how to apply mindfulness to your life and work · unhappiness; he said you could change your...

Meditation and Psychotherapy: A Dual Approach that Can Speed Healing Mark Epstein, MD - Main Session - pg. 1

Meditation and Psychotherapy:

A Dual Approach that Can Speed Healing

the Main Session with

Mark Epstein, MD and Ruth Buczynski, PhD

National Institute for the Clinical Application of Behavioral Medicine

How to Apply Mindfulness to

Your Life and Work


How to Apply Mindfulness to Your Life and Work: Mark Epstein, MD

Meditation and Psychotherapy: A Dual Approach that Can Speed Healing

Table of Contents

(click to go to a page)

Psychotherapy and Meditation: Different or Similar? ............................................. 3

The Impact of Both Psychotherapy and Meditation ............................................... 4

Practices of Meditation in Psychotherapy .............................................................. 7

How Self-Observation Can Avoid Personal Responsibility ....................................... 9

Why an Approach to Ending Everyday Suffering Is Faulty ....................................... 10

How We Can Broaden the Context of Practice ....................................................... 11

How Psychotherapy and Meditation View Suffering ............................................... 12

Cultivating a Realistic View with Buddhist Practice ................................................. 15

Trauma: The Way Into and Out of Self .................................................................... 15

The Rush to Normal ............................................................................................... 16

A Buddhist Approach to Developmental Trauma .................................................... 17

Juggling and the Meditative Process ...................................................................... 19

When the Mind Has No Pride ................................................................................. 21

Realizing That We Don’t Need More ...................................................................... 22

About the Speakers ............................................................................................... 25


Dr. Buczynski: Hello everyone and welcome. I am Dr. Ruth Buczynski, a licensed psychologist in the State of

Connecticut and the President of the National Institute for the Clinical Application of Behavioral Medicine –

and I am so glad that you are here today.

We have a special guest who we’ve been trying to get for a while and finally succeeded. I am excited to

welcome Dr. Mark Epstein. He is a physician psychiatrist in private practice in New York City. He is the author

of several books.

We first got to know him through his book Thoughts Without A Thinker, and that was followed by

Psychotherapy Without The Self, and The Trauma of Everyday Life.

So, Mark, welcome – I am so excited that you are here. Thank you very much!

Dr. Epstein: Thank you so much. Pleasure to be here!

Psychotherapy and Meditation: Different or Similar?

Dr. Buczynski: Let’s start out by just getting your take on how psychotherapy is different from meditation.

Dr. Epstein: Freud used to say that the best he could do was to take someone from a state of neurotic

misery and return them to one of common unhappiness.

The Buddha, in teaching meditation, took common unhappiness as his starting place. So, psychotherapy –

neurotic misery and meditation – common unhappiness: I used to

think that was a good explanation for how the two were different.

I am starting to think that maybe they are both the same, in that

common unhappiness is a pretty good achievement.

The Buddha didn’t actually promise complete relief from common

unhappiness; he said you could change your perspective about it – which is something that psychotherapy is

“The Buddha didn’t promise

complete relief from

common unhappiness; he

said you could change your

perspective about it.”

How to Apply Mindfulness to Your Life and Work: Mark Epstein, MD

Meditation and Psychotherapy: A Dual Approach that Can Speed Healing


also effective in doing.

I am more interested in how psychotherapy and meditation are similar than

in how they are different – but they certainly employ different methods.

Dr. Buczynski: Let’s go ahead and talk a little bit about it from the opposite

perspective – how they are similar.

Dr. Epstein: Both work with the mind. Psychotherapy and meditation are both technologies that have

evolved in different cultures at different times to use the mind to treat the mind.

They both work because of our peculiar human ability to both be in a situation and to observe ourselves in

the situation at the same time – the so-called self-reflective capacity of the mind.

Both psychotherapy and meditation take advantage of the self-reflective

capacity of the mind.

Dr. Buczynski: Would you say that meditation has the potential to go

beyond therapy – or is that not the best way to think about it?

Dr. Epstein: No, I wouldn’t say that meditation has the potential to go beyond therapy. I think it depends

how you define each of them.

Some people spend a lot of time in meditation and then realize, “Oh, my God – there are some issues going

on. I’d better get into therapy.” In that case, therapy really goes beyond meditation.

Sometimes people work very well in therapy and they get about all they can, but they still want to do work

on themselves – and then often they’ll turn to meditation.

Meditation is a way of working within oneself, but still with a therapeutic endeavor.

The Impact of Both Psychotherapy and Meditation

Dr. Buczynski: I would like to try to illustrate how these two practices can have different effects on a patient

– and maybe it would help if we stuck with the same patient.

“Psychotherapy

and meditation are

both technologies

to use the mind to

treat the mind.”

“Both psychotherapy

and meditation take

advantage of the self

-reflective capacity

of the mind.”


You described a patient in one of your books – the patient’s name was Jean – can you tell us about her?

Maybe we can look at both psychotherapy and meditation and its impact on Jean.

Dr. Epstein: Sure. But before I talk about Jean, let me just go back to your

last question for just another moment.

When I was first working with meditation, I was still in Harvard Medical

School, and I worked at the time for a well-known cardiologist named Herbert Benson, who was one of the

first popularizers of meditation as a treatment modality for hospitalized patients.

He was a cardiologist and he was treating high blood pressure. He realized that there was something in the

meditative experience that might be useful in bringing down people’s blood pressure – that you could induce

what he called the “relaxation” response,” which is the opposite of the “fight or flight” response.

That was in the early seventies – one of the first attempts to talk about the therapeutic potential of these

Eastern practices.

And this is a very important point – the fact that the mind could have physical effects – that was a

breakthrough at that time, and one of the most important distinctions that was being made.

We weren’t sure that psychotherapy could directly bring down your blood

pressure, but meditation was a specific technique that people could learn

to do in a twenty-minute session at home.

Meditation was another therapy that physicians could offer their patients,

and it has been incorporated now into hospital-based practice.

The work of Jon Kabat-Zinn, mindfulness-based stress reduction and others, piggybacked off of that early

work of Benson’s.

Coming back, now, to the question of my patient Jean whom I wrote about – there are many people who

practice meditation techniques that are designed to quiet the mind, calm the body, and induce a state of

relaxation – a state of stress-free quiescence.

One can become very proficient – just as when you study yoga, you can become very proficient at doing

advanced yoga postures. You also can get very good at advanced meditation techniques.

“Many people practice

meditation techniques

that are designed to

quiet the mind, calm

the body, and induce a

state of relaxation.”

“That the mind could

have physical effects

was a breakthrough.”


But that doesn’t always solve all the underlying emotional problems.

There’s a famous story from some of my Buddhist teacher friends, who teach three-month meditation

courses, of people who do the entire three months and get very, very quiet – they’re existing in very refined,

subtle, beautiful mental states.

Then, when the retreat ends, and people start talking – they call their wives or their husbands on the

telephone and so on, their thinking mind with all their neuroses and all their problems comes rushing back.

There’s a famous story of one man running through the streets after

the retreat ended toward the meditation center trying to find the

teacher, saying, “It didn’t work! It didn’t work!” He thought it was

going to solve all of his problems forever.

I’m a psychotherapist and a psychiatrist who doesn’t think that people who practice meditation are crazy just

for doing meditation. So often, some of these advanced meditation practitioners come to see me when they

realize, “Oh, maybe I should be talking to someone…”

This patient, Jean, whom you asked about, was such a person. She was a very advanced meditator, had done

a lot of long retreats, and was a very accomplished and sophisticated woman in the Eastern world.

But she had some fears, underlying fears, in her intimate relationships, and she was attuned enough to those

fears to let herself come to see a psychotherapist – who happened to be me.

I approached her much as I do anyone else; I don't have my patients lie on a couch – we sit face-to-face and I

talk like a real person and ask them to talk to me like a real person.

Over the weeks that I was seeing her, I had the sensation that, even though she was conversing readily, in

some ways, she was avoiding me. I didn’t really know – what was she avoiding? Was I right about this?

I probed a bit, and with just a little bit of probing, Jean began to get in touch with the way that she was

keeping me at bay.

That crystallized in one session where she had the closest, real insight that anyone comes to in

psychotherapy – at least in my experience – and she said, “I think I’m pushing you away because I’m scared

that if I let you get close to me, that you’ll leave me.”

“With just a little bit of

probing, Jean began to get

in touch with the way that

she was keeping me at bay.”


That insight – if she let me get close to her, I would leave her – where was that coming from?

It made sense to her emotionally, but it was pretty unlikely that I was going to leave her if she let me get

close to her. She might have to leave me eventually if she let me get close to her, because her therapeutic

work would be done, and that might have been part of the issue.

But I think she had experienced real losses in her early life where her parents had inexplicably moved away,

and the pain of that – the trauma – had never really been processed.

She was having a classic psychotherapy experience that something was going to happen, which in some

sense had already happened, but she had never really dealt with it.

Dr. Buczynski: How did it turn out?

Dr. Epstein: It turned out fine. She let me get close to her – we talked about what happened in her

childhood; she began to have other relationships. I don't see her anymore.

Practices of Meditation in Psychotherapy

Dr. Buczynski: The psychologists Daniel Brown and Jack Engler got some interesting results in one of their

studies when they looked at experienced meditators and anxiety.

Can you tell us about that study and what they found out about practices of meditation in psychotherapy?

Dr. Epstein: The study that I remember that Jack Engler and Dan Brown engaged in – I don't know if it is the

one that you’re asking me about, but it is the one that I always come back to.

Jack Engler, after finishing his training as a PhD in psychology, took all of his projective tests – all the

psychological testing devices that he had learned – and he gave

those tests to different groups of people – beginning meditators, a

control group who had no experience with meditation, advanced

meditators, and even teachers of meditation.

He found that even in the most advanced group of meditators,

there was no diminution of internal anxiety, no lessening of

“Even in the most advanced

group of meditators, there

was no diminution of internal

anxiety only a greater

willingness to acknowledge

the anxiety that was there.”


internal anxiety – only a greater willingness to acknowledge the anxiety that was there.

So, he found a greater openness but no real personality

transformation. I always find that very comforting because it means

that we don't have to change ourselves…in order to grow.

We just have to become more honest, more open, and kinder in the

presence of our own pain.

Dr. Buczynski: Maybe the part of them that was more open to anxiety was also less avoidant of it.

Dr. Epstein: Yes, the part of them that was more open was less avoidant, for sure, and less afraid of the

anxiety. But the raw material of the anxiety was still present.

So, based on their research and on my own clinical experience, the

notion that meditation, in its relaxation response mode, should free us

of all anxiety is a false idea.

People are anxious because they are people, and anxiety is a part of the

human condition.

To imagine that it would be possible to live anxiety-free is to set up a kind of false absolute that we can never

reach – we just feel bad that we are bad meditators or we are bad therapists. We use it to punish ourselves

instead of to help ourselves.

In dealing with terminally ill patients and their families, this is something that medical practitioners have to

face all the time…

We want people to accept their illness without fear, without anxiety. We have all kinds of notions of how

people should deal with these incredibly difficult things in a good way.

If it is not possible to eliminate anxiety, then maybe we don't have to have those expectations for our

patients. Maybe we can meet them a little more directly where they actually are without any kind of subtle

judgment…

Dr. Buczynski: Or expectation. And also to disappointment.

“In order to grow, we just

have to become more

honest, more open, and

kinder in the presence of

our own pain.”

“That meditation, in its

relaxation response

mode, should free us of

all anxiety is a false idea.

Anxiety is a part of the

human condition.”


How Self-Observation Can Avoid Personal Responsibility

Dr. Buczynski: You have said that some meditators become “enamored of the observing self” – that in the

beginning, meditation empowers and uses that capacity for self-observation as a way to avoid personal

responsibility. Can you explain what you meant by that?

Dr. Epstein: I can try! Freud, when he talked about psychotherapy, talked about how one has to achieve

what he called a “therapeutic split in the ego,” so that the ego is both observing and experiencing – as in

when you’re looking at dreams.

The dream is the experience and then the ego talks about it to the therapist – commenting on it and trying to

figure out what it means.

In meditation, there’s a similar therapeutic split in the ego where you are sitting, in classical meditation, on

your cushion. Your mind is racing on in what we call the “monkey mind” or “Why won’t the thoughts stop?”

It’s hard to be in the present, and you are thinking about your first girlfriend, and you are thinking about

what to do when you go home…the mind is chattering on.

You are also watching or observing or feeling all of that, trying

your best not to react, not to bite, not to cling to whatever it is

that is happening in the mind and body.

That’s the same kind of therapeutic split where you are both subject and object in what is happening.

The language that is used to give the meditation instruction suggests that you be detached but not

disinterested. But of course, it is possible to err on either side of that.

The Buddha’s instructions for meditation were they were always looking for what he called a “middle way.”

The technique of being a meditation teacher is always to look which way someone is falling. Are they going

too far to the right or too far to the left? Are they veering too much off that middle way?

It is quite possible in meditation to be much more detached, so that, in fact, you lose interest and you stop

taking responsibility for whatever is happening – “Oh, those are just my thoughts running on” or “Oh, I’m so

angry – it’s just anger coming up in me, and it’s not really me who struck you the other day. It was just

outside of my control.”

“The language that is used to

give the meditation instruction

suggests that you be detached

but not disinterested.”


It is possible – that is an extreme example – but it is possible to be a

little too dissociated – a little too detached if one practices

meditation the wrong way.

That is why people need meditation instructors, meditation

teachers, who are sensitive to that and can pull people back.

Psychotherapists are also sensitive to that and can pull people back from one side or the other.

Why an Approach to Ending Everyday Suffering Is Faulty

Dr. Buczynski: Is that what you meant when, in your new book, you talked about the Western application of

both psychotherapy and meditation in our approach to ending everyday suffering and trauma as faulty?

Dr. Epstein: Yes, I think I was hinting around at that same thing – for instance, the mindfulness movement

within the psychotherapy world…and maybe many of our listeners are familiar with that…

Jon Kabat-Zinn and the people around him at the University of Massachusetts Medical Center have basically

created one particular technique from Buddhist thought, which is the practice of mindfulness.

They developed and taught it as part of a mindfulness-based stress reduction technique which has worked its

way into the mental health world under the rubric of cognitive and behavioral therapy.

This is where patients are taught how to observe their own physical and mental symptoms in exactly this way

– detached but not disinterested – not reacting in their usual way with fear or anxiety. This is enormously

helpful.

One of the unintended side effects of the popularization of that particular meditation technique is that some

of the emotional material that is traditionally under the domain of psychoanalytic psychotherapy, depth-

oriented psychotherapy, never gets dealt with.

This is where people are exploring the intense feelings that normally we try to keep at bay – feelings of rage,

loneliness, depression, erotic desire, conflicts that have to do with, “Do I want to be with this person or not?”

and what we call the “leftovers” – the primitive agonies from childhood.

“It is possible to be a little

too dissociated – a little too

detached if one practices

meditation the wrong way.”


It is very possible to practice mindfulness from a cognitive-behavioral point of view where none of that gets

dealt with.

I am much more interested in a more sympathetic approach – bringing together the best psychotherapy and

the best of meditation practices.

How We Can Broaden the Context of Practice

Dr. Buczynski: Following that thought, Mark, what do we need to do differently when we are practicing

mindfulness?

Dr. Epstein: I am not sure that we need to do anything differently, but the context in which we practice

could be broadened.

That is why I think my work has been of interest to psychotherapists

who still sit and talk with their patients without a handbook or a

formula for how the sessions are supposed to go.

There is still room for an exploration of the unconscious – although the

idea of the unconscious has fallen out of fashion, I think it still exists within each one of us and the forum for

the exploration of it in our culture has been the practice of psychotherapy.

I’m still an advocate for psychotherapy, but it can be rejuvenated through the introduction of some of these

Buddhist ideas.

Dr. Buczynski: It would seem to me that we rejuvenate psychotherapy all by itself…sometimes by just

focusing on the patient and how the patient feels, as if the other people in the family don't matter.

Dr. Epstein: There has been a big movement in psychotherapy towards what is called relational therapy.

This is where the therapist, the psychiatrist, or the psychologist is no longer the authoritarian figure, no

longer the blank screen, no longer just the prescriber of medications or the teacher of new methods of

coping with stress.

Relational therapy is where the actual back and forth between patient and therapist – what happens in the

“The context in which

we practice could be

broadened. There is still

room for an exploration

of the unconscious.”


room, what happens in the relationship between the two – becomes the substance of the therapy.

That is a very interesting way to do therapy – a two-person meditation

instead of the traditional one-person meditation. A lot of people are

looking at what is going on between them.

Dr. Buczynski: Do you see that at all as Rogerian?

Dr. Epstein: Carl Rogers is way out of fashion, but yes, I think that is the essence of what he was talking

about when he did his pioneering work. Just repeating back the last two words of what the patient said,

which is really the Rogerian technique that took hold – isn’t so interesting.

But in a much deeper way, he was bringing the personality of the therapist into the room and saying that we

can make use of that in trying to help people.

Dr. Buczynski: Or how about the Gestalt approach?

Dr. Epstein: The Gestalt approach was very modern – in the

sixties and seventies.

It was a very modern attempt to update a psychoanalytic psychotherapy, by bringing not just the personality

of the therapist into the room but by bringing the present moment into the room – making the present

moment the central focus of what was going on.

Instead of looking to the past for the causes, the main principle of Gestalt therapy was to see what the

patient was actually doing to keep – like my patient Jean – the therapist away or to keep the patient himself

or herself out of a direct experience of the present moment.

That is very meditative. What we are mostly doing in meditation is trying to be in the present – trying to see

all the different ways that we keep ourselves from being in the present moment.

How Psychotherapy and Meditation View Suffering

Dr. Buczynski: Let’s talk a little bit about how both of them view suffering and trauma. Can you compare

them from that perspective?

“Relational therapy is

where the actual back and

forth between patient and

therapist becomes the

substance of the therapy.”

“What we are doing in meditation

is trying to be in the present –

trying to see all the different ways

that we keep ourselves from being

in the present moment.”


Dr. Epstein: In my latest book that has just come out today, called The Trauma of Everyday Life, that was my

original reason for wanting to write the book even though I was

familiar with Buddhist thought for more than thirty years.

It took me a long time to really listen to the fact that the Buddha had

lost his mother when he was a week old.

It is in all the myths and legends about the Buddha – it is in all the Buddhist art, but no one had ever made

anything of the fact that the Buddha’s mother dies when he is a week old.

And I thought, “Oh, what if I try to write about the Buddha the way Erik Erikson wrote a psychobiography of

Luther or of Gandhi? What would I say about the fact that his mother died when he was just a week old?”

It has to have meaning; there was this introduction to suffering – the kind of introduction to trauma that took

place before the Buddha. After all, he was a human being and must have known what was going on in his life

before becoming the Buddha.

He would have a loss – he would have already bonded the way babies bond, the way infants bond with their

mothers; he would have felt that and then it would have disappeared.

And I thought, “That was his first introduction to suffering.” Then his father steps in and tries to protect him –

he builds a palace wall around him so he is never again exposed to old age, illness or death.

At twenty-nine years old, he replicates his mother’s abandonment of him and leaves his wife and young child,

to go out into the forest, which is where all the therapists were in those days – to try to get some therapy.

The Buddha, when he got his therapy and started teaching, he realized that he could go back into the world

and relate to people again.

He framed his teaching the way the doctors of that time talked

about a disease by saying, “There’s a disease. It’s called suffering.”

The word he used was dukkha. His first Noble Truth was dukkha;

dukkha means “hard to face.” He said, “There are aspects of life

that are hard to face” – so maybe the loss of his mother, eventually, was hard to face. Certainly old age,

illness and death are hard to face.

“No one had ever made

anything of the fact that

the Buddha’s mother dies

when he is a week old.”

“The Buddha framed his

teaching the way the doctors

of that time talked about a

disease by saying, ‘There’s a

disease. It’s called suffering.’”


So there is a lurking sense of trauma – they didn’t have the word

“trauma” in the Buddhist days. He had to make up a word, which was

dukkha – but there is a lurking sense of trauma.

I like to say that if we are not suffering from posttraumatic stress

disorder, we are suffering from “pretraumatic” stress disorder.

We all sense that it is coming – “Even if I make it to eighty-five, I am going to end up in an assisted-living

home, and then I’m going to have to experience death – and what’s that going to be like? What about those

doctors who are going to be taking care of me? They’re not going to treat me right...”

We’re all sitting on those kinds of anxieties.

So the Buddhist notion of trauma – that there are aspects to life that are hard to face – is very close to the

Western tradition, which is the notion that when we are

confronted with death or serious injury in ourselves or in

someone we are close to, it fills us with intolerable feelings of

fear, horror and anxiety, and we experience trauma.

Then the psychoanalysts have added another description of

trauma that they call “relational” or “developmental” trauma which is the trauma that young children in the

Buddha’s age group – from one week on up to three years or so – face.

This is the trauma that young children face when their caregivers are not attuned enough to the child’s

emotional experiences.

Even though children can’t speak yet or think in words, they are subject to terrible, terrible anxieties.

Those anxieties, feeling s of panic, and fears, can really only be dealt with if the mother or father or other

caregiver is sensitively attuned to what the child is going through.

The child can only cry – but the parent has to pick up, hold, interpret

and feed back to the child what is going on and make it tolerable.

When that doesn’t happen, this is another kind of trauma that people

end up with. Many of us end up with these traumatic residues –

primitive agonies tend to color later emotional experience, especially

“The psychoanalysts have

added another description of

trauma that they call ‘relational’

or ‘developmental’ trauma.”

“If we are not suffering

from posttraumatic stress

disorder, we are suffering

from ‘pretraumatic’

stress disorder.”

“The child can only cry –

but the parent has to be

able to pick up, hold,

interpret and feed back

to the child what is going

on and make it tolerable.”


our intimate relationships. They tend to reveal themselves in our intimate relationships.

Cultivating a Realistic View with Buddhist Practice

Dr. Buczynski: You go on from here to talk about why it is important to have a realistic view if you are trying

to practice Buddhist principles.

Dr. Epstein: Yes. If you are trying to practice Buddhist principles or if you are a patient in therapy, or if you

are just trying to live your life, it is helpful to have a realistic view.

When we have an unrealistic view, we are living according to our

expectations for how things are supposed to be.

Things never are the way they are supposed to be – so that means

we are at odds with the way things are.

We are either angry or ashamed, blaming ourselves, blaming someone else, and we become internally

preoccupied with why things are not the way they should be. That makes us lonely and bitter, and people

don't want to connect with us.

So it is much better to have a realistic view, and then we can still connect with each other, which is what we

all want.

Trauma: The Way Into and Out of Self

Dr. Buczynski: You have also said that, “Trauma is both the way into and the way out of self.” Can you

elaborate on what you mean by that?

Dr. Epstein: The self, whatever the self is – which is in both Buddhist thought and psychoanalytic thought –

remains a mystery.

But we all have a sense of the self. I know who I am as opposed to who you are.

The self is built on all the traumas that we go through – from birth to early life with our parents, to the first

“When we have an unrealistic

view, we are living according

to our expectations for how

things are supposed to be.”


day of school, to what it is like to be in fifth grade, to being on the sports

teams. All of those, both joys and sorrows, are what the self relates to.

The self is built on the remnants of that – what our memories consist of. As

far as the traumatic ones go – the things that are hard to face, if we don't make enough room for those things

that are hard to face, then we are in a pretend mode – what I sometimes call the “rush to normal.”

If we are in a pretend mode, a kind of false mode, then how real can we be with another person if we are all

the time projecting some kind of false image of who we think we are supposed to be?

Trauma is the way into the self – that is what forms us. To be honest and

real about who we are, we have to be able to talk about what is hard –

yes, we were upset when our parents divorced or, yes, we were upset

when some other terrible thing happened.

Trauma is also the way out of the self. We don't need to be and we aren’t limited by our sufferings. We have

an inherent capacity to relate with love and kindness and understanding to ours’ and other’s sufferings.

The capacity to relate is actually much stronger – it is much more us than the negative things that have

conditioned us. That is the “detached but not disinterested” part of the meditation.

When we can learn to connect more to that relational self, then we are freed from the limited view of

ourselves as conditioned by the traumas.

We are not so much the lonely, suffering, angry, bitter, shamed person – we are someone a little kinder – a

little more loving.

The Rush to Normal

Dr. Buczynski: You referred to something that I wanted to follow up on and get your thoughts on – you

referred to “rush to normal.” Can you tell us what you mean by that?

Dr. Epstein: There is so much pain and suffering in the world – there is so much that everyone goes through

on a given day, in a given week.

“Trauma is the way into

the self – that is what

forms us. Trauma is also

the way out of the self.”

“The self is built on

all the traumas that

we go through.”


It is not just a Judeo-Christian-Lutheran kind of conditioning; it involves suffering and trauma, too – the

presentation of self and protection of one’s “face” is part of that culture as well.

Many people don't want to reveal the depth of their suffering. They feel

that they will be shunned, or they will not be accepted if they do. They

feel that they must “put on a good face.”

If their dog dies, if their child is sick, if they are struggling in their marriage, if they are fighting with their

parents – they feel that they should be able to function without

any of that insinuating its way into their being.

People put a lot of pressure on themselves. That is what I am

calling the “rush to normal” – they put a lot of pressure on themselves to get over their suffering quickly – to

get back to work and to get on with the next thing, but I am not in favor of that.

A Buddhist Approach to Developmental Trauma

Dr. Buczynski: I want to spend a little bit of time talking about a Buddhist approach to developmental

trauma. That is something that you have written about in your recent book. How does a Buddhist philosophy

see this type of trauma and how it should be addressed?

Dr. Epstein: There is a famous Buddhist sutra, called the “splinter of rock discourse” in which the Buddha is

seen talking about a splinter of rock that is lodged in his foot.

In the sutra, the Buddha is lying on his side with his legs curled up, and not

complaining at all about the pain of the splinter.

I was very interested in that. The Buddha has a splinter. The Buddha has pain. I

thought maybe we could take – and I know it’s not necessarily meant to be a metaphor for psychological

pain, but it might as well be – the splinter of pain, the splinter of rock, that the Buddha is carrying as a

metaphor for the death of his mother when he was a week old.

The splinter is a pain that can be both physical and emotional. Maybe it is a physical illness that takes us to

the nurse practitioner or to the clinic or to the doctor, and we feel guilty – “What did I do to make this

happen?” or “Is this my karma…?”

“People put a lot of pressure

on themselves to get over

their suffering quickly.”

“Many people don't

want to reveal the depth

of their suffering.”

“The splinter is

a pain that can

be both physical

and emotional.”


Or maybe it is psychological pain that is giving us physical symptoms and we go to the gastroenterologist or

we go to the psychotherapist.

Some of those pains, some of those splinters, are bits of primitive agony that people are carrying from their

earliest days or earlier times.

I’ve written about another patient whose early life was all about taking care of his anxious mother. Her

anxieties were his reason for living. He had to sleep in the same bed with her; he had to listen to her pain; he

had to comfort her – that was his job.

When he grew up, his own anxieties frightened him terribly. He had no idea how to deal with his own

anxieties. They reminded him of his mother, but there was no one there to comfort him.

He couldn’t comfort himself the way he had comforted her, and he was in terrible pain.

That is an example of the kind of developmental trauma that you are

asking about. His own anxiety had to be submerged – to survive he

had to take care of her. No one was taking care of him.

In adult life, that becomes a problem. He had to learn – and both meditation and psychotherapy worked

together and were very useful to him.

First, he had to learn what these anxious feelings were – he had to identify them as anxiety. Then, he could

learn to deal with them without a whole lot of fear.

Dr. Buczynski: In a way, that sounds like either meditation or psychotherapy.

Dr. Epstein: I think that they work together. I’m all about using whatever works, and they have certain basic

commonalities although they come from very different places. They both

have basic commonalities that make them extremely useful for us.

Dr. Buczynski: Are there times when a patient has developmental trauma

and you would not use meditation?

Dr. Epstein: Often, the remnants of developmental trauma surface on meditation retreats. Sometimes in

those environments, the meditation teachers don't know what to do.

Meditation teachers are not schooled as psychotherapists; they can be frightened by this sudden anxiety or

“Some of those pains,

some of those splinters, are

bits of primitive agony.”

“He couldn’t comfort

himself the way he had

comforted her, and he

was in terrible pain.”


sudden pain or sudden rage. Often, these look like psychotic thoughts, and

teachers just want to send the patient home.

It is not always possible to predict when that is going to happen. But it is

possible to help people in those situations.

Sometimes the sitting alone in the quiet and the silence of a meditation retreat is not what a person needs

the most when those kinds of feelings erupt and they have no idea what is happening.

Once they have been in a therapeutic relationship and developed the ability to put language to the

experience, then the meditation and mindfulness techniques can be very useful in desensitizing them to their

own emotions, which is one of the tasks that needs to happen.

Juggling and the Meditative Process

Dr. Buczynski: You talked in one of your books – I forget which one – about how, when you were first

learning to meditate, you actually learned to juggle. How is that relevant?

Dr. Epstein: When I was first learning to meditate, I was coming from Harvard where I was an

undergraduate. I only knew how to learn in one way, which was to study and do my homework.

I was going to all these meditation classes, and I was learning the technique. I was trying to study and I was

trying to do my homework, but I was missing some element.

If I had been more of an artist or if I had been coming from art school, I would have known another way of

learning, which has to do with learning how to enter into a creative process.

This is where one has some kind of faith or trust in one’s own instinctive ability to grasp something. I didn’t

have that much instinctive faith or trust.

Some friends of mine…decided to teach me to juggle. In learning to juggle, which I started to practice with

my student mind, I was able to get three balls in the air.

But to do the juggling, I couldn’t be in my thinking mind anymore. I had to be much more in my body and in

my hands – where my hands and my mind were connected in a way that they weren’t usually.

“Often, the remnants

of developmental

trauma surface on

meditation retreats.”


I really liked the feeling of being able to keep the juggling going.

I realized that that was a perfect metaphor for what meditation is about.

In doing meditation, you are not alighting on – you are not fixing yourself on any one ball – you are keeping

all of them in the air.

You learn by watching the breath or by doing a mantra or whatever you do

–those are just the training wheels.

When you really get going in meditation, it is like you are making room for

everything and you are not holding on to anything.

Thoughts are coming and going – they don't stop. Feelings are coming up – deep feelings, scary feelings,

shards of primitive agony. Dreams, memories, and plans are coming up. Sounds are coming in from the

environment. The body is aching. Feelings of love and joy sometimes even arise.

But what you learn in meditation is to just keep juggling – you just keep letting it all happen. You don't alight

on any one aspect. You don't cling, and that not clinging is so hard because we all cling.

In meditation, you see where you are clinging, which would be the equivalent in juggling of when the balls fall

out of the air and when you drop them. You can see when you are clinging, what you are clinging to, how you

are clinging, and then you start again.

That process of seeing where you are clinging is the meditation.

The equivalent is when you would see the balls drop out of the air – It is,

“Oh – where was I then? My mind wandered.”

The meditation keeps everything flowing, not clinging – but no one can do that forever. “Oh, what a good

meditator I am.” With that there’s a little bit of clinging.” Then, we say, “Oh, yes – look at that ego – look at

that conceit. Okay, I see it. Now I can start again.”

So, meditation is the juggling – seeing the clinging, learning from it and then returning to the practice.

“In doing meditation,

you are not fixing

yourself on any one

ball – you are keeping

all of them in the air.”

“That process of seeing

where you are clinging

is the meditation.”


When the Mind Has No Pride

Dr. Buczynski: You spoke in your book about a meditation teacher who once said that, “The mind has no

pride.” What did he mean?

Dr. Epstein: He was making a joke. He was coming out of his own two-week retreat – a long, silent retreat,

and I happened to be there doing my own retreat, and he was chuckling to himself.

What happens on these retreats is that you observe your own life, and the humor of it becomes very, very

obvious – you see your own preoccupations and how petty they can be, “Who’s making that noise over

there? Who’s scraping their fork?” You notice how angry you can get over the stupidest things.

He was emerging from his retreat and this line had formed in his mind,

which was like a joke to himself: “The mind has no pride” – which had a

double meaning.

The enlightened mind has no pride because the false notions have been

seen through so there is no one there to be conceited. He really meant, “Oh, look at all the crap in my mind.

There’s no room there for pride and humility.”

Dr. Buczynski: How is our inner dialogue different from our thinking mind?

Dr. Epstein: I think it’s the same – our inner dialogue and our thinking mind are the same, aren’t they?

There is something that happens in meditation through this self-reflective capacity.

When we are observing our own pride, we are observing our own pride with humor, and maybe that is a little

bit different from our regular thinking mind – we are in some kind

of dialogue with our own selfish preoccupations.

Most of the time we are just being driven by our selfish

preoccupations; we are really not stepping back to examine them.

In meditation there is no choice – there is nothing else to look at but your own selfish preoccupations.

So gradually you turn that into a kind of television show and you end up, like my teacher, making jokes about

yourself, as a way of putting language on the experience – which is really a humbling experience, to see how

“On these retreats you

see your own

preoccupations and

how petty they can be.”

“In meditation there is no

choice – there is nothing

else to look at but your own

selfish preoccupations.”


self-centered one actually is.

Realizing That We Don’t Need More

Dr. Buczynski: You spoke in your book at one point about, “We all get reduced to a seven-year-old who is

basically trying to figure out, “Who’s gotten more than I did?”

Dr. Epstein: Yes. I was writing that as the parent of several

children around that age so that image was big in my mind. It’s

a humbling and liberating experience, not just a painful

experience, because it goes to what we were talking about

before – the “rush to normal.”

It is when you can admit, “Oh, yes, okay. I’m really at base here – just a seven-year-old who worries about

who wants more.”

Then you realize you don't have to take the biggest piece – you can deliberately offer some of your ice cream

to somebody else – because really you don't need more all the time.

Dr. Buczynski: With this sense of “you don't need more, how does that develop?

Dr. Epstein: How does that develop? It develops naturally. I think that is the amazing thing that I have

learned from Buddhism in particular: Buddhism is very optimistic, much more so than psychoanalysis, which,

developing in the midst of the World Wars could err on the side of some

kind of fatalism.

Buddhism, like some psychoanalytic thinkers, sees an inborn tendency

towards the good – that the Buddha mind is inherent in everyone and it

is just these obscurations of self-centeredness that get in the way of our

good heart.

Basically, if we use our minds to examine ourselves, we can peel away the selfish layers, and underneath

these selfish layers, we are relational beings.

We are all like mothers who have babies – they don't have to go to school to learn how to be mothers. There

“You realize you don't have to

take the biggest piece – you

can deliberately offer some of

your ice cream to somebody

else – because really you don't

need more all the time.”

“If we use our minds to

examine ourselves, we

can peel away the selfish

layers, and underneath

these selfish layers, we

are relational beings.”


is nothing more difficult than taking care of an infant – they are impossible: they need to be fed and they are

completely demanding.

If you were your usual selfish self with an infant, the infant wouldn’t survive. But mothers somehow rise

above themselves – they know how to do that under the pressures of biology.

The Buddhist idea is that underneath our selfish thinking minds, we are all mothers – the capacity to relate in

a non-egocentric way is already wired in biologically.

We can come to that capacity the way doctors and nurses have to come to that in their work. That capacity is

there in everyone – if you can create the right environment, you will grow into the good and it will emerge.

It is not to say we are not all capable of incredible destruction; if you put us in a

bad environment, the worst qualities will also emerge. This is not unidirectional,

but we all do have that capacity to grow into the good.

Dr. Buczynski: Yet a lot of life doesn’t feel like that. For me, the analogy breaks down a little bit in that the

mother has a precious little infant; there is quite a difference between the mother and the infant and it is

very apparent that the infant is so needy.

When we are being that seven-year-old, we are playing with other seven-year-olds who, in the way you

described it in the book, are “getting more than we are…”

Dr. Epstein: The other seven-year-olds are precious little infants, also. They are

precious little infants; you are a precious little infant – and we can relate to each

other in that way.

We have the capacity to relate in that way. It is not required, and we can certainly relate in many other ways;

our own sense of ourselves as a deprived seven-year-old needing more often gets in the way.

But based on the studies that are done, we see what really gives people a sense of value, and what gives

people a sense of satisfaction. The greatest satisfaction comes out of giving.

Dr. Buczynski: As someone stays in a mindfulness practice, do they achieve that?

Dr. Epstein: If someone stays in a mindfulness practice, they are at least in some kind of tension with

themselves around that. I don't know how much people achieve; I think that is completely individual.

“The Buddhist

idea is that we

are all mothers.”

“We all have that

capacity to grow

into the good.”


But the facility of touching that is always there. There are moments that

come in a mindfulness practice where you are able to let go of your

selfish preoccupation, and it feels wonderful.

Dr. Buczynski: I am afraid we have to stop. I appreciated this time and

found so many fascinating ideas that we covered.

I am so glad that you have come out with another book. It is going to be

exciting to see people diving into that book as they did your first book, and to see what you do next.

Dr. Epstein: Thank you! Thank you very much.

Dr. Buczynski: Take good care, now and again, thank you so much.

“There are moments that

come in a mindfulness

practice where you are

able to let go of your

selfish preoccupation,

and it feels wonderful.”


Mark Epstein, MD is a psychiatrist in private

practice in New York City and the author of a number of

books about the interface of Buddhism and

psychotherapy, including Thoughts without a Thinker,

Going to Pieces without Falling Apart, Going on Being,

and Open to Desire.

He received his undergraduate and medical degrees

from Harvard University and is currently Clinical

Assistant Professor in the Postdoctoral Program in

Psychotherapy and Psychoanalysis at New York

University.

Ruth Buczynski, PhD has been combining her commitment to mind/body medicine

with a savvy business model since 1989. As the founder

and president of the National Institute for the Clinical

Application of Behavioral Medicine, she’s been a leader

in bringing innovative training and professional

development programs to thousands of health and

mental health care practitioners throughout the world.

Ruth has successfully sponsored distance-learning

programs, teleseminars, and annual conferences for

over 20 years. Now she’s expanded into the ‘cloud,’

where she’s developed intelligent and thoughtfully

researched webinars that continue to grow exponentially.

About the speakers . . .

how to apply mindfulness to your life and work · unhappiness; he said you could change your...

Documents