27 February 2012

Ian Gawler Blog: Do meditators need psychotherapy?



Quote of the day

Life is hardly more than a fraction of a second. Such a little time to prepare oneself for eternity! 
                                                                                                         Paul Gauguin

While some would say you would have to be crazy not to meditate, is meditation on its own enough? More and more research is coming out to validate meditation’s benefits, but if you have an emotional or mental difficulty, is meditation on its own enough? Or do you need psychotherapy, or counselling? Or in the more traditional sense, do you need the added benefit of the wisdom that comes with mind training and teachings?

I first learnt to meditate through the great psychiatrist Dr Ainslie Meares when I used his methods way back in the seventies to help overcome my cancer. A world authority on hypnotherapy, Meares discovered meditation through his interest in pain management. He then turned his whole psychiatric practice over to therapeutic meditation, wrote the first major book in the world on the subject, “Relief Without Drugs” in 1967, and claimed meditation could and would heal just about anything.

Meares was very much a man of science. He believed good health was a dynamic state of balance and really valued the capacity of the body and the mind to return to that balance given the right conditions. His experience told him one of the most reliable and profound ways to do this was to meditate in a particular way.

Meares’ meditation method revolved around relaxing physically and calming the mind profoundly. He was of the view that in the resultant state of deep relaxation, the body returned to its natural state of balance, as did the mind. Put very simply, he believed this re-established the natural order of good health – in body and mind. He believed this form of meditation was enough.

After Dr Meares’ death in 1986, I have been fortunate to deepen my own experience of meditation through many years of study with the great Tibetan Buddhist teacher, Sogyal Rinpoche. A key principle in Buddhism is fundamental goodness; that in our essence we are all whole and pure and good. Sure, we stuff up from time to time; sure some people do really terrible things, but all that is due to disturbances in our mind. Because of our ignorance, because of our chasing after the wrong things, because of our aversion to other thing, because of what is going on in our minds and our emotions we make poor choices and stuff up. But in our hearts, in our essence, we are whole and pure.

In Buddhism, meditation is regarded as the reliable pathway to take us past our ignorance and stuff ups, to take us back to who we really are, to take our mind back to its natural, healthy state.

In theory this all sounds pretty good, but in real life, is meditation enough?

I have to say in my experience of working with a wide range of people and conditions over 30 years, maybe, maybe not. Whether meditation can fix significant emotional and mental health issues seems to depend on the techniques that are used, the capacity of the person involved, and the quality of their relationship with their meditation teacher.

I can speak with some experience and knowledge about three techniques that warrant serious consideration in the field of therapeutic meditation, the Meares technique, Mindfulness and Dzogchen.

i) The Meares technique. 

Ainslie Meares was my mentor from when I first started running lifestyle based therapeutic cancer groups in 1981, up until his death in 1986. He explained to me that if you have a glass full of muddy water and you keep stirring it, you just get more and more muddy water. However, if you calmly put the glass down and leave it, the mud settles and you end up with clear water. If the mud is the analogy for emotional anguish and mental turmoil, he claimed his method of meditation involved learning to allow our emotions and thoughts to settle, with the effect that the mind cleared.

I can attest to many people having this experience. Just like the natural property of water is to become clear when undisturbed, so too when we learn to relax profoundly in body and mind, the mind finds its own natural peace.

But here is the catch. What of the mud? The analogy is good as when I began teaching meditation I found many people reporting this new-found deep, natural peace; as long as they kept meditating. Many reported a “hangover” effect. That is, if they stopped meditating, the peace lasted a while, but then the old states of mind reappeared as the mud welled up again.

So for these people meditation became like many medications for psychological conditions. You needed to keep taking it; and for many, the meditation took on almost an addictive quality. There was a need to keep the meditation going to maintain equanimity. So a healthy addiction, one with many positive “side effects”, but somewhat addictive all the same.

When I asked Ainslie about this his answer was simple; “What’s the problem? Why stop meditating?

In fairness, Ainlsie was a pioneer and I imagine he would have addressed this issue in more depth had he lived longer.

ii). Mindfulness. 

If we use Jon Kabat-Zinn’s definition and say Mindfulness is paying attention to our present moment experience deliberately and non-judgmentally, what does it have to offer psychotherapy? From the growing body of research, quite a lot it would seem; but there are two big issues worth being aware of if transformation is of interest.

Basic Mindfulness teaches us how to take the reaction out of things. So it is one thing to have a disturbing emotion or thought; it is another thing to be disturbed by that emotion or thought. Get it? Disturbing emotions and conflicting thoughts are common enough, often make good sense, sometimes not, but of themselves are just emotions and thoughts. They have the potential to be toxic, but of themselves they are just emotions and thoughts. It is our reaction to them, our secondary thoughts that they are bad or scary or wrong, or that something about us is bad, scary or wrong to be having such an emotion or thought, that creates the toxicity.

Mindfulness takes the reaction out. Mindfulness teaches how to be aware of our emotions and thoughts and to be non-judgmental. This leads to acceptance, relief and a clearer, more content mind.

But again, like with stirring the muddy water, what happens if you stop being mindful? Answer: it is easy to go back to the same emotions and thoughts with the same unhelpful reactions.

A more advanced form of Mindfulness takes us from the symptom to the cause. Disturbing emotions and conflicting thoughts do not exist in a vacuum. They have their own causes and conditions. What has been referred to as “Basic” Mindfulness, simply attends to the emotions and thoughts as they manifest, moment to moment. But these can be viewed as symptoms of deeper issues, the causes.

Transformative Mindfulness goes beyond the “simple” emotions and thoughts, to investigate and mindfully become aware of their causes. So for an adult who has experienced childhood abuse, there may be regular disturbing emotions and thoughts.

Basic mindfulness teaches us how to be aware of the thoughts without investigating or analyzing the cause. In doing so, it can free us from the anguish and turmoil of those emotions and thoughts, but it does little to transform the cause. This basic approach is very safe and easy and as such can be very useful, but it has the same quality of letting the muddy water settle and not doing anything about the mud at the bottom of the glass.
With Transformative Mindfulness we take our attention to the cause; in our example to the abuse. This is much more challenging and requires a good deal of mental stability so that it can be done in a way that is not overwhelming. It is a process can take some building up to and that can be supported and “held” by an effective therapist or group.

By giving our full attention, our full awareness to something like this, what happens is that the complex of emotions and thoughts around it can quite literally dissolve. This does not negate the memory of what happened, in fact sometimes the memories become clearer, but it does free the memory from the hurt and the adverse emotions and thoughts. It leads to a deep recognition that the event took place; bringing with it a new perspective and understanding, and what can seem to be a strange but powerful sense of acceptance and compassion – compassion for self and compassion for the others involved.
This is transformation.

iii). Dzogchen

Dzogchen can be translated as the great perfection and is regarded as the highest form of meditation in Tibetan Buddhism. It aims to go directly to the experience of our own true nature, that pure, enduring, fundamental aspect of our being.

Importantly, in Dzogchen there is the recognition that we all have this innate purity courtesy of being human. If we are alive, we have it. It is there, in us all, naturally. There is no need to seek it in some exotic external place, or to try to “make it happen”, it is just there, in us all the time.

The trick is to experience this fundamental goodness directly, but the problem is that most of us have lost touch with it. Meditation is how we reconnect, and the suggestion is that by doing so we reconnect with our fundamental goodness and that this flows into our daily life, freeing us from the effects of difficult emotions and thoughts.

So what of Psychotherapy?

Well firstly, for anyone having psychotherapy, or counselling for that matter, meditation makes the therapy easier and quicker. Meditation frees things up. It is like it weakens the glue that commonly binds us to the traumas in our lives. Frees us up to see things more clearly and objectively. Gives us the inner strength to revisit and transform old and current traumas.

Meditation facilitates the processes of psychotherapy and counselling.

So what is the difference between the two? The Oxford defines psychotherapy as “the treatment of disorders of emotion or personality by psychological methods”. Click here for the Wikipedia entry on psychotherapy - very interesting and informative.

Counselling is defined as “a therapeutic procedure in which a (usually) trained person adopts a supportive, non-judgmental role in enabling a client to deal more effectively with psychological or emotional problems, or gives advice on practical problems”.

Curiously, very little research has investigated the relative long-term benefits of the different psychotherapies. There is considerable controversy about which form of psychotherapy is most effective, and more specifically, which types of therapy are preferable for treating which disorders.

Back in 1952, in one of the earliest studies of psychotherapy, Hans Eysenck reported that two thirds of therapy patients improved significantly or recovered on their own within two years, whether or not they received psychotherapy.

Having completed a Masters in counselling myself, I always enjoy contemplating what makes for therapeutic change. Way back in 1957, Carl Rogers published a paper on this topic that I still find challenging and to have some validity.  The paper, entitled The Necessary and Sufficient Conditions of Therapeutic Personality Change was published in(link: http://shoreline.edu/dchris/psych236/Documents/Rogers.pdf)The Journal of Consulting Psychology, Vol. 21, pp. 95–103. Click here for the full paper. In it, Rogers said that for therapeutic change to take place, the following are required, and I quote:

“1. Two persons are in psychological contact.

2. The first, whom we shall term the client, is in a state of incongruence, being vulnerable or anxious.

3. The second person, whom we shall term the therapist, is congruent or integrated in the relationship.

4. The therapist experiences unconditional positive regard for the client.

5. The therapist experiences an empathic understanding of the client's internal frame of reference and endeavors to communicate this experience to the client.


6. The communication to the client of the therapist's empathic understanding and unconditional positive regard is to a minimal degree achieved.

No other conditions are necessary. If these six conditions exist, and continue over a period of time, this is sufficient. The process of constructive personality change will follow.”

In 2001, Bruce Wampold, a former statistician who went on to train as a counselling psychologist, published the book The Great Psychotherapy Debate. In it Wampold reports similar findings to Rogers:

1. Psychotherapy is indeed effective

2. The type of treatment is not a factor

3. The theoretical bases of the techniques used, and the strictness of adherence to those techniques are both not factors

4. The therapist's strength of belief in the efficacy of the technique is a factor

5. The personality of the therapist is a significant factor

6. The alliance between the patient(s) and the therapist (meaning affectionate and trusting feelings toward the therapist, motivation and collaboration of the client, and empathic response of the therapist) is a key factor.

Wampold concluded "we do not know why psychotherapy works".

Back to Rogers again. Very clearly, but speaking in psychological language, Rogers said it all comes down to care and love. If the therapist is caring and loving, and the client “gets it”, feels it, whatever else happens is only important in that it makes the therapist feel congruent.

So if someone who is trained and believes in one modality of therapy, breaks their rules and tries something else, it will not work. If they do what they have trained in, believe in, have experience of, and confidence in; it will work. So for example, one therapist who is passionate about short term therapy may well hold the potential to be just as effective for any given individual as another therapist who believes passionately win long term therapy. What is important is that the individual therapist is authentic. If they are drawn to short term therapy, they need to study and work with that. Drawn to long term therapy? Better study and work with that. Now there is something to challenge our way of thinking  - and our attachments to particular methodologies.

So is it the same with meditation? Do the different therapeutic meditation modalities rely on Rogers same six conditions? Does the impact of meditation depend more on the teacher than the technique? We can speculate, but the truth is we have no scientific evidence either way. Historically it is claimed the teacher is of paramount importance and it is easy to make a case for the advantages of different methodologies. But there is plenty more to learn.

So do meditators need psychotherapy?



In my early days I met plenty of people whose meditation served them well to allow  “the mud in the water to settle”, but who underneath remained quite disturbed. Not many in my experience fulfilled Dr Meares expectation that meditation would fix all their problems; some did but not many. Most still needed help and psychotherapy would have been a good option!

This is why I added imagery and mind training sections on emotional health to what I taught via my groups and writings. Getting rid of the mud left at the bottom of the glass required either concerted mental effort, and maybe a good therapy or two, or it required a more profound and more transformative style of meditation.

Shining the light of wisdom on old traumas with Transformative Mindfulness or the profound stillness of Dzogchen meditation will do the trick, but that takes developing quite a capacity in the meditator. This can be facilitated by a good relationship with a good teacher.

Sogyal Rinpoche has this effect on people – regularly. Over the years, one of the things that has given me more and more confidence in Rinpoche and his teachings, has been to observe the number of people whose lives have been transformed for the better through studying and practising with him.

In my own work, the focus has been on working with groups, and at the heart of those groups has been the teaching and practice of meditation. I see very few people individually. Instead, when people have problems or issues that surface, I encourage them to talk about it within the groups and we work on those issues directly. The experience is that many in the group will relate to whatever issue is presented, and everyone gets to work through their own variation in the process.

In doing so, there is an openness and ease that develops with the actual concept of having a problem. Instead of personal issues feeling as if they can only be discussed behind closed doors because they are somewhat shameful, embarrassing or too painful, there comes the recognition that everyone has difficulties and there is something liberating in being open with all of this. As well, a collaborative atmosphere develops and bonds the group with real care for each other developing. This takes the focus off the therapist (which can be very strong albeit useful in individual therapy and to a lesser extent in groups) and makes working through issues more of a community activity.

Throughout my 30 years working with the Foundation, and whether working with people affected by cancer, MS or other illnesses; or working in a prevention or wellbeing context, I have found working in groups to be the most effective. True, we have provided individual counselling as well, and there is no doubt some people have benefited from this a great deal. As I said, I do a little of this myself, but the focus has been on group therapy. What I also find very effective are short interventions around the edges of the groups, often in the form of brief conversations in the tea break during the group, or before or after the group itself.

What is also without doubt is that for those who can learn and apply what I have called Transformative Mindfulness, or the deeper essence of Dzogchen, then meditation is indeed enough.

It is worth noting some studies have shown group therapy to be more effective than individual therapy and there is little doubt it is more cost effective, with studies showing group therapy to be up to four times more cost effective then individual therapy.


So what to do?

Eat good food and meditate. Meditate in a way that feels congruent to you. Learn from someone you feel really cares about you and whose rational makes sense to you. Someone you feel some peace with, and with whom you can develop some confidence. Maybe it is as simple as aiming to open and trust your heart. If you do go to a therapist, be aware that the relationship you have with that person is of paramount importance. You need to feel that they understand you and are really committed to your welfare and wellbeing. Dare we say it, you need to feel they love you in an altruistic and deeply caring way.

Of course, just to complicate matters more, it is obvious that many resources available to a person experiencing emotional or mental distress—the friendly support of friends, peers, family members, clergy contacts, personal reading, healthy exercise, research, and independent coping—all present considerable value.

What is your experience?

If you have managed to read this far, you must have some interest! This is by far the longest blog I have ever written; maybe it is one of the longest ever written!!! However, it is linked to the talk I recently gave to the Australian Association of Buddhist Counsellors and Psychotherapists on this topic: Do meditators need psychotherapy?

So whether you are a therapist, a meditator, or simply someone interested in this discussion, please feel free to comment, either in the comment section below; or via email to info@insighthealth,com.au.

NEWS


Meditation in the Forest with Ian and Ruth Gawler: April 30 to May 5 

The 7 day meditation retreat Ruth and I will lead prior to Easter in the Yarra Valley. Take time out to reflect, to be with yourself and like-minded people, learn more about and deepen your meditation; all supported by the great food at the Gawler Foundation and amidst the delights of the Upper Yarra forest.
This retreat is deliberately pre Easter so you have time to integrate and enjoy the calm over the Easter period.        Click here for details.

RELATED BLOGS


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RESOURCES


CDs:   Healthy Emotions and Mind Training

BOOKS: Meditation - an In-depth Guide

You Can Conquer Cancer and The Mind that Changes Everything

ON-LINE: Mindbody Mastery – downloadable meditation program with great support package.




12 comments:

  1. AS ALWAYS A THOUGHTFUL AND REWARDING ARTICLE

    ELFIE CRYSTAL

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  2. As usual, Ian, your blogs are thorough and well thought out. Your references to Anslie Mears, Carl Rogers and Bruce Wampold are interesting and highlight the importance of our emotional availability to, acceptance of those seeking our help.

    I'd like to emphasise briefly four areas not specifically included in your presentation that I think are important to mention:

    The first is that effective psychotherapy also depends on the therapist being well trained and knowledgeable about the sorts of things their clients/patients are dealing with. Some people take the guidelines you quote as a kind of permission to believe that almost anyone can do it. Excellent training and extensive exposure to a variety of different modalities is fundamental in being able to do the job well.

    The second is that a great deal of personal growth is stimulated through helping people deal with the practicalities of life. As people learn how to eat, exercise, rest ... well (which you teach) related emotional-psychological problems start to surface and can be dealt with. This is partly why I think your life-style orientation to dealing with serious physical illness is so helpful. Of course, people need to know how to respond to these 'arisings' so the outcome includes psychological healing.

    Third, in my experience meditation and dealing with the historical origins of current problems, even when associated with a meditative availability to what arises, are often not enough. The reason for this is that people's early experiences are powerful influences on their later lives and capacities. Digesting such past experiences and their flow-on effects using meditation is fundamental. At the same time, and this is the main point here, new input (experiences, learning ...) is often needed to complete the process. Someone who was unloved may need a loving experience, someone who was subject to violence may need to experience tenderness and caring ... etc. And in some forms of psychotherapy such corrective experiences are available.

    Fourth, as people become more integrated, cleared, refined, expanded ... through meditative processes, the direct experience of past incidents often surfaces. When this is within the persons capacity to integrate and manage, all is well. When deeply disturbing, eruptive, extremely intense, however, external help and support may be necessary. This may require the expert invovlement of a psychotherapist who is familiar with dealing with these kinds of outpourings. It is not straightforward for the inexperienced.

    Thanks again Ian for a thought provoking blog.

    Ken

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  3. What a fascinating blog. And what a long one. Nevertheless I managed to read the whole thing on my iPhone! I have just re-read it now on a big screen and would like to share some of my story with you.
    I am both a meditator and a psychotherapy client, and for me the two are inextricably linked. Without the benefit of meditation, and the emotional insight it gave me, I would never have embarked on psychotherapy in the first place. I learned to meditate while attending one of George Jelinek's MS retreats at the Gawler in 2010. Until then I thought my life (apart from the intrusion of MS) was pretty stable, as good as it could get. I certainly didn't think I had any psychological or emotional issues that might need the help of a therapist. But the mud in my water turned out to be pretty thick. I realised while still at the retreat that things were not as I had always thought them to be. And I realised that the peace I was getting from meditation was something I wanted to keep forever, but that I would need to resolve some issues to be truly peaceful.
    After a few months of meditating at home after my return from the retreat, I felt strong enough to embark on therapy.

    My experience has been that meditation has helped the therapy process along. It has also been vital that the therapist I see is a believer in meditation and is interested in all things spiritual. But he is a conventional couch therapist nevertheless and meditation itself plays no part in our sessions. Meditation has also helped me to survive the waves of emotion that inevitably come from the therapy process.
    Meditation is on-going, constant, and will be part of my life forever. Psychotherapy is a short-term intervention. At some point in the future the need for therapy will no longer be there - then I will be left with meditation alone.
    It didn't occur to me to treat the emotional issues through meditation alone - by finding a meditation therapist - probably because of 'traditional' medical values. i can imagine though that with the right therapist the same results could be achieved.

    I did also attend Sogyal Rinpoche's public talk in Brisbane at the end of last year and experienced an incredibly powerful peaceful transformation while there - impossible to describe in words. I imagine that if I was blessed with that gift every day there would be absolutely no need for therapy of any kind - what more could I possibly need?

    Thanks for your wisdom,

    Karen Law

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  4. Great article Ian. Thank you. I have been studying and practicing therapy and Buddhism for over 30 years. This is a complex and lengthy topic, but to be concise; Yes, I agree that both can be highly effective and complement each other.
    As human beings, if we could just transform our hearts and minds, we would! However, many of us can't, without many skillful means in our 'toolkits.' I believe that good therapy and amazing Buddhist teachings and meditations are some of the most effective ways that can help us learn how to transform ourselves. Both are usually a process over time, and everyone has their own path of heart to follow. Deeply trusting our own nature and finding the person and practice to support us in working with our past and present and developing our authenticity and deep essence of who we truly are, is, for me, our path of awareness and compassion

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  5. Nice tutor. Your way of presentation is really too good. I am totally impressed by your post. I am looking for your more updates. Keep them coming.

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  6. Your article resonates with my own experience, having childhood trauma using Yoga &meditation for 25 years, I also have followed Sogndal Rinpoche, and also mindfulness. After leading small retreats three years ago my experience has led me to the same conclusion. I am not sure if in one life time we can live fully alive or if our past experiences will continue to have subtle effects, especially in the case of deep trauma, but I do know that we each can find the way through deepening these inner journeys to self, connecting with others and sharing, this somehow has a profound healing effect that can not be measured, it is a case of "just is". Thank you Ian for what you give to the world. See you at the October Retreat.

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  7. In relation to Dr Meares and the glass of muddy water.... perhaps it was intended that we have adequate spontaneous period of reverie\daydreaming each day. In recent times, particularly since the industrial revolution and even more so in the digital age the lifeway does not facilitate the spontaneous experience of reverie and so we must contrive the circumstances so that we get our daily dose and we call this meditation. In the old way of humanity we had no work. We hunted and gathered. We had time for reverie. Now we must seek out physical exercise to make up and the relaxing mental exercise we call meditation.In a similar way we must watch our diet, get out into the sun (safe exposure only), exercise and get enough sleep.. even if it the sleep is monphasic rather than the biphasic pattern to which we are designed to experience but again the industrial revolution put the end to that.
    Anyway, just some thoughts. Your message has been positive for many years and has done a great deal of good. Keep up the good work. OB

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  8. Hi Ian; as you know, I deeply respect your work and enjoy your blogs. However, these are almost impossible to read because of the dark blue/purple background near the head. In fact, to read them, I have to copy and paste into a word document. It just needs some lightening of the background.
    Thanks Mate
    John Coleman ND

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  9. i saw this expert in 1973 He belittled and shamed me, i was intending to talk about the sexual abuse I endured as a child, however he all he did was talk about how he only treated rich women and that he was not interested in my problems. As I was seventeen at the time and had tried to commit suicide and had thought that I may finally find help, he sent me away feeling more helpless and useless than I had ever felt before. Now that my partner of 31 yrs has cancer and we are given this man as a guru and a beacon in a dark place to hold on to, all I CAN FEEL IS A DEEP AND ENDURING ANGER and hatred to a so called expert who has infected my life with a deep and enduring distrust of anyone who pretends to have an answer or solution or way to deal with real problems. This pretender was only ever interested in how much money he could make. I make no apology for my comments. I am a 60 year old woman with many past hurts that may have been resolved all those years ago.

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    Replies
    1. Dear a"anonymous". I feel for your distress. After all these years to still feel such anger you must have been deeply, deeply hurt. From what you say, I am assuming you are referring to Dr Meares and given he died many years ago, there is obviously no way to resolve this with him in person. If it would help, please do contact me via info@insighthealth.com.au. I hope you may still find peace in this matter and in your life.

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    2. Dear "anonymous",
      I was very affected the intensity of your hurt and disappointment with your experience with Dr Meares.
      I must say, I googled and "Ainslie Meares" as I do from time to time, as my mother has told me many times of an appalling incident with Dr Meares, whereby he assaulted her, asking her to put on a white hospital gown and proceeded to rub her breasts telling her what a healthy young woman she was. She was suffering from post natal depression, innocent, fiercely intelligent and vulnerable. She so needed help and this incident kept her from seeking it for many years. I have no doubt of the veracity of her experience.
      As a Psychotherapist myself, I have felt horrified sad and outraged each time she has told me the story and have wondered how many others may have had some kind of similar experience. I know that's now what you've shared here however you may feel somewhat supported and validated in your experience by reading my response. I do wish you very well. Please deal with the anger and hurt though as this will just keep hurting you.
      My very best wishes to you,
      Marie

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  10. Hi,
    Very interested in meditation and and avid acolyte - also following the comments for some amazing experiences. I think mindfulness and meditation techniques change you to a calmer, more self aware individual.
    Thanks
    Bren

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