The publication of his new book Going to Pieces Without Falling Apart (Harper Collins, 1998), confirms Mark Epstein as one of the preeminent synthesizers of the wisdom of East and West. The following interview with Inquiring Mind editors Wes Nisker and Barbara Gates reveals how he brings this wisdom and his own meditative insights to his work.
Inquiring Mind: In your new book you say that as a psychotherapist, you have adapted Buddhist practices to the needs of your clients. Specifically, how do you use the dharma in a therapy session?
Mark Epstein: I think about therapy as doing a two-person meditation. So in a therapy session, I try to give the same kind of impartial attention to everything there is to observe, making the entire space a field of meditation.
IM: Do you instruct the client to be aware of everything in that meditative way, or do you act as the mindfulness for both of you?
ME: I don’t tell my clients to be in that mode, but I try to set a good example.
IM: How does your mindfulness facilitate the therapeutic process?
ME: First let me say that I think the best psychotherapy, whether or not it is labeled Buddhist or meditative, is creating exactly the kind of space that I’m describing. As it is conventionally practiced, however, most psychotherapists have their own agendas for their patients. They are trained to look for conflict and to draw it out of the patient in a particular way. That process will often support the therapist’s view of how change is supposed to take place rather than how it might naturally occur.
For instance, in working with anger, a lot of therapists—and also a lot of patients—believe that what is most important is to express that anger. Upon seeing the hint of anger in a patient, a therapist with this kind of agenda might encourage the patient to express the anger, act it out, get angry at the therapist, you know, try to exhaust the anger through expression. My training in Buddhism has taught me something different, which is basically that anger is bottomless, and that the way to transform it is to create enough space around it so that the anger can come and go on its own. So while I’m very attentive to anger in a patient during a therapy session, I don’t necessarily encourage expression of it but only an acknowledgment of its presence.
Most therapists these days are also trained to look for what’s called “transference,” that is, all the ways the patient brings some earlier relationship to bear upon the relationship with the therapist. So when the therapist gets a sense that the patient is treating him the way the patient must have treated his mother or father, the therapist is trained to focus the attention on the transference relationship and to make interpretations, such as, “Oh, you must be experiencing me like your mother.” The conventional strategy is to feed the transference, to consciously try to turn the patient-therapist relationship into a transference relationship and then to resolve it. Then, presumably, the therapy is done.
I’ve been wary of doing that with my patients. I try to be attentive to the transference, but then just to allow it to dissolve so that we can have a real relationship, meaning a direct, in-the-moment relationship between the two of us as we actually are, instead of encouraging a fantasy transference relationship.
IM: In that way do you feel that you come to a different sense of a person or find a different kind of healing?
ME: I believe that I am finding something more immediate and playful, which therefore has the potential to be more liberating than bringing up and going over the old, conditioned, patterned relationship. I’m not saying that I don’t work with the transference, only that those old patterns are usually so obvious they don’t need to developed and promoted in the way conventional psychotherapists are taught. These patterns can be talked about as they come up, and then they can be let go of, right in the moment. And it is precisely that letting go of the transference from moment to moment that is so much like meditation, and it can free the person in the same way that meditation can.
IM: So you are offering people a relationship that reveals a different way to be.
ME: At my best.
IM: Do you ever talk explicitly about meditation with patients?
ME: Usually only if somebody asks. Besides, a lot of people who come to me already do have a practice, and they come to me because they know that I won’t think they are crazy, at least not for having a practice. But I don’t ordinarily prescribe meditation for people who come to me who aren’t already practicing. I will sometimes reveal what I have learned from my own experience of meditation, and I don’t hide the fact that I have been deeply influenced by my practice.
One of the creative aspects of doing this work is figuring out appropriate ways to unhinge somebody from themselves. I try, in one way or another, to make someone aware of how they interfere with their own flow. One of the best ways that I’ve found is to directly cue somebody into their physical experience. Even veteran meditators, with all their training, continually try to figure everything out in the mind. It’s a deeply ingrained habit. So when I’m talking with someone about a difficult personal issue, I will look for the appropriate moment and then try to direct the person’s attention to the body or breath. I’ll interrupt and ask the person what they are feeling in their stomach or ask them to be aware of how they are subtly holding their breath. Bringing attention to breathing is a very underutilized technique in psychotherapy. People often hold onto the out breath when they are anxious. If I can get them to pay attention to how they are holding their breath, it often relieves the anxiety, or allows the anxiety to convert itself into the natural excitement or energy that is being held in. Becoming aware of the body or breath, people can begin to surrender to their natural wisdom.
I also make use of my experience of meditation at certain critical times in the therapy, for instance when a person is starting to experience a difficult emotion and is afraid it will overwhelm them. I draw on my knowledge of mindfulness to show them, in the moment, how to be with those difficult feelings without getting overwhelmed. I don’t necessarily talk about what I am suggesting as mindfulness. I just say, you know, “Try to feel what’s happening in your chest right now.”
IM: In your book you say that your patients’ most common fear is that they will be overwhelmed by their feelings; the ego is afraid it will lose control.
ME: Most of the people who come to see me are having some trouble around emotions, and they usually have one of two basic strategies in trying to cope with their difficult feelings. One is to push the feelings away because they are afraid of being overwhelmed by them. The other is to be overindulgent with the feelings and to act them out too much without ever really experiencing them. Because of my Buddhist training, I know that it is possible for someone to create an internal environment in which any feeling can be experienced, without either having to express that feeling or become overwhelmed by it. People are helped immensely by learning this skill.
IM: That requires that people learn how to fully allow and experience their feelings, which in turn requires that the feelings somehow be held or sustained.
ME: Exactly. And it requires an understanding of what feelings really are. What I have noticed, in myself to start with, is that although we may be able to talk about feelings, we don’t readily understand the extent to which our emotional states are physical experiences. I think the defensive strategy that most of us adopt is to jump away from the physiological sensations and into our minds. We try to turn our feelings too quickly into thought, which means that the bodily aspect of the emotion is being pushed away. That’s how people become estranged from critical aspects of themselves. When we learn to experience the complexity of our emotions in our physical being, they become more understandable as well as more tolerable. Therapy can then become a kind of practice ground for knowing and exploring our feelings.
IM: Many people discover in meditation that they are much more aware of their thoughts than they are of their feelings, and yet it seems as though feelings most often are leading in the dance.
ME: That’s a nice way to put it. I believe that feelings do lead. I’ve been especially drawn to the ideas of the child analyst D.W. Winnicott, who describes in great detail how a child develops an over-reliance on thinking. Winnicott explains that when a child has to cope with either an impinging or an ignoring environment, the most common defensive strategy—perhaps just because we are humans with brains—is to go up into the mind and to start thinking about how to manage the situation. That strategy takes the child away from her feelings and leaves her, as one of my patients put it, spinning in the eddies of the mind. I believe that what Winnicott says is true for most of the people who have come to me for therapy. I think that over-reliance on this defensive, coping, mental energy stays with us from childhood. I’ve also noticed that all the thinking usually has a certain kind of sadness attached to it, the sadness of a child who is either not being seen or not being left alone enough. What can happen in therapy or meditation is that by paying attention to all that obsessive thinking, we begin to feel the sadness beneath it, often only noticeable as a subtle physical sensation. I believe that to contact this sadness is often to get at the root of all the thinking.
IM: Some Buddhist teachers encourage the practice of staying with a feeling so that a meditator can experience it fully and become familiar with it, while others instruct you just to let the feeling go saying that it’s only another experience arising, and you needn’t pay any more attention to it than you might a fly buzzing by your ear.
ME: I think there are times when the advice just to let go is very skillful. Some Buddhist teachers would also advise countering a disturbing emotion with its opposite, hoping to quickly balance it out. That strategy can also be useful, showing people that their minds are made of more than just negative emotions. But ultimately, I think the real freedom comes from the ability to allow whatever feeling is arising to appear, play itself out, and leave on its own. That is the training of true equanimity.
IM: Most conventional Western therapy seems to be based on the notion that the psyche can be fixed, and once it is fixed we can live happily ever after without any negative emotions. In contrast, the Buddhist approach is that the psyche or self is a mixed bag by its very nature. That’s the Buddha’s realistic perspective, the First Noble Truth.
ME: I feel that the materialism that is endemic to our culture has infiltrated our way of thinking about psychology. So we idealize a perfect self and believe that by building it up—through self-improvement, self-knowledge, self-discovery, self-esteem—we can create a self that won’t suffer anymore. What the Buddha says, and many great psychoanalytic thinkers would agree, is that any notion of a concrete, inviolable, nonsuffering self is an illusion. In the Buddhist view, in order for a person to be happy, the ego has to keep unraveling. So the ego comes into existence briefly when it has to accomplish something and then dissolves. The self is always forming and de-forming, evolving and devolving. If we can make way for that process instead of getting in the way of it, then we can start to experience ourselves as we really are. That’s really the meaning of the title of my book, Going To Pieces Without Falling Apart.
IM: In your book you imply that this therapeutic method can allow people to experience what Buddhism describes as “emptiness” or anatta.
ME: Conventional psychotherapy is continually trying to cure people of their feelings of insufficiency. However, I believe that if people are always trying to push away this sense of insufficiency, then they will never really understand the truth of their condition, or what the Buddhists mean by emptiness. In fact, our own psychological emptiness—our sense of not being good enough or real enough—contains an important kernel of truth. None of us ever can be as real or strong a self as we imagine we should be. If we could only settle back into the feeling of psychological emptiness and dwell there for a little while, we could use that feeling as an entry into a fuller and richer experience of ourselves. By always trying to fix the psychological feeling of emptiness or fill it up with something, we are refusing to explore the Buddhist emptiness, which can be a very enlivening and satisfying experience. In the Western psychological emptiness, we find a bit of wisdom, but no compassion, only a lot of fear. If we can accept psychological insufficiency, we can approach true emptiness.
IM: In your book you talk about a little-known paper called “On Transience” written by Sigmund Freud, which echoes this idea. In the paper, Freud tells about taking a walk with friends who just can’t seem to enjoy the beauty of the surroundings and are instead always lost in their thinking. He sees their thinking as a defense against feeling sorrow. Freud says they can’t let themselves feel the beauty or the joy of the walk because they are afraid of the sorrow of losing it.
ME: Freud was pointing to the fact that we often cut ourselves off from our bodies and our experience and retreat into our minds. That sense of estrangement is, I think, the psychological emptiness of the Westerner. Just as Freud’s friends in the story refused to open themselves to the beauty of the countryside surrounding them, most of us retreat into ourselves and refuse to open to joy or love or to each other. We are so afraid of loss or emptiness that we stay closed and alone, caught inside ourselves. That’s what people complain about when they come to therapy. What I hope to do is allow people to begin making contact with their experience. That, I believe, is the beginning of intimacy—with ourselves, others and the world around us.