The Zen of Therapy
I first tried meditation nearly fifty years ago, and I have practiced psychiatry as a therapist for nearly forty. In that time, I’ve written several books comparing, contrasting, and translating the ideas of one into the language of the other, all the while continuing to see clients and attend regular silent meditation retreats.
And yet, while my encounter with meditation has been the most important influence on my work, it was never something that I could describe easily. Meditation has taught me, changed me, and shaped my life. But how do I use it—or how does it use me—in my interactions with patients? I know meditation has taught me how to sit still and listen non-judgmentally, but are these the only ways it has contributed to my process? How do the teachings of mindfulness show up in my day-to-day sessions? What seeps through from my meditative experiences into conversations with my patients?
In 2019, I tried to find out. For a year – coincidentally, the year before the pandemic changed the practice of psychotherapy forever – I probed my process more deeply, taking notes on a range of therapy sessions, exploring how mindfulness was impacting my work with my clients. The result is my most recent book, The Zen of Therapy.
As I reflected on this year of work, I can see one thing clearly: I introduce my patients to a meditative sensibility by the way in which I relate to them. Maybe this should have been obvious from the start! But in examining my method, I can see that while I am different with every patient, I am myself with all of them. I learned from meditation how to let myself be, and this is the quality that guides me.
As is evident in the accounts that make up the heart of The Zen of Therapy, I do not model this sensibility by resting calmly in a meditative state while my patients free-associate. I engage actively. But I am very quiet inside when I am working; all of my concentration, all of my attention, goes to the person I am with. And I want to know everything, from the television shows they are watching to the food they are eating to their most shameful thoughts and reflections.
I believe in the power of awareness to heal. I want my patients to see how and when and where their egos, or superegos, are getting the best of them, because I know that if and when they can see this clearly, something in them will release. And their best chance of seeing it comes when my mind is quiet. Somehow, my inner silence resonates in them and feeds their awareness.
Each person is like a Zen koan I cannot solve with my rational mind. I have to give myself over completely, while staying very much myself, to let the koan and my response to it become one thing. When this one thing fills the interpersonal field, the hidden kindness in life, present in each of us, gets revealed.
People come with all kinds of strange sorrows. They want to understand their experiences and learn from them, to make sense of what has made them what they are. Yet learning from experience alone is not all that it is cracked up to be. There is more to a person than who they think they are, and sometimes therapy has to create circumstances conducive to unlearning. How often have I disoriented people to the systems and explanations they have created for themselves?
When enough trust is built in the therapeutic relationship, there is a chance to release, and be released from, a self-preoccupation that is no longer serving a reasonable purpose. And simple kindness is the fuel of that process. When the objectifying mind drops away, even for an instant, all kinds of latent interpersonal possibilities emerge—for connection, empathy, insight, joy, and, dare we say, love. How to make this happen remains the trickiest of questions.
There is no formula to follow, no script that can be written that will ensure success. But this project has affirmed for me that therapy does indeed have the potential to catalyze such openings. Therapy can bring out the hidden intimacy that gives meaning to life. What risks I have sometimes taken with my patients! How brave and vulnerable they have been in response!
Mark Epstein, M.D. is a psychiatrist in private practice in New York City and the author of a number of bestselling books about the interface of Buddhism, meditation and psychotherapy, including Thoughts without a Thinker, Going to Pieces without Falling Apart, and his newest, The Zen of Therapy. He received his undergraduate and medical degrees from Harvard University.