Open Book

A Vehicle of Awakening

Can Psychotherapy Be a Spiritual Practice?

Magazine Issue
March/April 2022
The Zen of Therapy

How do you know what to believe? Siddhartha Gautama—the Buddha to you—would say, don’t take my word for it, or the words of your teachers, or anyone else, or even your own logical mind in its ambitious and solipsistic interiority: examine all your beliefs. And by examine, the Buddha would mean: see what you see, pay attention to the evidence of your senses, orient yourself to the world before you, investigate it all, then draw your own conclusions. But hold even these conclusions lightly, as you keep looking and studying and revising.

The Buddha was a scientist—I’d say a radical empiricist—living in northern India in the 5th and 4th centuries BCE, back when that sort of understanding of your own life and experience was curated by a high Brahmin culture, with its priests and Great-Grand-Lord-High-Everything. Like all absolutist hierarchies everywhere, there were beliefs in this and that, and you had to be a special person to be allowed to know certain things.

Two thousand years before Western Enlightenment, the Buddha discovered that you could think for yourself—a revolutionary idea, with one hefty and demanding caveat: along with your senses, you have a mind that organizes and apprehends, that can do a good job or not so good a job of evaluating the world before it. So here’s the trick: the mind itself needs observing—if we might reify the mind into a thing for our purposes here. It’s like a prehensile tool: it grabs and pokes, but it also slips around, evades unpleasant facts, loves its pleasures, yet becomes a dog on a bone with its harsh judgments. Central to the project of dealing with “reality” (let’s call it), not to mention dealing with the problem of suffering, is how to develop an understanding of one’s own mind-activities. Could such a project not be more congenial to the work of psychotherapy?

Mark Epstein, a New York City psychiatrist, thinks so. As, of course, do many others in Western culture, people who have come to appreciate not only Buddhist thought, but also meditation and other mindfulness practices: psychotherapists of all stripes, philosophers, trauma experts, wellness practitioners, researchers in human nervous systems, students of consciousness, and—I’m a bit uneasy here—corporate trainers, influencers, speakers at well-meaning conferences, self-justifying pundits of all sorts.

In the 1970s, Epstein started on a path: studying Buddhism, practicing meditation, learning to sit in silence. Early on in medical school, he discovered that his study of Buddhism made therapy “make sense.” Traveling to Thailand in those heady days, he met and sometimes befriended other adventurers exploring what were then “exotic” Eastern spiritual practices. Some returned to Western cultures ready to teach these exciting new ideas, although the practice of meditation, the central galvanizing idea of “mindfulness,” rested in the margins, off-center and too insubstantial for busy, pragmatic Americans. That was then.

Nowadays, Epstein asks himself how actual Buddhist thinking might show up in his New York City basement office in an actual therapy session. The heart of his new book, The Zen of Therapy: Uncovering a Hidden Kindness in Life, is a year’s span of swift and captivating vignettes: prepandemic scenes from this or that session, with this or that person. He made no effort, he writes, to chart the progress of “any particular patient but focused instead on my own feelings of having contributed something of value in whatever encounter I chose to record.” But there was a question before him: “What am I offering my patients that is different from what a non-Buddhist therapy gives? And if something is coming through, what is it, and how is it coming across?”

Reading this, I thought, huh. Hasn’t he always compared Buddhist ideas with the conceit and projects of psychotherapy? A prolific writer, he’d early on written Thoughts without a Thinker, a classic, a mix of earnest explanation and telling anecdotes to illustrate how Buddhist teachings and, say, Freudian ideas might inform each other and even dovetail. More books followed, all stitching and restitching the contours between Buddhism and the Western traditions of psychotherapy. But in The Zen of Therapy, he abandons a typical Freudian language of drives and appetites and instincts for a language of relatedness and connection, starting with a connection to yourself and to your own mind. That’s a topic, as it turns out, that Buddhism has down cold.

He keeps the Freudian idea of a superego, that harsh tyrant, and you’ll have to read the book to see how he turns it into a Spanish clown. But in the end, he takes therapy to be a spiritual endeavor, one that, like meditation, is a vehicle of awakening. In contrast to an old-fashioned religious practice, where one might be hoping for grace to relieve a burdening humanity, therapy turns the gaze, lightly, toward the burden. In this regard, the psychologist John Welwood noted that people sometimes use spiritual practice as a way to transcend complicated and difficult emotions, like anger and greed, enacting a kind of spiritual bypassing that’s really just a fancy, self-inflicted form of sliding dissociation. Too, too transcendent. So then, what does psychotherapy gain from understanding Buddhist ideas?

Take Jack, Epstein’s long-term client, who’s lived his 60 years weighted with the inconsolable pains of his Holocaust-surviving parents, an engulfing bleakness that registered in his boyhood as something to do with his own inability to make it up to them. In one session, he laments, “Will I ever be healed?” to which Epstein suddenly says something new to him: “You are already healed.”

It’s a statement puzzling enough that Jack pauses, for a moment—just a moment!—not caught in the usual cycle. Epstein adds that Jack helped his parents by being born, that being born was itself an act of compassion in their lives. When the session ends, both men can feel a surprising moment of instability in Jack’s unshaken conviction, “a lightness,” Epstein writes, “I associate with the release of age-old psychic attachments.” And here he explains clinging, which he thinks is a central principle in any Buddhist therapy.

He argues that understanding the origin of early trauma goes only so far. (As one sage used to say, “Understanding is the booby prize.”) The task is to get interested in how we’re stuck, how we repeat the same thoughts and feelings over and over, how much we identify with these thoughts and the pain they generate. We all take our own disturbing emotions so seriously that our defenses against them generate much of what we experience as our very personality, our immutable traits.

Most of The Zen of Therapy consists of these snapshots of one person or another, brief bright sketches, illuminations I’d call them, revealing as swiftly as they do the person at hand. They also reveal the full-bore presence of Epstein, his reactions in the moment, his playfulness and quick understanding, as well as his second thoughts, his deliberating later about what had caught his attention and why he’d said this and not that.

Along the way, Epstein presents little tutorials on the work of Donald Winnicott, not a Buddhist himself but, I’d say, Buddhist-y. Winnicott’s work focuses on the basic mother–infant couple as our best model, a relationship not of competition and retaliation despite the infant’s “ruthlessness,” but of a kindly holding and containing. Epstein’s model of meditation itself leans into this notion of a gentle holding as a person sits with their own wild and ruthless thoughts, which becomes his model for therapy. It’s nothing passive. Epstein holds things lightly, but he’s often blunt, sometimes surprisingly pushy. Other times, he lets something pass that a therapist trained or bent in another direction would invariably seize upon.

Take Willa, who announces that she loves Epstein; she’s in love with him. Epstein pauses to let recognition of this love register. But he doesn’t stop to analyze the transference of early childhood feelings now being visited upon someone else, no looking-over-the-top-of-his-glasses questioning. He sits instead with the innocence of Willa’s admission. “It was like a revelation,” she says. The revelation being that she can feel a simple love as if it’s no big deal, after an unnerving history of unstoppable sexual abuse in her adolescence, perpetrated by her accomplished father, not helped by her depressed and numb mother.

The point is not that other therapists wouldn’t pause to consider whether a pointed inquiry is necessary, but that as therapists we have different reasons for our pausing, our raising an issue now, or later, or never. And here is Epstein’s reason: Willa is shifting out of clinging to a fixed feeling, in this case an attachment to an ever-cycling feeling of having been tarnished by love. She has a moment of blessed release from her own ruthless negativity.

Epstein observes that a meditative awareness “encourages people to accept their neuroses, their conflicts, their shortcomings, and their troubling emotions, but not be caught by them.” So he works to loosen one’s identification with the already known self. (Tellingly, one of his books is subtitled A Guide to Getting Over Yourself.)

There’s a difference, he argues, between ignoring an emotion or a troubling idea and leaving it alone. He notes that both meditation and therapy develop the seeker’s stamina to work with not-knowing, to tolerate ambiguity and ambivalence and inadequacy. So he watches carefully as the mind begins to reveal itself: a “vivid and transparent thing hidden within the twisted shards of our personality,” hidden enough that we remain blind to the “vivid transparencies” of other would-be beloved human beings.

For example, take Lakshman, an older man. He understands his objectification of women is a problem, yet it entertains him to sit in the crowded subway car, fixated on rating who’d be a good screw or not. He has just returned from a visit with a spiritual teacher who’s tried to help him by telling him this: Love the thoughts. Lakshman is puzzled: He does love the thoughts, that’s the problem, because he’s also ashamed of them.

The teacher has added another directive: See yourself as a soul. Now that puzzles even Epstein, who thinks that Lakshman might start with seeing the souls in the women he so crudely objectifies. But quickly Epstein gets it: Lakshman is attached to the vision of himself as a great lover, and yet it’s a cover for an experience of himself as weak and inadequate, so unsettling that he blots out the feelings with his immersion in vivid sensual pleasures. He cannot see even his own soul.

Several months after this session with Epstein, Lakshman has an emergency with his heart, an arrhythmia. He gets a pacemaker, and now, he says to Epstein, he sits on the subway wondering who’s a good accountant. He’s lost his interest in sex and hardly knows who he is anymore. Buddhists in general love these moments when we don’t know who we are, when our hardened identities are challenged. Besides appreciating the lively and even intimate quality of not-knowing, where we’re moved to scratch our heads and look again, we now have a cliff’s-edge chance to investigate, to look over at the looming gap. “Learning by unlearning,” Epstein writes. “Disorienting systems is something both Buddhism and therapy can agree on.” Although we won’t learn how it turns out for Lakshman, we get this flash of him, as we go on, two flashes in all, a few post-session observations from Epstein, and then we’re on to the next client.

So take Donald, who has a cranky wife, or so he’d say. It turns out that it’s Donald who has a temper, who arrives home with takeout soup and sandwiches for his wife and daughters, only to sulk the rest of the evening because his wife made a comment about the portion size of her soup. This situation, Epstein explains to him, is a golden opportunity to experience “the cry of the self that doesn’t exist.”

Luckily, Donald doesn’t leave in disgust at his gnomic remark. Instead, he asks, “What would you say to me, if you were there in the room and could whisper in my ear?” Epstein thinks, what would I say? He surprises himself: “Have a sense of humor at your own predicament.” Humor, need it be said, is the great unraveler of our own pomposity, our own Great-Grand-High-Lord-Everything, if that’s your problem.

Epstein reflects that it’s not that the self is not real, as a teacher in Mongolia told a New York City professor of Buddhism, who told it to Epstein—the oral tradition at work here—but rather that most people think the self is “really real.” And we invest it, this accumulated self, with more substance than it actually needs, a substance that’s fed by grievance. Truly, it’s changing all the time and would grow and learn even more except that we keep trying to make it something solid and secure and fixed. “Happiness,” wrote John Tarrant in a book Epstein references, “is not an add-on to what you already are; it requires you to become a different person from the one who set off seeking it.”

The vignettes, the illuminations, keep coming, one after the other, all vivid, making room for, say, a Buddhist-y working with the intractability of anger, not something to be papered over, but also not something to get stuck in, either. Or a discussion of “injured innocence,” and innocence after tough experience, and the progression from grievance to gratitude that Epstein thinks both Buddhism and psychotherapy share.

There’s a developmental richness to Epstein’s ideas, where themes rise up from the disparate vignettes almost to surprise himself, where metaphors gather weight and resonance as the tales advance through this designated year, where poems are referenced again and again, showing something different each time. Woven throughout are observations he treasures from John Cage, the avant-garde composer whose valuation of even the most ordinary, uninteresting sounds Epstein finds to be a model for how to value, well, everything.

But still, I had questions. I’d been reading The Zen of Therapy: Uncovering a Hidden Kindness in Life, wondering, where’s the hidden kindness? And why Zen, and not Thai or Tibetan Buddhism? Epstein has a cosmopolitan immersion in Buddhism and its variants, but his homebase looks to be Insight Meditation, arising out of the historically early Buddhist Vipassana (awareness) practiced in Thailand for one, and developed into a Western variant with Joseph Goldstein, his teacher, and others in central Massachusetts. But koans, little stories and riddles, have been used in Japanese Zen Buddhism to shake people out of their rigid thinking. And Epstein appreciates a therapy session for its Zen koan-like properties, its capacities to manage discontinuities and riddles, to leap away from the accumulated self. That’s the awakening that psychotherapy can facilitate.

And Epstein has preferred kindness, rather than the more ubiquitous compassion. He defines kindness as an enactment of noninterfering attention. But your capacity for that kindness, your recognition of a “vivid and transparent thing,” is often hidden, covered over by the efforts to make a solid, unassailable self. In Buddhist thinking, there’s a fundamental benevolence to be discovered by “peeling away . . . overly elaborated and often punitive self-concepts.” You start with yourself, start with bringing this kindness, this gentle attention to your own confusions and pain—as in meditation, as in therapy—so that you can carry that skill into a wider and increasingly less solipsistic world. Attention is kindness. We’ll end, as he does, on that tender and succulent note.


Molly Layton

Molly Layton has been writing for the Psychotherapy Networker for more than 25 years. Her short stories have been nominated for a Pushcart Prize and included in the Writing Aloud Series at the InterAct Theater in Philadelphia.