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West Meets East

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PNSO11-1Creating a New Wisdom Tradition

By Ronald Siegel

As mindfulness practices work their way into the psychotherapeutic mainstream, we’re starting to ask more clinically sophisticated questions: Who needs what practice when? What about the downsides of some mindfulness interventions?

Twenty-five years ago, when our small group of Boston therapists began meeting to discuss how we might apply ancient Buddhist meditation practices in our work, we didn’t often mention it to our colleagues. Most of us had trained or were working in Harvard Medical School facilities, and the atmosphere there was heavily psychoanalytic. None of us wanted our supervisors or clinical teammates to think of us as having unresolved infantile longings to return to a state of oceanic oneness—Sigmund Freud’s view of the meditation enterprise.

At that time, Buddhist meditation was becoming more popular in America, and intensive meditative retreat centers were multiplying. The new centers often were staffed by Western teachers, many of whom had first encountered meditation in the Peace Corps and later trained in monastic settings in the East. Some of our group had studied in Asia; others had been trained by these newly minted Western teachers. Regardless of our backgrounds, what we shared was that we’d all experienced how radically meditation practices could transform the mind.

Therapists of the day typically viewed meditation as either a fading hippie pursuit or a useful means of relaxation, but of little additional value. Meditation teachers had their own biases toward psychotherapy, typically regarding it as a “lesser practice,” which might prepare someone for meditation but couldn’t really liberate the mind. So those of us who were involved in both domains, and viewed them as complementary, largely kept to ourselves.

During the subsequent decade, while the therapy and meditation communities continued to show little interest in each other, mindfulness meditation was making inroads into the medical community. This was largely through the efforts of Jon Kabat-Zinn, who, beginning in 1979, had adapted ancient Buddhist and yogic practices to create Mindfulness-Based Stress Reduction (MBSR) at the University of Massachusetts Medical Center in Worcester. This standardized, 8-week course couched meditation practices in Western, scientific terms. Their working definition of mindfulness—“the awareness that emerges through paying attention on purpose, and nonjudgmentally, to the unfolding of experience moment to moment”—made the concept readily accessible.

In its early years, MBSR was used primarily to augment the treatment of stress-related medical disorders, and was of particular interest to clinicians working in behavioral medicine. It wasn’t considered a form of psychotherapy, and MBSR teachers weren’t necessarily psychotherapists. In Boston and other psychoanalytically oriented cities, therapists were finding other developments more compelling. The zeitgeist was shifting toward biological psychiatry and short-term treatment. Cognitive-Behavioral Therapy (CBT) began to gain traction, along with a variety of systemic and humanistic approaches. Meditation practices received little attention.

Mindfulness Meets Psychotherapy

The first use of mindfulness in psychotherapy to capture widespread attention among clinicians was Marsha Linehan’s Dialectical Behavior Therapy (DBT), introduced in the early 1990s to treat suicidal individuals with complex disorders for which little else seemed to work. The central dialectic in DBT is the tension between acceptance and change. In searching for a means of helping therapists and their clients to experience what she called “radical acceptance”—fully embracing helplessness, terror, losses, and other painful facts of life—Linehan drew on a number of mindfulness practices from Zen traditions and Christian teachings. Because she empirically demonstrated that DBT could help challenging and volatile patients, the method rapidly became popular. Interest in it grew throughout the 1990s, but even though mindfulness skills were a core part of its approach, mindfulness practices still didn’t gain much acceptance within the wider therapy community.

The next big development came from Zindel Segal, Mark Williams, and John Teasdale, cognitive psychologists in the tradition of Aaron Beck, who were working on treatments for depression in the 1990s. They came across mindfulness practice through Jon Kabat-Zinn and MBSR, and were struck by its power. This led them to formulate a treatment, eventually called Mindfulness-Based Cognitive Therapy (MBCT), which combined elements of an 8-week MBSR course with cognitive therapy interventions designed to help patients gain perspective on their thinking and not identify with their depressive thoughts. The first results of their work, published in 2000, were dramatic: for patients who’d suffered three or more major depressive episodes, attending an MBCT group cut their relapse rate by 50 percent over the next year. Since not many interventions in our field cut anything in half, this caught the attention of the CBT community and piqued interest in mindfulness practices.

Around the same time, Steven Hayes and his colleagues had been developing behavior therapies based on a radical philosophical orientation that they called “relational frame theory.” They didn’t initially describe their work as mindfulness-oriented, but as the word began to be used in behavioral-research circles, they started to adopt it. Their treatment is called Acceptance and Commitment Therapy (ACT), which they describe as a psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility. ACT doesn’t teach many formal meditation practices, but uses imagery, metaphor, and brief exercises to cultivate awareness of the present, loosen identification with thought, and increase openness to the experience of moment-to-moment change. Beyond these more traditional mindfulness practices, ACT encourages clients to identify and pursue activities that give life meaning.

Throughout this period, our study group in Boston was emerging from obscurity. In the mid-1990s, we formed The Institute for Meditation and Psychotherapy and began putting on small conferences and workshops for clinicians. During the first few years of the new millennium, interest grew rapidly, and by 2005, members of our group published the first comprehensive professional text on the subject, Mindfulness and Psychotherapy. In the same year, we approached Harvard Medical School with the idea of developing a conference on the topic. We worried that the committee that decides these matters would feel it was an unsuitable subject for such an august institution, but after being presented with peer-reviewed published studies on the topic (mostly coming from CBT circles), they agreed to let us try. Seven hundred people showed up, and the conference was a great success. It was clear that times were changing.

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