a moment of doubt…”
The last element is educating which serves as a process of information giving. It aims at helping client in developing a new perspective towards his predicament. It is also essential for developing the Right View and Right Thought. In the below quoted part, Stephen explained the relationship between “me” and suffering so as to introduce the doctrine of non-self:
Stephen: “When you are in pain and you ask yourself, ‘Who is in pain?’ sensations are experienced, but who do they stick to? In pain, for instance, it is that sense of ‘me,’ of ‘someone suffering,’ that seems to intensify the anguish. Indeed, the stronger the sense of ‘me,’ the more difficult it is to deal with pain. The more there is a ‘me,’ the more there is someone to suffer. ‘Me’ is the name of our resis¬tance to life, of our constant angling for satisfaction…”
The last implication as drawn from the notion of “does not trace the causes of suffering to any transcendental reality such as Creator God or higher being” is to stress on the importance of the client’s participation and responsibility in the helping process. This is also universal to all psychotherapeutic traditions. In Buddhism, the doctrine of kamma also attempts to assert the individual responsibility. Therefore, Buddha suggests one should be his own refuge. Just like what Stephen told Stan:
Stephen: “…whether it be the displacing of cancer from the body or the displacing of ‘you’ from the cancer. I don’t know what is right for you. Only you can find your way through. You must lead yourself gently and with great awareness…”
In sum, the above discussion has demonstrated how a psychotherapist, based on the message of Buddha, used a non-intrusive and non-interpretive attitude to assist the client in using suffering in a constructive way at practical level and how the interrelated factors of the Eightfold Noble Path have practically incorporated into the helping process.
Conclusion
Both Buddhism and Psychotherapy claim to protect mankind from suffering. However, they offer the term “suffering” a total different meaning – Buddhism believes in “no grit [suffering], no pearl [noble and satisfying life]!” while western psychology believes in “on grit [symptom, the manifestation of suffering], pearl appears!” I think this difference should be mindfully aware of when psychotherapists try to draw reference from each other. In fact, the different understanding of suffering is only one of many debating concepts between Buddhism and western psychology. There still many questions are waiting for an answer:
“Buddhism and therapy both debate the nature of dukkha, the nature of the self, the meaning of salvation/health, the purpose of life, the mechanisms of dependency, the manifestations of impermanence, the meaning of process, the role of ethical integrity, the function of introspection, the boundary between experiencer and phenomena the nature of moral causation and a myriad related subjects.”
I agree with David Brazier, there is a border region between psychotherapy and spirituality [Buddhism]. However, it is not necessary to interpret both traditions could not join hand-in-hand to cooperate and enrich each other. As mentioned before, Buddhism can advocate psychotherapist re-visiting the meaning of suffering in their practice and to rediscovering suffering in a moralized manner. On the contrary, Buddhism can also learn from the experience of western psychology so as to avoid being over contaminated by Scientism and Materialism. Integration, as stated by Hayao Kawai, is never an easy task especially both of them are originated from totally different cultures and philosophies.
Reference
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