MAKING FRIENDS WITH PAIN AND OVERCOMING SUFFERING

You may have read the title of this article and thought to yourself, “Why would I want to make friends with pain? I’ll do anything to avoid it!” Paradoxically, it is only through acknowledging and going through the pain of our suffering that we can then work with it, overcome it, and achieve happiness. As the Dalai Lama has said,

We have to relate the Four Noble Truths to our own experience as individual human beings. It is a fact – a natural fact of life – that each one of us has an innate desire to seek happiness and to overcome suffering. (The Dalai Lama)[i]

The Four Noble Truths that the Buddha taught provide a universal framework for the practice of Buddhism. This small book can be viewed in the context of this basic teaching of the Buddha after he gained enlightenment under the Bodhi Tree in India.

The First Noble Truth is that life is suffering. Until we find a way out of our own unhappiness through our individual path toward healing and growth and our spiritual practice, we are stuck in the endless cycle of samsara. Like a hamster on a wheel, humans tend to do the same things over and over, and wonder why we’re not getting anywhere and staying miserable.

The Second Noble Truth describes the cause of our suffering, that is, our attachment to our thoughts, our possessions, our negative beliefs and emotions, and above all, our clinging to a solid sense of self.  It is difficult to let go of these attachments. They become habitual patterns. We mindlessly perpetuate these patterns, wondering why things never change. Both psychotherapy and Buddhism provide tools in this regard to help us mindfully disengage from our negative habits and tendencies.

The Third Noble Truth teaches that our suffering can actually cease through our letting go of our belief in a solid self and coming to understand on an experiential level that all phenomena are empty of a solid self and are impermanent, always changing if we stop long enough to notice. This is so difficult for us humans. It is so hard to let go of our habitual tendencies and our thoughts. Enlightenment, “lightening up,” is possible, however, through practicing on our path with patience, discipline, diligence and above all, compassion and gentleness.

The Fourth Noble Truth describes the path that leads to the cessation of suffering. The yearning to let go of the habits that cause our suffering is universal. Sometimes, we use unhealthy means in our attempt to escape suffering. We find, however, that there is no escape from doing the work if we want to heal. We have to lean into our pain and go through the suffering to get to the other side.

Only through leaning into and experiencing our pain can we transform our suffering and develop compassion, true understanding, healing and growth.

 

[i]Dalai Lama, H.H. (1997). The Four Noble Truths. London: Thorsens.

HEALING SHAME THROUGH MINDFULNESS

 

The experience of shame can be unbearable. In fact, in her March 2015 TED talk on public humiliation, Monica Lewinsky noted that research has found that feelings of shame can be more intense than feelings of happiness and even anger. Shame unacknowledged can lead to deep depression, isolation, substance abuse and suicidal ideation. It is truly a toxic emotion.  We all make mistakes, but there is huge difference between the message “I made a mistake” and “I am bad or unworthy because of my mistakes.”

Shame is closely connected to fear – the fear that we will be severely punished and rejected because of our flaws. When we experience shame, we often isolate ourselves, believing ourselves to be unlovable damaged goods. Shame and vulnerability researcher Brene Brown has observed:

Shame is about the fear of disconnection. When we experience shame, we are steeped in the fear of being ridiculed, diminished or seen as flawed. We are afraid we’ve exposed a part of us that jeopardizes our connection and our worthiness of acceptance.[i]

When we are in the throes of the intense feelings of shame, we tend to forget that we all make mistakes, and that we all experience shame at times. This knowledge can help us develop compassion for ourselves and others, and helps us remember that none of us are perfect. As Brene Brown has noted, “Shame cannot survive being spoken. It cannot survive empathy.”[ii] Staying silent and isolated will only increase the feelings of shame and disconnection. It may take some discipline to get out of your self-imposed exile, but do it. Having even just one trusted empathic friend, family member or therapist with whom you can speak about your feelings of shame will go a long way to easing those feelings.

The experience of shame can be alleviated through mindfulness and awareness. The first step is to acknowledge it when it arises. Our body sensations are the best signal of what we are actually experiencing, including the feeling of shame. Through practice and discipline, we can actually let go of shame as soon as we feel it in our bodies, and before it blossoms into negative thoughts about ourselves.

Shame and fear are often felt in the pit of the stomach, or solar plexus, as a tight ache or fluttery sensation. Breathe into those feelings and explore them. Use your breath to explore the sensations, including their texture, temperature, color, movement, shape and size, so that you become so familiar with them that you recognize and pay attention to them as soon as they arise.  As thoughts of unworthiness or fear of disconnection or rejection arise, simply come back to your breath and to the body sensations associated with your feelings, and allow the thoughts to dissolve. Keep coming back to your breath and body.

In energy work, the solar plexus is the location of the third chakra, the source of our will and self-power, and is yellow in color. The following is a visualization I spontaneously created, using the energy of the third chakra,  to heal my own feelings of shame. It has benefited me greatly, and I share it with you with the aspiration that it is of benefit to you as well.

  1. Breathe into your solar plexus, which we sometimes call the pit of our stomach. Feel the achy tightness or other body sensations that arise.
  2. Imagine yellow light in the area of your solar plexus as you feel the body sensations. Explore those sensations with your breath.
  3. Let the yellow light grow and brighten, and start to glow like the sun, loosening the tight feelings with its warmth. As you do so, memories of childhood shame may arise. Allow yourself to feel them as well as current feelings of shame with compassion, as if you were holding that young child within you.
  4. As you experience this self-compassion, imagine others in your life also holding you in compassion and love, and allow the yellow light to grow and glow. Extend gratitude to yourself and others holding you in compassion and love.
  5. Allow the yellow light to transform into a beautiful golden halo that surrounds you and those who are there supporting you. Let the golden halo protect you. As you experience the sensations of this healing golden light, let your fears and shame dissolve, knowing that you are human, perfect in your imperfection, and that you are safe and loved. Breathe into those feelings of safety and love.
  6. As you continue to experience the warm protective glow, remember that we are all flawed, and that we all sometimes experience shame and fear when we make mistakes. Expand the golden light with your breath and extend it outward to all beings who are caught in the web of shame and fear. Extend the compassion you are developing for yourself to all other beings who are with you on this journey that we call being human.

 

[i] Brene Brown (2008). I Thought It Was Just Me (but it isn’t). New York: Gotham Books, p. 20.

[ii] From Oprah Winfrey interview with Brene Brown, posted on huffingtonpost.com on August 26, 2013.

THE GIFT OF THE PRESENT MOMENT IN THE THERAPY SESSION

 

Therapy is not all about talking about the past, as many incorrectly assume. Rather, the psychotherapist’s goal is to work with the client in the here and now, while both therapist and client observe how past experiences inform the present moment. Psychotherapy works best when the past is being re-experienced in the present, in a safe and non-judgmental space. It is not about just talking about the past, but feeling the accompanying body sensations and emotions as fully as possible, and experiencing the energy and dynamics of the relationship between the therapist and client. As the client-therapist relationship grows, and the client is able to trust the therapist to maintain a safe environment, the client can re-experience the past more fully, and can then learn from and heal past wounds and transform the present.

For example, a client I will call “Joan” came to see me after the death of her father. Joan’s grief process was complicated by the difficult relationship she had with her father. It soon became apparent that Joan had a hard time in relationships with others, including me, as a result of her father’s domineering and controlling personality and her resulting lack of trust in herself and others.  Joan’s lack of a sense of safety and trust was apparent in our sessions together and in the dynamics of our relationship. Joan constantly questioned my motives and often threatened to quit therapy. She would get inordinately angry when she felt I was not listening to her, and resisted seeing her father as anything but perfect.

I knew from my own work that fear of judgment and abandonment are also core issues for me, as they are for many people. As a result, it was difficult for me to stay present with Joan, especially when she threatened to leave or criticized me. I often felt like I was walking on eggshells with Joan, afraid to say or do something that would set her off. I found myself becoming defensive, and tended to retreat into intellectual theories, trying to sound smart and look good. When I was able to slow down, take a breath, simply observe my experience and not react, I was able to choose a more authentic and skillful approach to my work with Joan.

I knew that staying with Joan’s experience of pain and confusion, and being a calm, compassionate and consistent presence in the face of her anger and threats, were the keys to helping Joan heal.   This was a long and exhausting process for both of us. Joan finally came to realize that I wasn’t going to abandon her, no matter how much she fought to keep me at a distance. As Joan gradually felt safe opening up to me, she was able to acknowledge that her father was not perfect, and that he did not provide her with a sense of safety and security in the world.  Like me, Joan tended to retreat into intellectualizing and analyzing, asking me “why” I thought her father was that way, and “why” she reacted the way she did. Joan would revert to over-intellectualizing and anger when her pain and vulnerability felt too raw and scary for her.

Giving Joan intellectual answers to her “why questions” was not what she needed. Instead, I continued to work on my ability to stay present and open with Joan, and we worked together on enhancing Joan’s ability to stay present and open with me. I encouraged Joan to notice when her anxiety with me increased and what triggers led to her urge to lash out. We focused on what she felt in her body: where the anxiety manifested physically, and what her body was telling her when she became anxious.

Staying in the body is a great way to directly experience the here and now. We Westerners tend to believe that our thoughts and mental processes are of more value than our bodies, but our bodies are far more useful in helping us access the truth. Joan eventually was able to get out of her head and into her body. She learned that she experienced tightness in her stomach when she became anxious. I asked her to fully experience that sensation by describing its shape, color, texture, temperature and other features. When Joan had a clear experience of that, I asked Joan what the sensations in her stomach were telling her. She saw that the message from her body was “run away, fight back. If you let yourself open up and be vulnerable, you’ll be attacked. You’re not safe.”

Joan’s increased ability to stay present in her body provided a number of important tools for her. She was able to tap into that feeling more quickly, and with a sense of curiosity instead of immediately striking back in a vain attempt to avoid her pain, anxiety and fear. The more quickly Joan could feel that sensation, the more she was able to choose whether she really needed to fight back, or to breathe into the sensations and allow herself to open up. As Joan started to open up, her awareness became more panoramic. She was able to slow down and experience the ebb and flow of energy between her and those she interacts with, and was more able to read others’ body language as well as her own in order to more ably attend to what was needed in that very instant.  Working together in the here and now of the therapy session, Joan and I have co-created a workable and authentic relationship.

One of the many gifts of therapy is what I learn from my clients, and my work with Joan made me realize that I must remain vigilant in staying open despite my fear of being judged or left. I became aware that when I felt Joan was about to attack me or denigrate what I would say, I felt a quickening my heart pound. I learned to breathe into that feeling and was more able to be present with Joan. As I became more authentic and vulnerable with Joan, she felt safe to be authentic and vulnerable with me. We can now appreciate each other and our shared humanity more fully, despite our pain and confusion at times.

Joan still has a long way to go to heal her shame and fear. The more Joan is able to stay with me in the present moment, the more she is able to do so in all of her personal and professional relationships. Joan is learning to slow down and open her heart to others without fear, and to be open to all that is available to her in the present moment.

 

HOW UNDERSTANDING IMPERMANENCE CAN HEAL DEPRESSION AND GRIEF

 

One of the most important tenets in Buddhism is that all phenomena are impermanent. All things and all beings are constantly changing. Nothing stays the same, and ultimately everything dies. We tend to consider this bad news. However, accepting impermanence can also be considered good news. If everything stayed the same, there would be no possibility for growth. Also, understanding that nothing stays the same can alleviate feelings of hopelessness, helplessness and overwhelm.

We all struggle to hold on to others and to things, and resist impermanence. This leads to tremendous suffering. The incorrect belief that things are “stuck” and will never change also results in great suffering.   I have observed in my years as a psychotherapist that the struggle to resist impermanence and the belief that things don’t change are universal. It is only through letting go of the resistance to change and impermanence that true healing and growth is possible.

For example, many of my clients with depression feel mired in difficult situations that they believe are permanent. It can take a lot of work for them to give up the beliefs that keep them stuck. I too am prone to depression. My Buddhist practice and study have been invaluable in helping me let go of my negative beliefs. I now know that those beliefs are just insubstantial thoughts that I no longer need to hold on to. Of course, I get thrown back into feelings of hopelessness on occasion. When that happens, I call on a friend to remind me that whatever situation is getting me down is impermanent and will change. My friend’s reminders are just what the doctor ordered at those times, and I feel a tremendous weight lifting and the restoration of hope just from hearing the words “remember that it’s impermanent.”

A big part of my psychotherapy practice is working with grief and loss. I have found that clients who have difficulty acknowledging that everyone dies have a very difficult time processing their grief. Of course, the death of a loved one or beloved pet is never easy. Although death is never easy for those left behind, always remembering impermanence helps ease the way, and despite profound sadness and grief, those who “grieve well” know that death is a natural part of life.

One of the most significant moments in my meditation practice occurred about fifteen years ago. My wonderful cat Andy was “meditating” with me at the time. I recall having a clear realization that Andy would not be with me forever. My emotions went from sadness to acceptance. I was left with a profound sense of the preciousness of life, knowing that the fact that nothing lasts is what makes life so precious. Andy, who died last summer, has ever since been my reminder of both impermanence and the preciousness of life. As the great Buddhist master Dilgo Khyentse Rinpoche said:

                                     Life is fragile, like the dew hanging delicately on the grass,  crystal drops that will be carried away on the first morning breeze.                                

                                                                            

The Importance of Self-Compassion

We throw the word “compassion” around so much that it can seem like a trite cliché.  Yet, the more I listen to my therapy clients, the more I realize that compassion — particularly self-compassion – is the key to healing ourselves and our relationships.

Compassion means “to suffer with.”  The word is generally used to describe empathy toward another.  However, I am clear that one cannot really have true compassion toward another without experiencing his or her own suffering and having kindness and empathy toward him or herself first.

The Sanskrit word maitri has been defined by Tibetan Buddhist master Chogyam Trungpa as unconditional friendliness, particularly toward oneself.  Pema Chodron, a student of Trungpa’s and a master in her own right, observes:  ” I teach about maitri a lot. In fact, sometimes I think it’s the only thing I    teach. I also teach about        compassion a lot, but actually compassion is a form of maitri so this unconditional friendliness to oneself, it seems to be what most of us do not have”  (www.shambhala.org/teachers/pema).

I have made this same observation in my work as a psychotherapist.  Most of my clients come in complaining of depression and low self-esteem.  They think that something “out there”–even something as beneficial as caring for others —  is going to make them “better.”  When I tell them that what will heal their depression is kindness toward themselves, some look at me as if I were speaking a foreign language – the idea of self-compassion is that alien to them!

For many, the messages they received in their families of origin have contributed to their low self-esteem and negative self-talk. Western culture’s emphasis on perfection doesn’t help.  Because of these familial and cultural messages, many believe that’s just the way it is, and their beliefs about themselves can’t be changed.

For example, a client I’ll call “John” recounted in his first session with me his regrets about the breakup of his marriage, and concluded “I’m a failure.”  In my work using the modality of mindfulness-based cognitive therapy, I challenged John’s belief, asking how doing something that he now regrets means he’s a failure.  I told him that he did the best he could at that time, and encouraged him that the key to his healing will be having compassion for himself and his human imperfections and neuroses. My homework for John was to simply notice when he calls himself a failure, what triggers it, and to start to challenge that long-fixed belief.  Changing these thoughts takes time, practice and discipline because they are so habitual and deep-seated, but it certainly can be done

I can challenge and have compassion for John, because I had to do the same work myself.  As I have recounted in other articles, after a period of regular mindfulness meditation practice, I was able to not only notice my negative self-talk, but realize that was just another thought, and that I could relegate those thoughts to my mental trash heap.  In fact, I told myself that if someone could have magically heard the way I talked to myself, they would have to turn me in to the police for abuse!

The Buddhist teachings on buddhanature or basic goodness are very helpful in developing self-compassion.  Those teachings tell us that we all have buddhanature, but due to our habitual tendencies and patterns, it is obscured and we have difficulty experiencing it.  An image I have found helpful is that of the sun in a cloudy sky.  The sun is always there, even on a cloudy day, but we can’t see it.  Imagine being in a plane, and seeing the sun in a clear blue sky after rising to an altitude above the clouds.  Indeed, the sun was there the whole time.

The next time you make a mistake or do something you consider less than “perfect”, take a breath, and try not to go on automatic pilot and start beating yourself up.  Instead, have compassion for yourself and all others who suffer in that way and remember the image of the sun in a cloudy sky.  Yes, you made a mistake and you can feel regret about it, and resolve not to do it again. Remember that your thoughts about your mistakes and imperfections are just fleeting clouds, and the sun of your self-worth is there the whole time.

 

 

 

EGOLESSNESS AS A TOOL FOR GROWTH IN BUDDHIST PSYCHOLOGY

Remember all those times when someone, in breaking up with you, said “it’s not about you; it’s me”?  That might seem like a trite cliche, but it is likely true. So little in life is really “about you.”

Buddhism teaches that the cause of all of our suffering is our clinging to what we believe to be our “self.”  Understanding egolessness or selflessness is the key to healing our personal wounds as well as our relationships, and is an important concept in Buddhist psychology.

We tend to cling to our belief in a solid “I” out of a fear of groundlessness, in a false attempt to create some ground under us.  However, in clinging to a solid sense of self, we close down our world, believing that we are in the middle of it all.  In other words, we become self-centered.  The experience of selflessness opens us from the claustrophobia of self-centeredness into the spaciousness of possibility and connection.

Analytical and mindfulness meditation are effective methods for directly experiencing and understanding that no true “self” exists.  Here’s an exercise that can help you get this important concept:

  • Sit in a comfortable position, and bring your attention to your breath.
  • Once you are relaxed and undistracted, examine your notion of a solid self, and ask questions that challenge that notion.  Some questions that can aid this exploration are: “Am I my head?  My hands? My gut?  My profession?  My hobbies?  My thoughts? Where is ‘I’ anyway?”
  • As you go through this exercise, notice your emotions and body sensations.  You might feel fear, and with accompanying tightness in a particular place in your body.  That’s normal – we all fear groundlessness until we realize that groundlessness, or selflessness, is actually an opening into spaciousness and possibility.
  • Be patient when you slip into a state of self-clinging.  We all have this habitual tendency, and it’s a tough habit to break.  Realizing the universality of self-clinging, we can develop compassion for ourselves and all others.  This in itself can be incredibly transformative and healing.

Because of our human tendency to cling to a sense of self to maintain what we believe to be stability and ground, you will need to return to this exercise over and over. As you become familiar with the body sensations that accompany your fear of selflessness, you can breathe into those sensations to loosen the grasp of self-clinging when it arises.  In doing so, you will have a better understanding of your everyday experiences, reactions and communications with others.

Have you ever noticed that the people in your life have different opinions and viewpoints about you?  If the “self” were solid, how would that be possible?  People’s views are merely their own projections, and no two people see things in exactly the same way.  This concept is extremely helpful in human relationships.  When we are able to get our ego out of the way, we can actually hear what another person is saying or requesting.

A useful way to put this into practice is in your personal and professional relationships, which always offer the opportunity for growth.  For example, when someone criticizes something we did, our habitual tendency is to immediately defend our actions – and ourselves.  At these moments, our egos tend to rear their ugly heads and we really don’t hear the request underlying the criticism.  It takes discipline to let go of the knee-jerk reaction to protect the ego.

One of the best tools for letting go of this tendency to defend our egos is to slow down, and feel where we feel the emotions connected with the criticism.  For me, it is a clenching in the stomach and jaw, and fluttering in my heart.  When I am able to slow down without immediately reacting, I take a breath and ask myself what those body sensations are telling me.  Often, it is feeling hurt and misunderstood.  I can then discern what the most effective response would be.  When I am able to leave my ego at the door, I breathe into my hurt feelings with self-compassion, and let it go.  I can then determine what the underlying communication truly is, and respond accordingly. This is the opening into true compassion, connection and openness.

Using the Buddhist Practice of Tonglen to Transform and Heal the Aloneness of Grief

The funeral has been planned and taken place. The cards and casseroles have stopped coming. Friends have gone back to their daily routines. It has been a month or so since your loved one’s death. Nothing feels the same. You feel alone. You feel like no one can possibly understand the depths of your sadness and despair.

Opening ourselves to our grief, rather than hiding from it, offers the possibility of true growth and transformation. It can be exquisitely painful to lean into one’s grief. Running from it, isolating ourselves, numbing our pain in alcohol, drugs or sleep can be so tempting. How, then, to allow ourselves to feel the pain of grief, and at the same time, let go of self-pity and feelings of aloneness and begin to heal?

A Buddhist meditation practice called tonglen, or “sending and receiving” can be very healing at this time. It is a practice all can do, Buddhist or not. Sogyal Rinpoche, in The Tibetan Book of Living and Dying (1994, p. 193), describes tonglen as one of the most “useful and powerful” practices in the Tibetan Buddhist tradition:

When you feel yourself locked in upon yourself, Tonglen
opens you to the truth of the suffering of others; when
your heart is blocked, it destroys those forces that are
obstructing it….[I]t helps you to find within yourself
and then to reveal the loving, expansive radiance of your
own true nature.

The practice of tonglen involves breathing in suffering and breathing out love and compassion for all beings, including yourself. As Sogyal Rinpoche states (p. 195), states,
“Before you can truly practice Tonglen, you have to be able to evoke compassion in yourself.” You breathe in your own pain and suffering, and breathe out peace, love and compassion for yourself. One way to do this is to imagine breathing in a dark cloud of smoke, and breathing out light. Once you are able to evoke a sense of self-compassion, you can then imagine breathing in the pain and suffering of loved ones, and sending them love and compassion on the outbreath. A natural outgrowth is to extend this sending and receiving to all beings.

The practice of tonglen allows the bereaved to know they are not alone: We all experience loss and grief. It helps us drop the “why me?” of self-pity, which can leave grief stuck in place. Instead of that self-centeredness, a sense of unity and compassion for all can develop.

Leaning into one’s grief through the practice of tonglen can be extremely healing and spiritually transformative. The Tibetan Book of Living and Dying and other works, such as the writings of Pema Chodron, go into further detail about the practice. In addition, trained meditation instructors in Buddhist centers throughout the world can work with you to deepen your understanding and experience of the practice.

THE MYTH OF PERFECTION: A BUDDHIST PERSPECTIVE

Many of the clients in my psychotherapy practice come to see me for depression and anxiety caused by self-criticism and negative self-talk. I have discovered that these clients are caught in the trap of perfectionism. Perfectionism has been defined in psychology (Stoeber & Childs 2010) as “a personality disposition characterized by an individual striving for flawlessness and setting excessively high performance standards, accompanied by overly critical self-evaluations and concerns regarding others’ evaluations.”

From a Buddhist perspective, perfectionism is kept in place by an attachment to the “self” as a separate, unique and real entity. In addition, forgetting that we are human beings living in samsara (the endless cycle of birth, old age, sickness and death and its attendant suffering) further solidifies perfectionism.

Human beings in the “human realm” of samsara all experience anger or aversion, jealousy, grasping, ignorance or lack of understanding and pride – known in Buddhism as the “five poisons.” Those with perfectionistic tendencies forget this, and believe that they are uniquely deficient when they experience these afflictions. Some feel so much shame, or have such a strong need for others’ approval that they try to hide behind a mask of perfectionism – covering up mistakes rather than owning up to and learning from them, overindulging in food, drugs or sex to numb the pain, giving in to others’ needs rather than expressing their own.

Instead of trying to deny or hide imperfections, acknowledging them mindfully can lessen perfectionism’s control. The first step is to mindfully notice your thoughts of self-judgment. The goal is to acknowledge those thoughts as soon as they arise and then let them go, dispassionately and without judgment. It takes a lot of practice not to get caught in the web of those thoughts.

One important tool in overcoming perfectionism or other dysfunctional tendencies is to recognize where you feel the associated feelings in your body. For example, if you experience jealousy, you might feel a hot, tight sensation in your chest. Exploring the sensation further, you discover that it would be red if it had a color, oval if it had a shape, and about two inches long if it had a size. Precisely describing the bodily feeling, as in the above example, is very effective in recognizing and letting go of self-critical thoughts as soon as they arise.

Then, breathe into that physical place with compassion, instead of immediately trying to avoid the feeling. You can’t turn it off like turning off the radio, and the more you try, the more intense it becomes. In the vernacular of the ‘70s human potential movement, “what you resist persists.” As you breathe out, breathe out light and space.

Continuing to breathe in and out in this way leads naturally to the Buddhist practice of tonglen, or sending and receiving – taking in the heavy, dark negative feelings, and sending out light, spacious healing feelings. This practice is first done for oneself, and then extended to all beings who suffer from perfectionism’s grip.

The benefits of this practice to counteract perfectionism are many and powerful. First is the engendering of compassion for oneself and one’s human foibles. Extending this compassion out to all who are suffering from perfectionism leads naturally to knowing that you are not alone, separate and distinct from all others.

We are perfect in our imperfection. Acknowledging and leaning into our imperfections with compassion and without judgment leads to tenderness and openness. As Leonard Cohen sang, “There’s a crack in everything. That’s where the light gets in.”

Psychotherapy and the Middle Way

When I hear the clients in my psychotherapy and grief counseling practice talk in black and white terms, or view their options in terms of extremes, I am reminded of the Buddhist concept of the Middle Way. When the Buddha was asked how one should meditate, he responded “not too tight, not too loose.” He analogized this to a string instrument, like a lute: If the strings of the lute are too tight, they will break, and if the strings of the lute are too loose, they won’t play.

So it is as we live our lives and navigate its changes. Ideally, we strive to find a middle way where the “strings” of our life can resonate. However, due to anxiety, we may get wound up to the breaking point, where there is no give and take, no spaciousness to allow things to be. On the other hand, we may be so downtrodden with depression that our “strings” are too loose — we just don’t have the emotional energy to tighten them enough to play.

The Middle Way can be likened to living in the space of ambiguity — which is truly the condition of life. Because of our emotional histories, living in ambiguity can be fraught with difficulties. In our anxiety, we frantically fill the spaces in our lives with doing, rather than being. Yet, possibilities for growth and renewal can only arise if we are able to rest in that unknown space. If we can take a breath and rest in that space, called “the gap” in Buddhism, we see that it truly is spacious, vibrant, alive and full of possibility.

Similarly, our emotional wounds sometimes prevent us from seeing the complex nature of the people in our lives, including ourselves. At its extreme, we see them as all good or all bad, known as “splitting.” In fact, sometimes the same person is seen as all good one minute, all bad the next. A goal for people in therapy with this type of issue is to be able to see the shades of gray — people, including the client, are neither all good nor all bad. Many people with this tendency are perfectionists, with resultant depression, eating disorders, self-injury and other issues. For these clients, having a safe experience that it is OK not to be perfect (and that perfection is in fact impossible for human beings) leads to self-compassion, and compassion for others. Their emotional “strings” can then be loosened enough to let themselves — and others — be, allowing for the possibility of joy, satisfaction and intimacy in their lives.

The Middle Way approach is also helpful in my work as a grief counselor. People who are struggling with their grief sometimes ask me “when will I feel better, and when will I ‘get over it’”? Some go the “too loose” extreme, numbing the pain of grief with drugs or alcohol, or jumping into a new relationship. Others go to the “too tight” extreme, idealizing and idolizing their deceased loved ones, or holding on tightly to their pain for fear that letting go will mean forgetting their loved ones. Finding that Middle Way, where the bereaved can safely feel and express their pain and go through their own personal journey of grief, without having a map, but the compass of the grief counselor, is a key component to growing and healing in grief.

Caring for Tibetan Buddhists at the End of Life

Many people in the baby boomer generation, who were raised in the Jewish and Christian faiths, have turned to Tibetan Buddhism and other Eastern religions.  As this generation ages and enters hospice care, it will be important for health care providers to understand their unique needs at this sacred time in their lives.

Broadly speaking, Buddhist practice emphasizes a deep understanding of the mind, the importance of karma (cause and effect) and preparing for death.  For Buddhist practitioners, the moment of death is considered the most important moment of life.  Developing a calm and aware mind, acting virtuously for the benefit of other beings and abandoning harmful actions are the most important practices for preparing for death.  If the Buddhist practitioner is able to stay relatively aware at the time of death, he or she can be reborn in what is called a “Pure Land” and continue on the path toward enlightenment.

The most important practice for Tibetan Buddhists and those supporting them at the end of their lives is called “Phowa”, or transference of consciousness.  Phowa is aimed at assisting practitioners to be reborn in a Pure Land, where the cycle of suffering, or samsara, ceases.

An important concept in Tibetan Buddhism is the concept of the “bardo”, which means “in-between.”  Every moment can be considered a bardo, or a transition to the next moment.  In fact, our present life is a bardo between what came before and what will happen next.  The bardo between this life and the next is called the “bardo of becoming” and is traditionally considered to be forty-nine days. It is a time of self-review and purification of negative acts, in order to be reborn if not in a Pure Land, then at least as a human being who has the potential of attaining enlightenment. It is said to be a very vivid and at times intense and frightening experience, and the practitioner’s spiritual community, or sangha, traditionally practices at the end of each week to assist the deceased’s journey through the bardo. The dying process is seen as a separation of the mind from the body, and it is the mind that continues into the bardo between this life and the next.  Therefore it is important for the mind to be clear and calm at the time of death.  It is said that whatever thought one dies with is the one that will return most powerfully when one reawakens in the bardo. Traditionally, it is said that it takes 72 hours for the mind to completely separate from the body and begin the journey into the bardo between this life and the next.

As death nears, clinicians and others should refrain from touching the body, especially the feet, because doing so may direct the patient’s consciousness downward to rebirth in a lower realm, where he or she cannot benefit others and have the potential for enlightenment.  The patient may wish to be in the traditional posture of dying, lying on the right side in the posture of the “sleeping lion”, which is the posture in which Buddha died.

In developing a plan of care for Tibetan Buddhist practitioners, the hospice team and other caregivers need to consider the patient’s views on suffering, alertness and karma.  The following are some considerations in developing a plan of care for dying Tibetan Buddhist practitioners:

1.  Determine if the patient has a spiritual teacher (or guru) and the patient’s wishes for contact with the guru, and how to contact him or her.

2.  Determine if the patient has a community of fellow practitioners (the sangha), and if so, how to contact them.

3.  Provide a quiet space for sangha members to come and sit with the patient to meditate or do Phowa practice.

4.  Help the patient arrange an altar with pictures of the guru and other pictures that are important to the patient for his/her practice, as well as any meditation tapes, prayer beads, etc.

5.  Clarify issues and wishes regarding the use of pain medications.  Many practitioners may believe that the use of pain medications may unduly cloud their minds, but unrelieved physical pain may do the same.  As with all patients, this is a balancing act.

6.  For the social worker and bereavement coordinator, understand any family dynamics issues — there may be unfinished business or at least conflicting feelings if the patient was raised in a different faith.  The chaplain, in doing his/her spiritual assessment may want to do a “spiritual ecomap”, which is like a genogram, which is useful for families who practice multiple faiths.  This will be more and more important as the baby boomer generation continues to age.

7.   It is also important to facilitate discussions with family members about the patient’s wishes for end of life and at the time of death.  Educate family members on the need for a calm and peaceful environment, and let them know that if they are too outwardly emotional, they may be asked to leave the room.

8.  Clarify after-death wishes.  Does the patient want the body to stay untouched for 72 hours in order for the mind to separate and enter the bardo?   Sangha members and others may come to be with the body during that time to recite prayers and read from the Tibetan Book of the Dead. If on the other hand, the patient wants to donate his or her organs, that is totally acceptable, and most Buddhist teachers say it is a great way to generate good Karma. Cremation is traditional, but confirm wishes, and if they want to be cremated, and determine if they want a ceremony or viewing.

9.  Bereavement support may also need to be modified — grieving sangha members may not want bereavement support in the first 49 days after the death, so that they can turn inward to help their fellow sangha member’s journey in the bardo.  With respect to non-Buddhist family members, listen for and validate any feelings they may have in regard to their loved one’s Buddhist practice.

References

Smith-Stoner, M. (2006).  Phowa:  End of Life Ritual Prayers for Tibetan Buddhists. Journal of Hospice and Palliative Nursing, Vol. 8, No. 6.

Sogyal Rinpoche (1994). The Tibetan Book of Living and Dying. San Francisco:  Harper San Francisco.