Christopher K. Germer, PhD is a clinical instructor in psychology at Harvard Medical School and a founding member of the Institute for Meditation and Psychotherapy. He is the author of The Mindful Path to Self-Compassion, and co-editor of Mindfulness and Psychotherapy and Wisdom and Compassion in Psychotherapy.
He taught Training Compassion: From the Buddha to Modern Psychology, with Mu Soeng, at BCBS September 7-9, 2012.
Insight Journal asked Germer to talk about some key aspects of the growing overlap of Buddhist ideas and practices with Western psychotherapy.
Insight Journal: Western psychology has had a couple of decades now, at least, in which the insights into human psychology in Buddhism have had a significant and broadening impact. Just how great has that impact been? Are there still doubters who think this is a fad of some kind that will pass?
Christopher Germer: There will always be doubters but they seem to be disappearing fast. In our culture, for better or worse, the scientific method is a major arbiter of “truth” and the sheer volume of psychological research is growing fast. For example, in 2005 there were only about 350 peer-reviewed articles on “mindfulness” in the psychological literature and now that number is almost 1800. Mindfulness, considered the heart of Buddhist psychology, has been integrated into every school of psychotherapy and has become a major treatment paradigm in its own right, with proven effectiveness for treating depression, anxiety, irritable bowel, chronic pain, smoking, insomnia, hot flashes and many other conditions. The military even conducts mindfulness-based “mental fitness” programs to reduce the incidence of post-traumatic stress.
The use of neuroimaging—objective measures of how the brain changes through mind training—has helped to remove doubts about the effectiveness of Buddhist meditation. In the future, imaging will probably be used clinically to identify maladaptive brain patterns associated with mental illness, and when that happens, techniques such as meditation will be tapped to alter how the brain functions. I believe that interest in Buddhist ideas and practices will only grow over the coming decades.
Positive psychology, which focuses on human flourishing rather than mental illness, is also learning a lot from Buddhism, particularly how mindfulness and compassion can enhance wellbeing. This has been the domain of Buddhism for the past two millennia and we’re just adding a scientific perspective.
I think modern psychology has just begun to scratch the surface of Buddhist psychology. Mindfulness was a fledgling science in 1985 and now it’s mainstream, but new vistas are emerging. For example, as social scientists and psychotherapists deepen their understanding of Buddhist psychology, they’re developing the new science of compassion, the science of wisdom, exploring the impact of refined states of consciousness on the brain and behavior, investigating the health benefits of ethical, pro-social behavior, and they’re developing a range of innovative treatment strategies for hard-to-treat mental conditions.
IJ: Do you worry that important parts of the Dhamma are being lost in translation, if you will, as they are applied in as part of a broader therapeutic approach?
CG: Probably not as much as I should. Thanks to Jon Kabat-Zinn and the Mindfulness-Based Stress Reduction program, therapists understand the importance of personal practice. That opens the door to new and interesting aspects of the Dhamma. However, we need to accept that most therapists will only skim the surface of the Dhamma. Even in Buddhist countries like Thailand, only a small minority of the population has the time or interest to meditate or read Buddhist texts.
I think the Dhamma is beneficial to people to whatever extent they’re willing to engage it. For example, there’s no harm in learning mindful walking or mindful eating and teaching it to others, and the power of these simple practices often triggers curiosity and leads to further inquiry and practice. We all have to start somewhere.
The notion of “insight”—insight into suffering, impermanence, and no-self—are still seldom discussed in clinical circles. Over the years, I suspect that more and more therapists will experience the transformative potential of insight when they go on retreats and bring that knowledge back into the professional conversation. Some colleagues are already taking a deep plunge such as Boston psychotherapists Bill and Susan Morgan who are on a three-year retreat at the Forest Refuge. The experience of insight is a valuable asset to therapists. For example, the insight that the severity of our suffering depends largely on our attitude toward it provides hope and emotional freedom in the midst of seemingly unbearable suffering.
IJ: What are the most important insights for Western mental health professionals to understand; to put it another way, which of these insights most radically transforms what the Western psychological tradition has taken as given?
CG: I think the insight I just mentioned is very important—our relationship to emotional pain is a key factor in how much we suffer. For example, the latest wave of cognitive behavior therapy understands that trying to directly change our thoughts is less effective than creating a wide, openhearted space for our experience—a less resistant, less avoidant relationship to our thoughts and feelings. This view is expressed in the mindfulness-based cognitive therapy maxim: “Thoughts are thoughts, not facts.” Psychoanalytic psychotherapy is also embracing the notion that shifting our relationship to childhood experience is more important than remembering all the details.
Another insight is the importance of intention. Until now, scientific psychology has been primarily concerned with thoughts, feelings, and behaviors. Since the advent of mindfulness and acceptance-based therapy, we’re noticing that progress in therapy can be measured by a shift in intention—moving from resistance and aversion to acceptance. Everyone who comes to therapy is resisting emotional pain, perhaps anxiety or depression. As psychologist Steven Hayes says, “Control is the problem, not the solution.” The path toward acceptance in therapy seems to occur in stages: (1) curiosity, (2) tolerance, (3) willingness, and finally (4) friendship. Full acceptance, or the ability to embrace the pain in our lives, may seem like a tall order, especially when a person is panicking or overwhelmed with grief, but getting there is the art of psychotherapy.
Yet another contribution of Buddhism to western psychology is that capacities such as attention, compassion and empathy are skills that can be learned, rather than simply a product of good genes or a fortunate childhood. Believe it or not, this is a new understanding. Sigmund Freud recommended “evenly hovering attention” as the optimal state of mind for an analyst, but he didn’t offer any suggestions for how to achieve that frame of mind (besides a personal analysis). Now we know that the skills of mindfulness meditation—focused awareness, open monitoring, and loving-kindness—can be practiced on the cushion and even during the therapy hour itself. The latter practice—relational mindfulness—is a relatively new interest for both American Buddhists and psychotherapists.
A fascinating new field of psychology that is co-emerging with Buddhist psychology in the West is “social neuroscience” or “interpersonal neurobiology.” Social neuroscience explores how human interactions shape our brains, and researchers such as Dan Siegel at UCLA have discovered that emotionally attuned interactions activate similar brain areas as mindfulness and compassion meditation. Therefore, our ability to pay attention with empathy and compassion can be developed when we sit in solitary meditation; skills that are essential to a therapeutic relationship and effective treatment in general. Graduate programs in clinical and counseling psychology around the country are starting to recommend and teach mindfulness meditation to their students.
Mindfulness is also being taught to clinicians for self-care and to alleviate compassion fatigue. Traditionally, self-care involves taking time off from work to recharge one’s batteries, but this approach doesn’t teach therapists to thrive during stressful situations themselves. Self-care keeps caregivers from drowning, as physician Michael Kearney suggests, but self-care with mindfulness is like “learning to breathe under water.” Compassion training, especially self-compassion, is also a protection against compassion fatigue. As neuroscientist Tanya Singer suggests, compassion fatigue is really “empathy fatigue.” Compassion is a positive attitude—closely related to loving-kindness—and is more energizing than depleting. Empathy alone, without the warmth of compassion, can be truly exhausting.
These are just a few ways that Buddhist theory and practice are affecting mental health care. The meeting of Buddhist and modern psychology is like a rising tide that is lifting a lot of boats.
IJ: Where would you say Western psychology is on the timeline of its evolution? If we use the metaphor of a human life, is it an infant, in grade school, adolescence, adult?
CG: I’d say grade school. I met a retired diplomat in India who accompanied Carl Jung on his first visit to Benares, and he quoted Carl Jung as saying that “compared to India, western psychology is in its infancy.” In the early 1900’s, William James at Harvard University said that everyone would be studying Buddhist psychology in about 25 years. That time has finally come, almost a century later. Mostly in the last 10 years, we’re witnessing a remarkable convergence of the ancient, introspective wisdom of the East with western, objective scientific psychology, yielding a more comprehensive understanding of the human psyche. Neuroimaging helps a lot to validate contemplative practice—now we can even measure changes in the connective tissue of the brain with 11 hours of meditation. I think we’ll go even further when we have the technology to measure energy in the body—chi. And neurofeedback—knowing when we’re generating beneficial brain patterns in meditation—may shorten the time we need to match our brain states to those of advanced meditators. I doubt that these scientific advances will ever replace the need for insight into the nature of the mind and abiding self-mastery, but recent discoveries in clinical and neuroscience are inspiring people throughout the world to take to the path of inner transformation. I recently visited Korea and China, and found that psychology colleagues (and monastics in Korea) were thrilled to see their ancient wisdom corroborated by modern science. That can only be a good thing for global evolution.
IJ: Looking at this from the other side, what are the most important findings of Western psychology that those of us trying to learn and practice Buddhism should know about? I’m thinking, for example, of the idea that meditation practice can be very helpful, but it can also provide a means of avoiding psychological issues that should be surfaced and dealt with.
CG: I see contemplative practice and psychotherapy as twin paths to emotional healing. It’s true that meditation can be misused as an emotional bypass, but usually not forever. Our unresolved conflicts slip into our lives sooner or later, either on the cushion or in relational conflict. Most emotional suffering originated in relationships and healing relationships can go a long way toward alleviating it. Therefore, therapy is often a useful adjunct to meditative practice, especially if the therapist shares a common model of how suffering is created and alleviated.
As adults, though, the days are long gone when other people can provide all our emotional needs—not the best therapist, the perfect spouse, a loving parent, or the ideal friend can satisfy our adult need for connection and validation. Practicing loving-kindness meditation, especially for ourselves, is an important vehicle for giving ourselves the affection we may not have received in childhood or yearn to receive in our daily lives. I believe my wife would agree that I require less maintenance since I stated practicing mettā meditation, and I feel a lot happier, too.
I think that Western psychologists are helping to put Buddhist ideas into modern language and concepts, which may help dharma teachers and meditators in their practices. Psychologists actively trying to figure out what works in mindfulness meditation—the mechanisms of action—and for whom. For example, they are exploring in great detail the different kinds of attention (focused attention, open monitoring) and qualities of attention (compassion, loving-kindness) from neurological, physiological, and cognitive perspectives. We’ve recently discovered that focused attention practice is probably more effective than loving-kindness to disengage from obsessional thinking. When the Dalai Lama is asked what meditation is good for what problem, he often says that we need “more research.” It may be cheeky to say this, but I believe a new Abhidhamma is currently being written by these very discerning scientist-practitioners who are teasing out the different elements of Buddhist theory and practice.
IJ: Are there specific Buddhist texts that speak to you more than others, as a mental health professional? Do you find there is consensus about these among you and other professionals who are familiar with the texts?
CG: I’d say the Satipaṭṭhāna Sutta and the Ānāpānasati Sutta get top honors among my colleagues. I’m also inspired by the Bodhicaryavatara, or The Way of the Bodhisattva by Shantideva. However, most mental health professionals derive their inspiration from meditation practice and commentaries by meditation teachers rather than texts. This is a gap that BCBS is uniquely positioned and actively engaged in filling. For example, Andy Olendzki has very popular courses on early Buddhist psychology and the Abhidhamma that offer continuing education credit to therapists.
IJ: How do you see the role of self-compassion, both in terms of Buddhism and Western psychology?
CG: Some Buddhist practitioners worry that the notion of “self”-compassion subtly reifies the self and leads to greater suffering. I think that’s true when our suffering is rather mild, but when our sense of self is engulfed in intense and disturbing emotions, such as grief, shame or despair, we need to rescue the observer—the experiencer—before we can pay attention to our experience. Giving ourselves the same warmth and kindness that we’d give to a loved one reduces our mental chatter, opens our awareness, reconnects us with others and the world.
Over the past eight years, a considerable body of research has shown that self-compassion is a core mechanism of emotional healing. It’s the implicit attitude of mindfulness, but it helps to explicitly practice self-compassion when we suffer, fail, or feel inadequate. For example, when we’re meditating and there is no comfort in paying attention to the breath or body sensation, we can simply put our hands over the heart and feel the warmth of our hands, the gentle pressure of the hands on the chest, and the rhythmic movement of the breath under our hands. That simple act reminds us that we’re not only paying attention, but we’re paying loving attention, to our moment-to-moment experience.
Self-compassion is often the only way that people can stop beating up on themselves (and fighting their experience) when things go wrong in their lives. Personally, I had debilitating public speaking anxiety for decades and mettā meditation finally gave me the strength to just be anxious during a speech and let the anxiety play itself out. The practice of loving-kindness meditation is currently a hot research topic and it’s the core practice in the eight-week Mindful Self-Compassion training program that Kristin Neff, a psychology professor at the University of Texas, and I have been developing and researching for the past two years.
IJ: How would helping others, as opposed to helping oneself, be seen as a therapeutic tool, in both contexts? Would it be seen similarly in both, or differently?
CG: There is a growing literature in positive psychology on the psychological benefits of compassion for others, gratitude and other “pro-social” emotions. I asked a pioneer in the field, Christopher Peterson, to sum up positive psychology in a few words, and he said, “other people.” Just like the bodhisattva vow, attending to the welfare of others is a prescription for happiness. It liberates us from the illusory prison of individuality. Both Buddhism and positive psychology are on the same page in regard to compassion for others.
In clinical practice, however, self-compassion is usually the starting point and is a more effective way of alleviating suffering. Once we have rediscovered the loveliness in ourselves, then we can see the loveliness in others. It’s impossible to embrace others when we notice and reject qualities in others that we despise in ourselves. The Dalai Lama echoed this view when he said:
“For someone to develop genuine compassion towards others, first he or she must have a basis upon which to cultivate compassion, and that basis is the ability to connect to one’s own feelings and to care for one’s own welfare…Caring for others requires caring for oneself.”
Ironically, in 2012, self-compassion can no longer be assumed. People don’t necessarily know how to be kind or compassionate toward themselves. Especially when we experience overwhelming emotional pain, most of us kick in negative core beliefs such as “I’m unlovable,” “I’m stupid,” and “I’m defective.” So the path to loving ourselves is often through others. A new research study has shown this as well. In loving-kindness meditation, we learn to evoke loving states of mind by first thinking of a living being who naturally makes us smile, such as a dear dog or cat, and then we tuck ourselves into that circle of compassion. “May you and I be safe and free from suffering.”
Practicing compassion for others, including altruistic action, occurs naturally when we feel more comfortable in our own skin. Historically speaking, this has been the starting point of most Buddhist practice—ordinary unhappiness, but we basically like ourselves—and then we progress toward to the abode of the gods, the Brahmaviharas.