Wisdom In Psychotherapy

Can We Afford It?

Magazine Issue
March/April 2013
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It wasn’t their research results or bestselling books that set apart Freud, Rogers, Minuchin, and Satir. They seemed to have a sense of what really mattered. Today have conceptions about clinical wisdom become obsolete?

Maybe insurers and managed care companies are right: psychotherapists today should just faithfully match empirically validated treatments to presenting problems and, whenever possible, encourage clients to take medications rather than engage in more costly, labor-intensive psychotherapy. Indeed, more and more therapists are following this approach, even though it rankles many of us trained during an earlier, less cost-conscious era, when efficient symptom relief wasn’t seen as psychotherapy’s primary goal.

Within the older traditions originally inspired by psychoanalysis, self-knowledge had a place of honor in both treatment and training that it no longer occupies. An analyst needed first to be analyzed to even imagine being an effective healer. In approaches as varied as Jungian, Gestalt, Ericksonian, and many forms of family therapy, insight into one’s own psyche—and interest in exploring its darker recesses—was considered a prerequisite to helping others understand themselves.

However, self-knowledge was only a step along the journey to the true prize: the treasured capacity for therapeutic wisdom embodied by the giants of our field—whether Sigmund Freud and Carl Jung or later innovators such as Fritz Perls, Carl Rogers, Milton Erickson, Salvador Minuchin, or Virginia Satir. What set these figures apart wasn’t their research findings, their place on the bestseller list, or even their distinctive clinical method. It was that they seemed to understand life so deeply and had such a penetrating sense of what really mattered that we believed they’d show us (and through us, our clients) a path to well-being and a more meaningful life if we studied them closely enough.

The question our field faces at this point is whether this older tradition that revered self-knowledge and clinical wisdom is still relevant. In today’s more strictly regulated, bottom line-driven mental health marketplace, should we care about anything beyond symptom relief? In fact, could it be that in a healthcare system that everyone agrees is too costly to sustain, tradition-bound concepts about clinical wisdom have become obsolete, a distraction from the task at hand, and a luxury that we can no longer afford?

The Value of Wisdom in Therapy Today

The overarching question too often ignored amid the time and economic pressures that shape much of contemporary psychotherapy is, what are we trying to accomplish? An insurer’s interest in quick symptom relief may be shared by a client and therapist, but what happens when this isn’t the case? For example, John grew up with a “typical guy” father, who saw women as subservient and lived his life as if the whole point was to be the dominant male in the primate troop (the advertising business, in his case). Deeply ashamed of his own emotional sensitivity, John felt constantly compelled to prove he wasn’t a “loser.”

He wasn’t a particularly unusual client, and we could have proceeded along a well-travelled path common today: having him take prescribed medication for his depression, teaching him relaxation techniques to deal with his stress, and providing a round of cognitive-behavioral therapy to help him replace self-critical thoughts with more realistic ones. But as his therapist, I thought he needed more. So we explored the culturally conditioned roots of his problems, both in the structure of his family of origin and his understanding of traditional gender roles. As a practitioner trained in mindfulness practice, I even invited him to look at the illusory nature of his (and everyone else’s) self—how it was constructed moment to moment from arbitrary identifications with certain thoughts and feelings. It was not your typical 21st-century, symptom-focused treatment plan.

Not only does this kind of approach go against the tide of today’s therapeutic trends, it also raises the question of what equips a therapist to lead a client in such a nonstandardized exploration. This kind of therapeutic work includes challenging dominant societal assumptions about identity, happiness, and the purpose of life. It’s hard to imagine that it will go well without at least a bit of therapeutic wisdom. How can a therapist without some grasp of how to live a rich and purposeful life, not to mention some perspective on the ocean of culture in which we all swim, help a client navigate these turbulent waters?

Even if all interested parties only want symptom relief, ignoring the cultivation of wisdom may still be a problem. Focusing exclusively on empirically supported techniques runs the risk of failing to develop the primary instrument of treatment—us. Even as much of the therapy literature, modeled after double-blind pharmaceutical research, has tried to eliminate the therapist as a variable, metanalyses like those of Bruce Wampold and others keep showing that we can’t take ourselves out of the equation. Again and again, we learn how much the therapeutic relationship matters.

Of course, this is self-evident to any old-school clinician. If I can’t open to my client’s hurt and anger because it scares me, if I need to hold on to my formulation of a problem to feel secure in my view of human nature, or if I need my client to think I’m smart, I’m unlikely to sustain a really effective treatment relationship. Wisdom is precisely what helps us avoid these impediments to be present for our clients. But what exactly is wisdom, clinical or otherwise, and can it be learned or cultivated? If so, how exactly do we go about acquiring it?

What Is Wisdom?

Virtually every culture has a word for wisdom, and people worldwide have little difficulty identifying those they think of as wise. But when it comes to precise definitions, wisdom is quite difficult for most people to describe. In this regard, it’s similar to a rather different area of human interest: hard-core pornography. In 1964, Supreme Court Justice Potter Stewart observed that hard-core pornography “is hard to define, [but] I know it when I see it.”

The study of wisdom is further complicated by the fact that there appears to be an inverse relationship between thinking of oneself as wise and actually being wise. Indeed, when I conducted an informal poll asking experienced clinicians to describe a wise therapist, one of the most commonly mentioned attributes was awareness of the limitations of one’s own understanding. This surprisingly ancient insight (found everywhere from Egyptian papyri to the teachings of Confucius) suggests that anyone who thinks that he or she is wise probably isn’t. The notion is supported by modern research demonstrating that, in general, people who think they’re competent are usually less competent than those who think they aren’t—the so-called Dunning-Kruger effect.

While wisdom has been investigated by reviewing ancient texts from contemplative traditions and setting up laboratory experiments to see how people tackle complex, ambiguous life situations, one of the most fruitful approaches has been to look at implicit theories—our often unarticulated ideas about what makes a person wise. That was the inspiration behind the aforementioned little study I conducted, in which I asked 30 seasoned clinicians to answer four questions: (1) What does it mean to be wise? (2) What are the particular qualities of a wise psychotherapist? (3) What gets in your way when it comes to being a wise therapist? and (4) Do you consider the cultivation of wisdom to be a treatment goal for your clients?

I discovered that when clinicians asked themselves these questions, their answers accorded pretty well with what researchers have found more broadly. Just grappling with the question seems to help us to become a little wiser, enriching our therapeutic work. But it can create conflicts for us in our practices, because, as we’ll see, wisdom can get in the way of following empirically supported protocols.

Here are some of the characteristics of wisdom identified by both researchers and the therapists who participated in my survey:

Concern for Others. Therapists in the survey overwhelmingly cited genuine compassion—concern for the suffering of others and a desire to help—as an important quality of a wise psychotherapist. This involves putting our client’s needs above our own, moment to moment.

It begins by actually showing up for the session, which is no easy task. Sometimes we’re concerned about looking kind or capable, so we posture to boost our image instead of being honest: “I tried reaching your doctor, but wasn’t able to get in touch,” rather than admitting, “I’m sorry, I forgot to place the call.” Or we fail to really pay attention because we’re distracted by outside worries or can’t be with pain that hits too close to home. I’ve often found myself tuning out while listening to a story about metastatic cancer or a kid’s car accident because I couldn’t bear to think that it might happen to my own wife or child.

A psychiatrist friend and colleague nicely summed up the difficulty of being fully present in her work. When asked what got in the way of her being a wise psychotherapist, she replied, simply, “Me.” Indeed, most therapists in my survey said that acting out of personal fears, concerns, and desires regularly prevented them from acting wisely.

But the opposite—wise presence—is possible. As Jon Kabat-Zinn said about speaking with the Dalai Lama, “You know, when talking with him, it feels like he’s really there with you, with genuine interest in the moment—not scanning the room for a better networking opportunity.”

In academic studies of wisdom, concern for others is often summarized as “concern for the consequences of our actions, in the near and long term, for those close and far.” By contrast, as we think of our own or others’ foolishness, it almost always involves focusing on immediate gratification for me or mine. President Clinton wasn’t thinking about others, or considering the long-term consequences of his actions, when dallying in the Oval Office with “that woman.” Nor am I thinking of the big picture when, dreading the paperwork, I’m tempted to take on a self-pay client over one with managed care coverage.

How might a clinical day be different if we stayed focused on the likely consequences of our actions, near and far? Would we treat our difficult clients differently, or perhaps worry less about looking good in front of our colleagues? Might we be less concerned about hanging onto our more gratifying, entertaining, or high-status cases?

In Buddhist traditions, wisdom and concern for others (compassion) are inseparable—they’re described as two wings of a bird or two wheels of a cart. They represent the coming together of the head and the heart, an integration which, itself, is often cited as a feature of wisdom. As therapists, developing either wisdom or compassion, one without the other, can lead to trouble. If we feel compassionately toward a client, but have little wisdom, we’re liable to become flooded with emotion, unable to see a path forward, and conclude that the treatment is hopeless. By contrast, if we’re wise—we grasp the big picture of a client’s situation—but are out of touch with his or her emotional pain, our comments will likely fall on deaf ears. Our clients need both wisdom and compassion. As psychiatrist Daniel Siegel puts it, they need to “feel felt,” and they need us to help them find a path through their suffering toward a fulfilling life.

Concern for others can change how we treat clients who are overly focused on their immediate desires. Getting clients to see the consequences of behavior for themselves and others—and choose ethical action—could become clinical goals. We might point out that the affair they’re considering is likely to feel good now, but will eventually cause a lot of suffering. If you live in Cambridge, Boulder, or Berkeley, you might even address the environmental consequences of buying an SUV. We often fear that exploring consequences in this way might come across as moralistic or parental, interfering with the safety of the therapy relationship. But sometimes addressing the short- and long-term consequences of actions, for those near and far, can enhance everybody’s well-being—even if managed care reviewers might prefer we choose a narrower focus.

Reflective Attitude. While most of us value lively spontaneity in a therapist, impulsivity can be a real problem. Virtually all my therapeutic and supervisory blunders occurred because I acted first and thought second. Early in my career, a woman revealed to me that she was mortified to have had a sexual fantasy about Jesus while looking at a statue of him in church. It so happened that a gay supervisee had recently told me he’d had the same experience as an adolescent, and it was what first made him suspect he was gay. Excited by my new insight into these forbidden matters and wanting to relieve my client of her shame by normalizing her experience, I shared this information with her. She canceled the next appointment. When I called to ask why, she told me that she couldn’t work with a therapist who was so obviously perverted. As one of my early psychodynamic supervisors once put it, “The right interpretation at the wrong time is the wrong interpretation.”

I’ve had many other unreflective moments in treatment, including “self-disclosing” just because I really wanted to tell my story, unthinkingly making a joke my client found offensive, suggesting a client confront a fear he wasn’t ready to acknowledge, and discussing violent fantasies as though they were normal when my client thought they were evil. Then there have been the inner unreflective moments, when I’ve become attached to facile, reductionist understandings of my clients’ difficulties: “It’s all a reaction to childhood sexual abuse”; “It’s because of his narcissistic father”; “She’s a borderline.” Across wisdom traditions and implicit theories of wisdom, the capacity to activate our frontal lobes, think before acting, reflect on our particular viewpoint, and consider the viewpoints of others appears repeatedly.

I recently learned an acronym from a friend that I find helpful: W.A.I.T. It stands for Why Am I Talking? This simple question can help cultivate a reflective attitude in treatment, assisting us in being a little wiser as therapists. As I sit with a client who’s getting enraged at his wife and feel the urge to calm him down, I can reflect on whether this is really in his interest, or is just to quiet my own fear. As I sit with an attractive client talking about her insensitive husband, I can pause and notice that I’m enjoying being seen as the more sensitive, lovable man. W.A.I.T.-ing helps.

it’s likely to contribute to the project at hand. Unfortunately, in our enthusiasm to learn techniques or protocols instead of developing the instrument of the therapist, it’s easy to forget to reflect.

Insight. The therapists I surveyed repeatedly mentioned that insight into our own inner experience and that of others—emotional intelligence—is an important element of wisdom. This involves: (1) Listening deeply, (2) Appreciating the factors that make us all experience the world differently, and (3) Being aware of the wounds and conditioning that inform our reactions to others. Insight helps us see that a “tired” client is actually depressed, or a confused client is having difficulty acknowledging anger toward her daughter. It also helps us understand why we’re reluctant to call a client we’ve neglected or are overly eager to please an intimidating one.

Here our earlier therapy traditions have much to offer. Therapists have long recognized the importance of listening deeply, whether inspired by Carl Rogers’s use of “reflective listening,” Sigmund Freud’s “evenly hovering attention,” or Theodor Reik’s “listening with the third ear.” Our bio-psycho-social models also help us step out of our own perspectives to appreciate how radically different the world can be for someone with another familial, cultural, or biological history. While the wise sages of old may have had an intuitive understanding of these matters, they didn’t have the maps and data that we have today.

We also have another tradition that has the potential to boost wisdom—the supervisory relationship. We can use supervision to explore our blind spots and discover where our wounds and conditioning get in the way of seeing clearly. During my internship, I recall meeting with a young woman who was deeply depressed. Week after week, she pointed out that my interventions were useless and her life was irretrievably hopeless. I used to leave sessions thinking, “I was a good student. I could’ve gone into so many fields. This is clearly not my calling.” Occasionally, following a particularly discouraging session, she’d come in the next week looking a little brighter. Once she offered, “Last week was a little helpful.” I thought, “To you, maybe. It just made me depressed!” Luckily, my supervisor helped me step back from my preoccupation with my own incompetence to notice that when this client felt that I really got it—that I could feel some of her despair—she felt more understood and a little less alone. This helped lift her depression.

This sort of insight, so central to the therapeutic wisdom of old, may not be particularly relevant to modern, symptom-focused treatments. In fact, a clinician monitoring progress with a depression inventory might view weeks of shared despair as indication that therapy was going in the wrong direction. But for therapy aimed at awakening or finding meaning in life, insight is essential. Using supervision to this end probably requires both our intention to grow wiser and wisdom in our supervisor—since it’s equally possible to use supervision just to gain approval for what we’re doing, collude in developing a simplistic view of our client’s difficulties, or otherwise reinforce therapeutic foolishness.

Intelligence. As Socrates put it, “The narrow intelligence flashing from the keen eye of the clever rogue” isn’t wisdom. Yet, being able to think clearly and logically (fluid intelligence) and having access to the knowledge needed to address the needs of the moment (crystallized intelligence) are necessary for wise action. As therapists, this means knowing something about psychopathology, lifespan development, diagnostic assessment, therapeutic methods, and cultural differences. It also means being able to hold multiple theoretical viewpoints lightly.

To get our advanced degrees, we need to master a wealth of information about human psychology. While often important, many times it’s not the knowledge itself, but our ability to not be too attached to a particular theoretical viewpoint that’s the real resource. Too easily, we can become like the Greek god Procrustes, who lived in a fortress near a major thoroughfare and would regularly invite passing travelers to spend the night on his grand iron bed. If the traveler was too long for the bed, no problem—he’d cut off his feet. If the traveler was too short, he’d stretch him out to fit. This is what our minds do when we’re too attached to a hypothesis about a client’s distress. We ignore information that doesn’t fit and elaborate on any information that supports our idea. As developmental psychologist Jean Piaget put it back in 1952, we readily assimilate information into our existing schemas, but find it difficult to accommodate our models to new data. And this makes us not so wise as therapists.

I once supervised a psychology intern who was treating a young adolescent with social anxiety. The teenager avoided parties and didn’t want to attend classes that required participation. The treatment team recognized this as a classic case of social phobia. They instructed my supervisee to construct a program of incremental exposure—a well-established, empirically validated approach. The intern dutifully followed the protocol, but the girl continued to resist, and the intern didn’t feel comfortable pushing her. The team suggested that the intern was colluding with the girl’s fear, reinforcing experiential avoidance, and worsening her condition. This went on for weeks. Eventually, the intern abandoned the social anxiety treatment for a few sessions and just talked with her client. The girl broke down crying, revealing that she’d felt misunderstood by her mother, and now by her therapist. The intern listened empathically, and the girl started doing better socially. Sometimes we need to admit when our model isn’t working and be open to shifting gears.

Not knowing is all the more difficult given current pressures to be goal focused and effective. It doesn’t fit easily with following empirically supported protocols. I’ve never tried it, but I imagine that managed care companies wouldn’t approve too many more sessions if I wrote on their form, “Still don’t know—trying to stay open minded” as my diagnosis and treatment plan.

Transcending Conventional Concepts. This is the aspect of wisdom most emphasized in Eastern contemplative traditions. In Buddhist psychology, it involves gaining direct understanding of the three marks of existence: impermanence (anicca), unsatisfactoriness (dhukka), and no-self (anatta)—and is an explicit aim of mindfulness practice.

Impermanence (anicca). This is simply the awareness that everything changes or, more accurately (since “things” are culturally conditioned constructs), that all phenomena are in constant flux. This is how any physicist or biologist would describe the universe—atoms and energy in constant movement—but it’s not how we usually see the world.

How might psychotherapy be different if we actually understood this? For starters, we wouldn’t be so surprised by illness, aging, and death, not to mention divorce, job loss, and car accidents. I’m amazed by how often I resist change as a therapist. I don’t want my client to feel worse, to be disappointed, or to leave treatment. I don’t want to be reminded that I and everyone I love will die, perhaps unexpectedly and too young. Everything changes and the wheel of fortune is always turning: what goes up really does go down. Remembering this during a session can be eye opening. It can help us see the big picture and not be so driven by our fears or wishes of the moment, which is an asset in whatever kind of treatment we’re doing.

Unsatisfactoriness (dhukka). This is a reality of the human mind. It’s what has been poorly translated as “life is suffering,” giving Buddhism the reputation of being a gloomy spiritual philosophy. A more accurate translation might be that life is difficult for everyone, and we repeatedly experience dissatisfaction. My favorite articulation of this principle comes from the great Western philosopher–sage Rosanne Rosannadanna, who pointed out, “If it ain’t one thing, it’s another.”

The realization that our minds are like Goldilocks—always complaining that things are too cold, too hot, too big, or too small—can be liberating. It can help us appreciate that it isn’t our external circumstances that determine our happiness or misery, but our reactions to those circumstances. This operates even during good times. Being reasonably intelligent, in the midst of eating our ice-cream cone or making love, we realize that the experience won’t last, and we start angling for ways to hold on to it.

Sonja Lyubomirsky, a Positive Psychology researcher at the University of California, Riverside, has concluded that our sense of happiness or well-being is 50 percent genetic: we’re born with a certain predisposition toward happiness or unhappiness. Another 40 percent of the variance has to do with our attitude toward experience—basically whether we’re able to be in the moment, appreciate what is, and not compulsively fight to try to make things other than as they are. Remarkably, only 10 percent of the variance accounting for our happiness has to do with whether we experience good or bad fortune—whether we’re lucky or unlucky in work, love, health, or wealth. This is really shocking, given how much time and energy we devote to trying to assure good outcomes and avoid disappointments.

How might insight into unsatisfactoriness change our daily experience as therapists? Personally, when I’m conscious of my mind’s capacity to make itself miserable no matter what my circumstance, I lighten up on needing sessions to go a certain way. Vacations are wonderful teachers in this regard. When I observe my mind worrying that it might rain when I’m in the Caribbean or that there might not be enough snow for good skiing when I’m in Vermont, I appreciate the hopelessness of finding happiness by getting my ducks in a row. Being aware of the mind’s tendency to be dissatisfied helps me let go of concerns about success and failure. It changes how I view my clients’ difficulties. I’m less likely to worry about their problem du jour and more apt to look for larger patterns of mind and behavior—such as clinging to pleasure and resisting pain—that have caused them suffering in the past, and are likely to do so again.

Understanding dhukka likely will have different implications for different sorts of treatment. If I’m aiming at increasing awareness, helping my client see the futility of finding happiness through getting a promotion, winning the lottery, wooing a romantic partner, or acquiring high-status friends, it would fit well with treatment. I might relay Joseph Campbell’s famous observation that many of us climb the ladder of success only to discover that it’s leaning against the wrong wall. I could then help my client look for pathways to happiness that aren’t subject to the hedonic treadmill—sources of fulfillment where we don’t need more and more just to regain our previous state of well-being. Learning to savor, engage more fully in intrinsically rewarding “flow” experiences, express gratitude, connect with loved ones, and find meaning in service to others (whether directly or through, art, discovery, or other avenues) might become goals of treatment. However, if I’m trying to help a client accomplish more concrete aims, such as quitting smoking or becoming more assertive, focusing on the fundamental futility of accomplishing goals could take the wind out of our sails. In that case, it might be better to keep these sorts of reflections to myself.

No-Self (anatta). This is the most challenging aspect of Eastern wisdom for most of us in the West to grasp, but is arguably the key insight in Buddhist psychology. It doesn’t mean that our bodies don’t exist or that we don’t have a name, zip code, or social security number. It refers instead to the fact that we’re interdependent organisms, constantly exchanging molecules with the rest of the world—part of the web of life. Our thoughts of being a separate “I” are misunderstandings, born of living in a narrative stream starring “me” (actually, mine stars “me”; yours stars “you”). If we observe our experience carefully, try as we might, we never find the little homunculus inside, the little man or woman who is “me,” but just discover an endless stream of sensations, thoughts, and images. We realize that the mind and brain are, as neuroscientist Wolf Singer puts it, like “an orchestra without a conductor.”

What are the implications of this insight for psychotherapy? For one thing, glimpsing it helps us lighten up on self-evaluation. Our work is so complex, and so subjective, that our sense of competence fluctuates wildly. As a psychologist friend once said, “I find I’m only as good as my last session.” Obviously, concerns about our competence can be significant impediments to treatment.

My worries about competence can make me need to be seen as kind, intelligent, caring, or compassionate. They can make me cover my tracks, not admitting that I forgot what my client told me last week, that I confused the names of medications, or that I don’t know as much about a particular disorder as I feel I should. Glimpsing no-self can help us better follow Rudyard Kipling’s suggestion that hangs over the entrance from the locker room to the courts at Wimbledon: Meet with Triumph and Disaster, and treat those two impostors just the same. Whether in tennis or therapy, attachment to success can contribute to failure.

Appreciating no-self can help us be more present in the consulting room, as it helps us take what arises in our hearts and minds less personally. If a client does something that makes me angry and I’m stuck in my usual narrative starring “me,” I’m likely to think, “I can’t believe he did that after all I’ve done for him.” If, by contrast, I have a glimpse into no-self, I’m likelier to notice tight muscles, an increased heart rate, and retaliatory images arising and passing, without getting so stuck in a narrative about injustice. When we can experience emotions as cognitive scientists describe them—instances of simultaneous bodily sensations, verbal narratives, and images—we can bear them at greater intensity with less reactivity.

This is helpful when hearing about our clients’ fear, pain, anger, or other difficult emotions. Since clients can really be with and explore only those emotions that we can tolerate, our capacity to bear their distress is critical. Zen traditions describe this aspect of wisdom metaphorically. If I were to dissolve a tablespoon of salt in a glass of water and try to drink it, I’d have difficulty—the water would be too salty. But if I dissolved that same tablespoon of salt in a clear, clean pond, I’d have no trouble taking a sip. Appreciating no-self helps us develop a mind like that pond.

Can We Become Wiser?

Western investigators have concluded that wisdom doesn’t necessarily accrue with age. We all know older folks who, rather than growing wiser, cling more tightly to rigid defenses, blame their difficulties on others, and live ever more constricted lives. But then there are some who become lighter, more loving, more tolerant, and develop a “big picture” perspective on it all. Can we choose one path over the other for ourselves and our clients? If so, how?

Wisdom researcher Paul Baltes, who found that clinical psychologists are wiser than the population at large (which may not say much for the population at large), speculates that people who are intentionally introspective are likelier to become wise than those who aren’t. This raises concerns about trends in training that deemphasize personal development, including entering treatment ourselves. If our only focus is to learn and faithfully implement techniques, we may not become very wise therapists.

While I’ve seen considerable evidence in my friends and colleagues that deliberately taking up practices from wisdom traditions, such as mindfulness meditation, has made them wiser, I’ve also found that just thinking about wisdom can have its own dividends. For me, this has often taken the form of heightened awareness of my own foolishness—the hundreds of times in the course of a day when I become preoccupied with my comfort, self-image, or cherished ideas. Observing my repeated moments of posturing, striving, and chasing after pleasure while trying to avoid pain seemed to help me lighten up, notice that my foolishness wasn’t really helping me or anyone else, and, occasionally, act a little more wisely.

As we all know, therapists today face a lot of pressures that don’t support the pursuit of wisdom. We’re encouraged by payers to resolve symptoms quickly and cheaply and move on to the next client. While this can sometimes constitute wise, compassionate action, often it doesn’t. We aren’t afforded much time for introspection or metabolizing the feelings that come up in a session, not to mention time for supervision, reflection, meditation, or other supports for seeing the big picture. Our clients are themselves discouraged from introspection by the pharmaceutical industry, which offers images of unbalanced neurotransmitters to explain their difficulties (the ads neglect to list “may lead to an unexamined life” among possible side effects).

So what are we to do? Despite these pressures, we might still adopt increasing our own wisdom, and that of our clients, as daily goals. This need not necessarily involve time-consuming, esoteric practices, though these can certainly support our efforts. We might simply look for ways to help everyone develop concern for others; see the effects of our actions short and long term, near and far; remind ourselves to reflect before acting; hold our ideas more lightly; and appreciate that everything changes and the mind constantly creates suffering by wishing things would be other than they are. We might especially try to notice how all of our self-preoccupation, engrossing as it is, alienates us from one another and makes everyone unhappy.

Who knows, if each of us tried to do this every day, we might all suffer less and live more awakened, less lonely lives. Just don’t tell the managed care companies.


Illustration © Ralph Butler

Ronald Siegel

Ronald D. Siegel, PsyD, is an Assistant Clinical Professor of Psychology at Harvard Medical School, where he has taught for more than 25 years. He is a longtime student of mindfulness meditation and serves on the Board of Directors and faculty of the Institute for Meditation and Psychotherapy. He teaches internationally about mindfulness and psychotherapy and mind/body treatment, has worked for many years in community mental health with inner city children and families, and maintains a private clinical practice in Lincoln, Massachusetts. Dr. Siegel is co-author of the self-treatment guide Back Sense, which integrates Western and Eastern approaches for treating chronic back pain; co-editor of the critically acclaimed professional text, Mindfulness and Psychotherapy and author of the new step-by-step comprehensive guide for general audiences The Mindfulness Solution: Everyday Practices for Everyday Problems,