The Spiritual Work of Psychotherapy | Omega

Mark Epstein reveals why the standard therapeutic approach of going more deeply into your problems can lead to a kind of sober honesty and humility, while adding a mindfulness practice will help you connect to your spirit, move away from your problems, and understand your authentic self—all necessary for healing and recovery.

There is an obscure story about one of Freud’s personal conversations that puts an interesting twist on the state of psychology in the West. The discussion was with Ludwig Binswanger, a Swiss psychiatrist and the founder of the existential movement in psychoanalysis. Binswanger felt that there was something missing in Freud’s approach to therapy—too many patients simply did not get better. He raised the problem of the paralysis of analysis with Freud.

Might there not be a deficiency of spirit, asked Binswanger delicately, such that certain people were unable to raise themselves to a level of “spiritual communication” with their analysts? Could this lack of spiritual communication be the thing that stopped people from healing? To Binswanger’s surprise, the old man readily acknowledged his point. “Yes,” he said, “spirit is everything.”

Binswanger thought that Freud must have misunderstood his use of the word spirit, perhaps thinking he meant something on the order of “intelligence.” But Freud continued on.

“Mankind has always known that it possesses spirit,” Freud said. “I had to show that there are also instincts.”

When Freud sought to make room for instincts against the background of spirit, he did not anticipate a time when we would forget about spirit altogether. He could not foresee an era when instincts would reign supreme. By the time I was growing up in twentieth-century America, however, spirit already seemed out of reach. Freud’s psychology was the accepted language of the mind, challenged only by B. F. Skinner’s behaviorism. Those of us who sensed a “deficiency of spirit” were aware only of a feeling of absence, a yearning for something intangible, a sense of emptiness that could not be explained. We did not have words or concepts for what we were missing. Even today, one of the most common questions that I am asked is the meaning of the word spiritual. Many people have lost touch with it altogether.

“Anything that takes us beyond the personality,” I usually reply. The most important gift that my encounters with Buddhism have given me is access to this spirit that Freud seemed to have taken for granted. Its recovery was of crucial importance to me.

Freud was wrong on one particular point in his conversation with Binswanger: Mankind does not always know that it has spirit—sometimes we forget.

How People Change

Examples of this forgetting abound, even among those searching for a spiritual life. The split between instincts and spirit comes up in my practice all of the time. A woman named Sally, for instance, called not so long ago seeking advice from me. I had seen her for a single session in consultation months before, and we had talked about a variety of therapeutic and spiritual issues. She was suspicious of the role of psychiatric medications in today’s culture. It seemed like some kind of brave new world to have mood altering drugs so readily available. But Sally wondered if there might not be a medicine that could help her. She had been plagued with chronic feelings of anxiety and depression for much of her adult life, and despite a healthy investment in psychotherapy she still felt that there was something the matter with her.

Sally had been taking a small dose of an antidepressant for several weeks, ten milligrams of Prozac, and she was finding that she felt calmer, less irritable, and, dare she say, happier. She was planning on going to a two-week meditation retreat later that month and was wondering whether to stay on her medicine while she was there. Something about taking it while on retreat made her uncomfortable, and that was the reason for her call. “Perhaps I should go more deeply into my problems while I’m away,” Sally questioned. She worried that the antidepressant would impede that process by making her problems less accessible to her. What did I think?

I was relieved to hear that Sally was feeling better. People who respond well to these antidepressants often have few, if any, side effects. They find instead that they feel restored, healed of the depressive symptoms that they were expending so much of their energy trying to fend off. Less preoccupied with their internal states, they are freer to participate in their own lives, yet they often wonder if they are cheating. “This isn’t the real me,” they protest. “I’m the tired, cranky, no-good one you remember from a couple of weeks ago.” As a psychiatrist, I am often in the position to encourage people to question those identifications with their symptoms. Depressed people think they know themselves, but maybe they only know depression.

Sally’s question was interesting not only because of the drug issue but because of her assumptions about what would make her feel better. The notion that we need to go “more deeply” into our problems in order to be healed is a prevalent one, and one that, as a therapist, I am sympathetic toward. Certainly, ignoring the shadow side of our personalities can only lead to what Freud once called “the return of the repressed.” Yet it struck me that there was a remnant of American Puritanism implicit in Sally’s approach, or at least a Judeo-Christian tendency to divide the self into lower and higher, or better and worse. Her belief that she should go more deeply into her problems reminded me of the Freudian emphasis on the instincts.

When people believe that they are their problems, there is often a desire to pick away at the self, as if by doing so they could expose how bad they really are. People think that if they could just admit, or even believe, the awful truth about themselves, they would start to feel better, but feeling bad about oneself seems, in fact, to be a bottomless pit. One never reaches the far end of it. While it usually fails as a strategy, “going more deeply” into our problems can be just another variant on trying to get rid of them altogether, back to a state of imagined original purity like the Garden of Eden. While most therapists would probably deny a religious influence on their thinking, many often collude unconsciously with this mode of thought. Going more deeply into one’s problems is the standard approach of most therapies—and it can indeed lead, at its best, to a kind of sober honesty and humility that gives people a quiet strength of character.

But to go more deeply into our problems is sometimes to go only into what we already know. This approach can also lead, at its worst, to a kind of jaded pessimism about the self, a resigned negativity that verges on selfhatred. I was quite sure that Sally did not have to go looking for problems on her retreat. Retreats are difficult enough, even for people who are not depressed. Her unresolved issues would come rushing in to fill every space whether she took her antidepressant or not, but she might have more success in not being sucked in by themwith themedicine inside of her. I told her that at this point I felt she needed to come out of her problems, not go into them more deeply, and that the antidepressant would not get in her way in that regard. To be overwhelmed while on retreat would not be useful.

As a therapist influenced by the wisdom of the East, I am confident that there is another direction to move in such situations: away from the problems and into the unknown. Sometimes this fills us with fear. But if we stay with our anxiety, we have a special opportunity to know ourselves more authentically. Buddhism is very clear about how important it is to move in such a direction, and, as such, it is relentlessly optimistic. Rather than going more deeply into our problems, Buddhism teaches us how to disentangle our minds from them. There is, in the Buddhist view, more to the mind than just neurosis. At the heart of all of us is the potential for kindness, generosity, and wisdom.

This is an approach that Western therapy has little experience with, but it is the foundation of Eastern wisdom. The contents of the mental stream are not as important as the consciousness that knows them. The mind softens in meditation through the assumption of a particular mental posture called “bare attention,” in which impartial, nonjudgmental awareness is trained on whatever there is to observe. Problems are not distinguished from solutions in this practice; the mind learns how to be with ambiguity while learning to be fully aware.

In my work as a therapist I have found it necessary to bring what I have learned from Buddhism back into the psychological realm. The spirit that Binswanger noticed ebbing out of the field is essential if true healing is to take place. People who are suffering want to change, but they do not know how. They feel, like Sally, that they have to go into their problems, or somehow get rid of them entirely. They want to analyze, or be analyzed, and they want to love, or be loved. But they do not know that to bring about true healing they have to learn how to see themselves as they truly are.

©Mark Epstein, 2009. Reprinted from Going on Being: Life at the Crossroads of Buddhism and Psychotherapy with permission from Wisdom Publications, 199 Elm Street, Somerville, MA 02144 USA.

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