Mark Epstein on psychoanalysis and meditation
I studied Mark Epstein's Thoughts Without A Thinker to learn how a psychoanalyst integrates mindfulness into psychotherapy.
Mark Epstein's credentials are impeccable. He is a long-time meditator, student of Buddhism, a psychiatrist practicing psychodynamic psychotherapy. He was mentored by some rather eminent scholars of Buddhism: Joseph Goldstein and Jack Kornfield.
The first part of the book lays out classical Buddhism in a framework of psychodynamic understandings. It is a fine introduction for the psychoanalyst, as he frequently describes Buddhism from the point of view of Freud's teachings. The second part describes Buddhist meditation and explains its workings psychodynamically. The third part presents a model of how Buddhist meditation can work hand-in-hand with psychotherapy.
It is this third part that is of great value to the therapist seeking ways to integrate meditation or mindfulness with treatment. In it, Epstein uses Freud's essay "Remembering, Repeating and Working Through." While I recommend reading this third part of the book carefully, as it is full of important insights, a brief synopsis might be helpful:
Epstein sees psychotherapy and meditation as going hand in hand. He does not see them used consecutively, or side-by-side, but rather being closely integrated.
Epstein focuses on the concept of the need of patients to deal with the `basic fault,' the feelings of inadequacy left over from growing up with parent(s) who did not devote enough attention to the child. He sees this as a sense of emptiness that must be dealt with in therapy, rather than dealing with specific incidents with the parents.
There are some problems of using meditation without the support of a therapist. Epstein writes, "meditation is often extremely efficient at bringing out the basic fault, but rather silent about dealing with it." (pg179). (In my experience as a therapist, this problem, as it is encountered by beginning meditators, can result in great discomfort, often so great the defenses keep it out of awareness. It can be a cause of many beginners finding reason to discontinue meditation just when they get started. Those who can verbalize it might call it a sense of emptiness.)
Also, meditation can stir up projections and transference that the classic meditation teacher may not know how to respond do. The therapist would see this as a natural and expected occurrence, and of course has the necessary training to use it productively with the patient. Thus the need for therapists versed both in therapy and meditation.
A huge benefit of meditation to the therapist comes from developing her or his own meditative practice. It has been said that the therapist's person is the first and foremost element in healing. The therapist who meditates can achieve a much more advanced `presence' with the client, and this can result in a stronger, more productive therapeutic relationship. The presence involves listening, but also an attitude of acceptance and openness, elements often nourished by meditation. For Epstein this means sitting with the patient without
an agenda
trying to force an experience
thinking h/she knows what is happening
feeling h/she knows the patient
As for the therapeutic process, Epstein writes, "Much of my work as a therapist with a meditative perspective involves teaching people, in the context of therapy, how to pay attention to what they are repeating in a manner that is both meditative and therapeutic." (pg. 193)
In discussing `working through,' Epstein defines it as `changing one's view.' While this will be a very challenging adjustment for experienced therapists, it is helpful once the nature of meditation is understood. It goes with the idea that `working through' means less an outpouring of emotion and more an ability to sit with emotion and see it differently, thus `changing one's view.' Many therapists will need to develop their own meditation practice before fully accepting this premise!
Epstein describes how emotion can be experienced in the body and thus experienced as part and parcel of the `I' rather than as split off elements. When emotion is experienced through the body it can be seen as something that arises and falls away, rather than as a feared, stuck part of the self.
In attempting to describe meditative states of mind, and the shifts in perception and attitude that can result, Epstein does a good job, but this is not easily summarized. Imagine writing an essay on the experience of swimming, for one who has never swum, versus offering the experience of swimming itself. Experiencing mindfulness meditation is much more than most authors can hope to adequately describe. Nevertheless, Epstein's core idea is that the patient needs to arrive at a place of feeling Robert Thurman's `injured innocence,' basically an indignation at the treatment received from loved-one(s), and then is most open to having a shift in feelings about that. It's sort of like moving from a position of swimming in the emotions, to a position a little bit away from them, where an `I' can observe them from a few feet away. The transition from there to a deeper appreciation of the `I' who is experiencing the suffering, rather than being consumed by the suffering itself, is an important part of growth.
Epstein has succeeded in explaining one way that meditation can help the patient. This conceptual framework is very important for any therapist wanting to provide more than superficial change, and deserves careful reading, followed by developing her or his own practice. Based on my experience, the therapist cannot go much further without jumping into the water and experiencing meditation firsthand. And that need not be seen as a price-of-entry to meditative therapy, since this very jumping in can help the therapist develop the choiceless awareness within the session that is so vital and valuable.
There are many exciting developments in the use of mindfulness and meditation in psychotherapy. A Buddhist approach is one of them. What gives such value to Epstein's approach, though, is his success at giving an overall theoretical psychodynamic framework. This book is an excellent statement on the `how it works' of meditation in psychotherapy. What is needed after a close reading of this material, are specifics on the `how to' of actually doing and using meditation within a psychotherapy practice.
For now, learning the `how to' in individual psychotherapy will remain the province of supervision, as approaches are developed client by client.