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By Alistair Campbell, PhD

He who binds to himself a Joy,
does the winged life destroy;
He who kisses the Joy as it flies,
Lives in Eternity’s sunrise.

(William Blake, “Eternity”)

There has been a remarkable and continuing growth in interest about the relationship between spirituality and health (physical and psychological) over the last 15-20 years. Masters (2007) has identified an increasing trend of publications from 1995 to 2006 which explore the religious and spiritual in relation to health. This growing interest in, and professional recognition of, spirituality and psychotherapy has also been noted by other commentators and reviewers (Plante, 2007; Post & Wade, 2009). Post and Wade have suggested that there is an increasing interest, for clients and therapists, in allowing the sacred into the consulting room. It is striking that this trend in interest parallels nearly exactly the growth in the dominance of the techno-rational approach to psychotherapy.

It’s important to remind ourselves that the underlying notions of mindfulness are not exclusively drawn from Eastern Buddhist philosophy. Rather, the idea of mindfulness is part of many esoteric and philosophical traditions – both Western and non-Western. Blake’s insight, expressed in ‘Eternity’, about the ephemeral experience of emotion (“Joy”) is a good example of an understanding of a ‘mindful’’ position that is based in Western transcendental poetry.

A core idea in the opening excerpt is the understanding that the desire/attempt to hold on to an emotion/experience leads to the loss of some deeper and more essential aspect of that experience. Blake proposes that by greeting the experience (with a kiss), and not trying to hold and engage it, there is an opening up to a deeper experience of Eternity and that it is this deeper experience, rather than the fleeting experience of Joy, that is to be sought and valued. The imagery that Blake uses here for the idea of Eternity is also profoundly interesting. Allowing Joy to fly from us enables us to live in a moment, a sunrise, which is a process. The sun rises, traverses the sky (our lives?) and then sets. It is not a ‘thing’ or an event. It is an experience.

Mindfulness has been defined as “The awareness that arises through intentionally attending in an open, accepting, and discerning way to whatever is arising in the present moment.”(Shapiro & Carlson, 2009) Shapiro (Shapiro, 2009) identifies, however, that mindfulness is both an outcome (mindful awareness) and a process (mindful practice). She defines “Mindful awareness” as an awareness or presence of mind that involves a “deep knowing” which leads to “freedom of mind”. “Mindful practice” is identified as a systematic practice of “…intentionally attending in an open, caring, and discerning way…” which requires a knowing and shaping of the mind.

One of Shapiro’s (Shapiro, 2009) concerns is to emphasise a requirement to better define the idea of ‘mindfulness’ before it can be properly integrated into Western psychology. Her concern here is to identify how the esoteric (non-conceptual, non-dualistic and paradoxical) idea of mindfulness can be translated into a language that clinicians and scientists can understand. By this she means (I would argue) that it is important to reduce or remove the spiritual basis of mindfulness in order for it to be accepted by within the techno-rational framework that presently dominates the field of psychotherapy.

The position seems to be that, if it is possible to define mindfulness as some rational/cognitive activity, then it can be taught more easily to people. This is the standard position of positivistic science that phenomena must be reduced before they can be understood. The difficulty with mindfulness, for this project, is that it is foundationally a spiritual practice which is based in a non-conceptual and paradoxical understanding of ‘mind’ and experience.

Mindfulness is a positioning in the world in order to ‘free’ the mind from our material life (‘samsara’) by disengagement from the illusion (‘maya’) that the world exists as an external reality. A fundamental basis of mindfulness is the assumption that we do not experience the environment itself but rather a projection of it, created by us. The aim of mindfulness practice is the achievement of enlightenment (‘bohdi’).

But, “enlightenment” is not a rational conceptual notion. It does not involve ‘understanding’, ‘knowledge’, ‘awareness’, ‘insight’, or any of the activities of the mind that we commonly understand to be good. Such activities involve the ‘grasping for’, the ‘seeking of’ enlightenment and, by their very nature, constitute the barriers to enlightenment. Ultimately, enlightenment is a state of mind that goes beyond the conceptual and cannot be achieved through rational means.

His Holiness the Dalai Lama, Sogyal Rinpoche (1992) describes his own experiences of enlightenment (and it is important to note that enlightenment is not a permanent state but a progression of experiences) as profoundly moving but essentially grounded in the everyday. Of his first, he relates that one of his teachers asked him the question “What is mind?” and then looked deeply into his eyes. He relates “I was totally taken by surprise. My mind shattered. No words, no names, no thoughts remained – no mind, in fact, all” (p.42). This is a very common relating of the experience by mystics and meditators the world over. After much practice in seeking conceptual knowledge and understanding the person is brought into some paradoxical and non-conceptual understanding of the world within which they experience profound and ecstatic states and a loss or loosening of their experience of their ‘self’ and the mind.

Mindfulness practice is traditionally based on a foundation of paradox. It is not possible to understand mind without knowing no mind. The various koans, teaching tales, sutras, and poems of Buddhist tradition are not meant to be wisdom but puzzles and challenges that may sufficiently confuse a person that they ‘spontaneously’ let go of their conceptual existence. As it is said: “It is simply your flawless, present awareness, cognizant and empty, naked and awake.” (HH Dalai Lama, 1992)

If you consider Shapiro’s ‘definition’ of mindfulness it is clear that she struggles with reducing the esoteric conceptualisation of mindfulness. Her language is clearly mystical and what she proposes can hardly be described as a definition from a ‘scientific’ point of view. But, why struggle to produce an ‘operational’ definition of mindfulness at all?

It seems most likely that the legitimation of mindfulness as a psychotherapeutic practice requires the removal of the spiritual dimension. This is, no doubt, so that the practice of mindfulness will be acceptable to the non-spiritual or those who consider there is no place for spiritual or esoteric understandings in a ‘modern’ and ‘scientific’ world. What if, however, the “active ingredient” of mindfulness practice is not the practice itself but the undertaking of it with a spiritual focus? In trying to make the non-conceptual conceptual it seems entirely likely that the essence of the practice is made absent and, probably, of less value.

One question that is worth pondering is why these non-rational and esoteric practices (mindfulness, ACT, meditation, etc) are increasingly popular amongst therapists? I think that part of the answer may be that most therapists are not techno-rationalists. The majority do not believe the idea that certain technical activities have been ‘proven’ to lead to ‘reliable’ change.

Most people are drawn to become psychotherapists because they are feelings based and are more likely to be high on creativity and artistry than anything else. Yet, at the present time, the practice of psychotherapy is dominated by ideas that are essentially anti-creative. The common understanding (spurious though it may be) is that ‘good therapists’ will follow a manual that someone else has developed, with little or no deviation, and deliver words, ideas, teaching notes, and skills development at clearly defined points in the ‘training’.

The current climate is one which promotes the ‘expert clinician’ as a trained technician able to implement procedures and practices not of their own making. The individuality of the therapist is to be eschewed as ‘error’ (in both the statistical and ethical sense) which should be minimised as much as possible. Most therapists know, or intuit, that this conceptualisation of the task of therapy is wrong and inadequate. But, there is sufficient force to these ideas that many therapists feel compelled to enact them – but, most probably, not to feel them in their souls.

Mindfulness offers a possibility for therapists to become engaged with the client in some deeper and meaningful way simply because it allows the introduction of the non-conceptual, the esoteric, the mysterious. There seem to be many attempts to make mindfulness a rational practice in order to exclude the mystery. But, I suspect that it is inevitable since it is not possible to properly describe mindfulness without using non-conceptual terms. What a relief this must be for many therapists. To be able to talk to clients about an attitude to mind and existence that allows for paradox and mystery.

There is a growing body of evidence that spirituality and religiosity had positive health benefits both as protective and restorative factors (George, Larson, Koenig & McCullogh, 2000). The essential point is that there is something about having a spiritual or religious belief which confers advantage for some people. One question is whether the secularisation of a spiritual practice, that is the performance of a spiritually derived practice without the spiritual framework, has any effect on the efficacy of the practice? It is an open question as to whether the pursuit of the operationalisation and secularisation of mindfulness, in order for it to be ‘acceptable’, diminishes whatever effectiveness it has.

Certainly, there seems to be evidence that mindfulness practice has a degree of efficacy for clinical conditions. A meta-analysis by Hofman and others (Hofmann, Sawyer, Witt & Oh, 2010) of 39 studies with 1,140 clients using mindfulness-based therapy for a range of psychological and physical conditions, found that mindfulness approaches had moderate effects.

This is interesting insofar as the effect sizes are no better and no worse than most of the published research on efficacy of various psychological treatments. So, there’s no particular reason why one would adopt a mindfulness approach over any other. I do wonder, however, whether a mindfulness approach that is practiced from within a spiritual frame, with the aim of achieving something more than symptom relief, might be more effective?

Though this is not specifically addressed by Post and Wade (1992) there is some suggestion that spiritually based interventions which are congruent with the spiritual position of client and therapist may be more effective. This question was addressed directly by Wachholtz and Pargament (2005) when they compared meditation conducted in a way that was consistent with a spiritual belief system to meditation that was essentially secular and a relaxation control group.

They reported that the spiritually focused group had significantly more positive outcomes, showed significantly lower stress response in a pain-stressor test, and tolerated pain for a significantly greater amount of time than both the secular meditation and the relaxation groups. Although such a study cannot be considered as conclusive, there certainly does seem to be some effect from including the idea of the sacred in teaching and working with a meditative practice.

One of the things that you can’t get away from in looking at mindfulness is that it originates in spiritual practice. The primary practice of mindfulness is related to meditation. In particular, it relates to the meditation on mind. Underlying this is the notion that mind constructs the reality and the experiences that we all have. There is a complicated framework of mind that is proposed in Buddhist philosophy where the contents of mind are the source of suffering in humanity by virtue of the habit of trying to grasp the idea, the notions, that occur in the mind as permanent representations of an external reality.

Although mindfulness is an idea that has been integrated into psychotherapeutic practice over the last twenty years it has been drawn from a spiritual practice, largely associated with Buddhism. Increasingly, it has become associated with the cognitive-behavioural tradition in psychology. In many ways it seems to be proposed as an alternative, perhaps an opposite, way of managing disturbing or (so called) ‘negative’ thoughts.

Mindfulness can be considered as a contrasting position in the sense that a CBT approach encourages the client to become engaged with the thoughts and to struggle with them whilst the mindfulness approach encourages the client to be unengaged by their thoughts/feelings.

I am not convinced, however, that there is very much difference between the techno-rational interpretations of mindfulness practices and a general CBT approach. Both require the acceptance of a particular understanding of the world which the client must be ‘taught’ or ‘socialised’ into and both require the therapist to be positioned as ‘expert’ to the client and thus able to ‘teach’ them how to do their approach to thinking better.

Mindfulness as it is currently promulgated is identified as almost a subset of cognitive behavioural intervention. It is assumed that people can be taught the process of meditative disengagement as a ‘skill set’. Within the cognitive behavioural framework patients are socialised into a particular way of thinking and it is this that is thought to be the “active ingredient”. Yet, within esoteric traditions it is the cultivation over many years of a habit of mind that is the “active ingredient”.

Many proponents of mindfulness identify that it is important to eliminate the idea of spirituality in relation to the practice of mindfulness, partly because it takes so many years before people are able to engage in deep meditative practice which might lead to transcendent experiences. As it is presented, the modern application of mindfulness is not about achieving enlightenment. It is focused on the control of thoughts. Thus, it is not the intention of a mindfulness approach in psychotherapy to direct or lead people into a fundamental change in the way that they experience the world. Rather, it is the teaching of a skill for controlling the way that people experience their own thinking. I can’t help thinking that by pursuing this line an essential aspect of “mindful awareness”, and whatever benefit that confers, is lost.

Author Information

Dr Alistair Campbell is the Head of School for the Australian Institute of Psychology and Australian Institute of Professional Counsellors. Contact: alistair@aipc.net.au.

References:

Blake, W. (1972) Complete Writings. edited by Geoffrey Keynes (Ed). Oxford University Press, Oxford and New York.

George, L., Larson, D., Koenig, H., & McCullogh, M. (2000) Spirituality and Health: What We Know, What We Need to Know. Journal of Social and Clinical Psychology, 19(1), 102-116

Hofmann, St., Sawyer, A., Witt, A., & Oh, D. (2010) The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. Journal of Consulting and Clinical Psychology, 78(2), 169–183.

Masters, K. (2007) Religiosity/Spirituality and Behavioural Medicine: Investigations Concerning the Integration of Spirit with Body. Journal of Behavioural Medicine, 30: 287-289.

Plante, T. (2007) Integrating Spirituality and Psychotherapy: Ethical Issues and Principles to Consider. Journal of Clinical Psychology, 63(9), 891-902.

Post, B., & Wade, N. (2009) Religion and Spirituality in Psychotherapy: A Practice-Friendly Review of Research. Journal of Clinical Psychology: In Session, 65(2), 131-146.

Shapiro, S. (2009). The integration of Mindfulness and Psychology. Journal of Clinical Psychology, 65(6): 555-560.

Shapiro, S.L., & Carlson, L.E. (2009). The art and science of mindfulness: Integrating mindfulness into psychology and the helping professions. Washington, DC: American Psychological Association Publications.

Sogyal Rinpoche. (1992). The Tibetan Book of Living and Dying. Random House, UK.

Wachholtz, A., & Pargament, K. (2005) Is Spirituality a Critical Ingredient of Meditation? Comparing the Effects of Spiritual Meditation, Secular Meditation, and Relaxation on Spiritual, Psychological, Cardiac, and Pain Outcomes. Journal of Behavioral Medicine, Vol. 28, No. 4. 369-384.

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