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The task of introducing meditation to secular, scientifically minded clients is getting easier as the body of neurobiological and clinical research we can refer to grows. For secular folks who’d be disturbed by the Buddhist roots of these practices, we can follow the lead of John Teasdale, Zindel Segal, and Mark Williams, who initially simply called what they were offering Attentional Control Training.

There are bigger challenges to this marriage, however. For example, some Buddhist clinicians and teachers worry that mindfulness practices will be “denatured” by therapists who don’t understand their true potential. They also point to the danger of relatively untrained clinicians functioning as spiritual teachers. Most wisdom traditions have strict criteria: one needs to attain certain levels of spiritual realization before guiding others. This realization is assessed in long-term, mentor-student relationships. So there’s the real danger that by venturing into territory traditionally reserved for spiritual adepts, clinicians will either miss the point of the practice or do more harm than good. The field hasn’t begun to address this problem yet, but it will have to if the integration of mindfulness practice and psychotherapy heads in a more spiritual direction.

From another angle, there’s the concern that, by opening the way to the more radically transformative potential of these practices, we may unethically lead clients where they never asked to go. After all, most clients come in looking for symptom relief, not for a radical reordering of their consciousness. Yet what if a clinician believes that such transformative work is the only real way to alleviate suffering? This is another question we haven’t begun to tackle.

The future of the integration of mindfulness and psychotherapy will depend on whether clinicians choose to use these practices for spiritual growth, inviting their clients to do the same, or teach these techniques to clients as a gateway to symptom reduction. If we head down the spiritual path, therapists will be faced with the question of how or when to address the transformative potential of these practices with their clients, or to speak of the insights they can yield. For example, if a client is grieving the loss of a love relationship, pointing out that everything changes and that there’s no way to hold onto anything will probably result in a terrible empathic failure or encourage the client to perform what psychologist and Buddhist teacher Jack Kornfield calls a “spiritual bypass”: escaping a painful emotion by defensively acting as though we’ve transcended such petty worldly reactions. Then again, there are moments in treatment when it may be beneficial to help clients understand that clinging to pleasure and pushing away pain multiplies our misery, or how transient life events and feelings really are. Figuring out when to stay empathically attuned to clients’ narratives and when this keeps them stuck in a relative truth is beginning to enter clinical discussions, and is likely to be of continuing interest to therapists who want to use mindfulness for more than just symptom alleviation.

The Fruits of Mindfulness

In the Buddhist tradition, the path to emotional freedom or sanity involves cultivating two interrelated virtues—wisdom and compassion. Traditionally, wisdom and compassion are seen as two wings of a bird or two wheels of a cart—both necessary for awakened action. Wisdom involves seeing the world as it really is, being fully aware of the “three characteristics of existence.” These are anicca, the observation that everything is a constantly changing flux of matter and energy; dukha, often translated as “life is suffering” but more accurately stated that the mind is always dissatisfied (or as the great sage Rosanne Rosannadanna put it, “If it ain’t one thing, it’s another”); and anatta, the realization that if we observe our experience carefully, there’s no “I” to be found, just the unfolding moment-to-moment of experience along with the mind’s running narrative commentary about it all. In the clinical arena, this manifests as seeing how all phenomena are interrelated and multidetermined, concern for the effects of our actions near and far, holding constructs lightly, not taking things personally, and being open to new experience. Buddhist compassion (karuna) involves recognizing and being open to suffering, and wishing to help others in their pain. In the clinical arena, this translates to nonjudgmental understanding, seeing others as fundamentally like ourselves, having the capacity to be with another’s pain, and being able to be compassionate with ourselves when we suffer.

If we choose to use them this way, the array of practices gathering under the mindfulness umbrella can help us and our clients inch toward greater wisdom and compassion, with the ambitious goal of developing greater psychological awareness and freedom. This is the ultimate promise and challenge of the marriage between mindfulness and psychotherapy.

Ronald Siegel, Psy.D., an assistant clinical professor of psychology at Harvard Medical School, is the author of The Mindfulness Solution: Everyday Practices for Everyday Problems, the coeditor of Mindfulness and Psychotherapy, and most recently, coeditor of the forthcoming book Wisdom and Compassion in Psychotherapy: Deepening Mindfulness in Clinical Practice.

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