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A Review of Psychotherapy and Buddhism: Toward an Integration
Psychotherapy and Buddhism: Toward an Integration.
By Jeffrey B. Rubin. New York and London: Plenum Press, 1996, xi + 207 pages, ISBN:0-306-45441-6, US $39.50
Reviewed By Harvey B. Aronson
Co-Director
Dawn Mountain Tibetan Temple Community Center and Research Institute
Private Practice of Psychotherapy, Houston, Texas
Harvey-Aronson@msn.com
Jeffrey Rubin has written a very useful, stimulating, and sometimes provocative work that carries forward the exploration of psychotherapeutic and meditative issues in the manner of Ken Wilber, Jack Engler, Dan Brown, Mark Epstein, A. H. Almaas and Jack Kornfield before him. This is a ten chapter work that juxtaposes reflections on psychoanalytic approaches to therapy with the practice of mindfulness in the Theravaada tradition. Mindfulness meditation has become something of a gold standard of Buddhist meditative traditions in the West. This is partly due to the genius of Jack Kornfield and Joseph Goldstein who created a simplified system of practice that is true to the original texts, yet which abstracts the practice from its cultural, linguistic, liturgical and monastic setting, aspects of Buddhism that can be problematic for some. No one writer will ever be able to do justice to all Buddhist systems of meditation. It is worthy of mention, though, that there are many systems of Buddhist meditation beyond the Theravaada, many of which are exoteric, and they, too, deserve extensive examination. They are not covered in this book.
Rubin offers us excellent clinical histories as a basis for rich reflection on the intricate interplay between Buddhist theory and practice on the one hand, and therapeutic processes on the other. It is in the area of Buddhist philosophy that I disagree most with Rubin's presentation. In Rubin's work, Buddhist theoretical material precedes the clinical material, and for the most part, I will follow that order.
Chapter Two contains a good overview of some major authors in the West who explored Buddhism from a psychotherapeutic perspective. Particularly refreshing was Rubin's appreciation of the complexity necessary when considering Buddhist meditation in relationship to psychoanalysis. He points out that simplistic unions of the two disciplines amount to a "shotgun wedding." At the same time, he raises questions about what he calls the "pseudo-complementary approach," instanced, according to him, by Wilber and Engler, who use the developmental model of modern psychotherapy as a basic frame for creating a hierarchy between psychological and spiritual development. Rubin powerfully presents material that argues against any overly simplistic approach that claims that psychological health is followed by spiritual emergence.
Rubin brings forward material about a young seventeen-year-old, petrified by the fear of death, who runs away from home, sleeps rarely, eats only if fed by concerned strangers, stops speaking, becomes oblivious and disheveled, never bathes, and is covered with infected insect bites and pus-filled sores (p. 48). This individual, who never received any psychiatric treatment, settles down to eventually become the revered Ramana Maharishi. In this way, Rubin argues against a neat progression of spirituality following psychological maturation. He suggests that Ramana is an instance of spiritual development preceded by emotional distress and behavioral aberration that was never explicitly addressed by psychological intervention. Spirituality in this case does not follow in lock-step upon emotional development. Finally, Rubin is critical of those he terms "Orientocentrics" who see the value of Buddhist meditation for therapy but fail to see the reverse. Rubin prefers to see complexity in the relationship between therapy and Buddhist meditation, calling them "antithetical, complementary and synergistic."
In Chapters One through Four, Rubin makes a number of observations about self in Buddhism. I differ with his approach on these matters. For example, Rubin identifies eternalism and annihilationism as described in Buddhist texts—the self is eternal or is annihilated at death—as narcissistic theories. If, in doing so, he is referring to the narcissism of the personality disorder, I do not see a correlation here. There is no information in Buddhist texts to support a sense of the personalities associated with particular views. If he is saying that these two views, eternalism and annihilationism, refer to self as eternal or annihilated, and anything related to self is narcissistic, I have serious qualms about equating the Buddhist term 'self' (atman) with the psychologically differentiated 'self' of twentieth century psychology. In both Hindu and Buddhist scriptures of 2500 years ago, the atman refers to an hypothesized ontological core of the person; the word was not being used in a psychological sense but rather in an ontological sense.
For example, Peter Harvey, in his work The Selfless Mind (Surrey, England: Curzon Press, 1995) identifies the metaphysical self (atta). In the Buddhist context, self is ultimately not found in any of the constituents of experience as an "unconditioned, permanent, totally happy 'I' that is self-aware, in total control of itself, a truly autonomous agent, with an inherent substantial essence" (p. 51). When the Buddha was arguing against eternalism and nihilism, he was arguing about whether or not a self that was eternal, or existed for one life and then ceased, could be found in our experience (Harvey, p. 39). The discussion was conducted within a philosophical, ontological, and ethical context, not a psychological one. The psychological self as we know it is an autonomous, feeling individual with a unique destiny, as Anne C. Klein has pointed out in The Great Bliss Queen; it is a product of the last 300–400 years of modern Western civilization.
Arnold Goldberg, in his "Introductory Remarks" to Advances in Self Psychology (New York: International Universities Press, 1980), identifies the psychological self as "the pattern of ambitions, skills, and goals, the tensions between them, the program of action they create, and the activities that strive toward the realization of this program are all experienced as continuous in space and time . . . they are the self, an independent center of initiative, an independent recipient of impressions" (p. 4). The Buddhist material shows a clear ontological usage for the terms atta/atman, and this does not have any direct correlation to the discussion of self in psychoanalysis or therapy. It is a mix of categories to read the psychological self into the material on the ontological self and therefore awkward to have eternalism and nihilism identified with psychological issues of narcissism.
Rubin claims that Buddhism, because of its theories of self, throws out "egocentricity," and "human agency." He states "there is no subject," "no agent," no ability "to evaluate phenomena," "no previous experience from which to learn," "no one who is exploited," "or alienated," and "no oppression to challenge or contest" (p. 66). In a note on page 67, he softens this by saying he is taking "Buddhist theorizing on human subjectivity . . . to its logical conclusion."
However, Rubin's characterization in the main body of his text is not supported by the material I am familiar with in Buddhist texts, history, or psychological and philosophical works. Certain texts, read out of context, might create a limited impression in support of such a characterization, but an holistic appraisal of any of the specific traditions does not. In Theravaada, for example, the self that is not to be found in our experience is an autonomous, substantial, ontological core (see Peter Harvey, The Selfless Mind). Conscious psychological functioning is never denied but rather exhaustively examined in the literature of the Abhidharma. Classically, for example, a chariot as a findable entity or essence is denied, but not the functioning of the chariot. Similarly, self as a findable entity or essence is denied, but not psychological functioning. In Theravaada, which is in some ways the easiest to understand, the self or chariot as a whole is seen to be a name or designation; it is not ontologically findable, though its smaller parts are.
The thrust of Buddhist philosophy, as I understand it, is to emphasize the workings of human agency through exploration of cause and effect. It is precisely in order to explain human change that the doctrine of impermanence and selflessness is used. Dependent on one moment, a second moment arises, neither completely the same nor completely different. Adherents to the philosophical notion of an unchanging self have all sorts of problems dealing with agency and change. How does human ethical action or spiritual endeavor relate to an unchanging soul? If the soul is eternal, is murder ethically negative?
The Buddha's enlightenment itself is filled with memories of his prior actions and their effects— human agency over and over. If we look at Buddhist psychology, cetana (intentionality) is the seed of all karma or action. Evaluation is present in the mental factors of vitarka (thought) and vicara (reasoning). The texts seem to counter Rubin's assertion concerning absence of agency, evaluation, and so on.
As to exploitation and alienation, the Buddhist suttas show the Buddha to be extremely sensitive to the most blatant social issue of his day, namely, inequities of the caste system which he addressed through the creation of an egalitarian sangha with hierarchy based not upon caste but on seniority and spiritual realization.
Rubin asserts that Buddhist teachings of selflessness somehow are responsible for sexual acts between teachers and students. In considering the motivation of the teachers in such situations, he says, "The acting out of such self-centered behavior is, in my view, directly related to Buddhism's denial of self-existence" (p. 67). Unfortunately, it is hard to agree with this. Anyone reading the newspapers knows that Buddhism is not unique in witnessing its clergy act out sexually. Christians who hold to a soul do it, and therapists who hold to a psychological self do it, too. Again, the material on self in Buddhism refers to the ontological self, not the psychological self. There is much to reflect upon with respect to such behavior among spiritual teachers; however, picking on the theory of selflessness would not be where I would look first. I would begin by looking at issues related to gender roles, organizational dynamics, systems theory, narcissism in teachers, sexual activity among authority figures, role and power inequalities, and so on.
Rubin finds that Buddhism engages in a "stance of self- nullification" (p. 71). This seems overly broad. Using criteria of modern psychoanalytic self psychology which assess a capacity to have vision, ambition and ability to carry through, the extant Buddhist material illustrates that the Buddha and his disciples had fairly rich and effective psychological selves, as opposed to the ontological variety. The texts do not talk of "psychological self" but do record the Buddha's alleged behavior and that of his disciples.
The Buddha had vision and a sense of humor; he was concerned for others, articulate, and philosophically sharp. Buddhism does not say there is a self and take it away; it just states that while we feel there may be an inherent self present, analysis shows it not to be findable in our experience (see Peter Harvey, The Selfless Mind, pp. 28-33). No thing is lost, just insight and wisdom are gained. There certainly may be some sense of losing or giving something up in the process of disillusionment, but Buddhist psychologists would insist this is due to a loss of a mistaken concept, not the loss of anything real. (See Jack Kornfield, citing Jack Engler, in Buddhist Meditation and Consciousness Research; Sausalito, California: Institute of Noetic Science, 1992). Realizing we are ontologically less, we become psychologically more.
Rubin sees great value in meditation. If it were to be stripped of its "self denying" aspects, it could, according to Rubin, lead to greater intimacy, and through reducing our sense of separateness, lead to a heightened sense of living, whether one is playing a musical instrument, watching an engrossing cultural event, participating in athletics, or making love (p. 70). This view imports meditation into our culturally influenced concerns for aesthetic enjoyment, hedonic satisfaction and peak performance. Meditation clearly can enhance experience in all of these ways. It is important, however, not to lose sight of the fact that classically it was taught as a practice for decreasing attachment—to aesthetic enjoyment and hedonic indulgence (they had not heard of peak performance)—and ultimately freeing individuals from the cycle of rebirth as a spiritual soteriological discipline.
Mindfulness practice is being suggested with increasing frequency in books of self-help for a variety of psychotherapeutic ills and for every type of self-improvement from corporate productivity to sexual pleasure. However, it is there stripped of its cultural, philosophical, ethical and soteriological context. There is, of course, substantial benefit from the simple practice of meditation. But perhaps struggling with the full range of Buddhist views might provide much richer spiritual meaning and a warmer heart. It is distressing to see such a rich tradition truncated.
It is when Rubin moves to a psychoanalytic consideration of Buddhist practitioners that I think he makes a very strong contribution. It is clear that unconscious motivations may have a significant part in the spiritual life, and Rubin rightfully calls attention to this.
Rubin presents a well-nuanced exploration of how involvement with Buddhist thought and practice played itself out for one of his clients. I found it refreshing that Rubin was able to see that there were "constructive, defensive, reparative and restitutive" effects for his client. Rubin here wisely opens the door for ongoing consideration of the diverse ways in which Buddhist thought and practice may affect a variety of people at various stages of life. I would only like to point out that the case of Steven was a case in which meditation and psychoanalytic psychotherapy were played out in conjunction. It remains a question what the psychological effects are for beginning and advanced practitioners when meditation is not done in conjunction with psychotherapy.
Rubin sees great improvement in his client's capacity for self-reflection when enhanced through mindfulness practice. This led to reduction in self-recrimination, increased self-demarcation and affect regulation. Rubin points out that the ideals of Buddhist practice seemed to have a two-edged effect on his client: they offered opportunities for offsetting his sense of badness on the one hand but played into his internalized perfectionism on the other. Rubin explores how Buddhist emphasis on minimal possessions becomes absorbed into a psychological agenda of self- punishment. He also elaborates ways that the meditation helped his client to avoid certain habitual emotional patterns, yet it encouraged cool emotions that seemed to stifle assertiveness. Rubin illustrates his clinical acumen by acknowledging his own countertransferential feelings about Buddhism and being mindful and aware of these in his work with his client. The case presentation is valuable to anyone who offers therapy to practicing meditators for the insights it offers into the various ways theory, practice, and therapist attitudes all contribute to a treatment process.
Chapter Six contains an impassioned argument for making mindfulness training available to analysts-in-training, stating that it would fill a significant void in the arena of training. This discussion is thoughtful and appropriate.
Chapter Seven discusses resistance to meditation. Rubin compares traditional hindrances to meditation to his psychoanalytic observations of what hinders people in their meditative engagement. His suggestions that students and teachers explore resistance is extremely germane. He asks that meditators consider "What is the resistance in service of? . . . What is it directed against?" (p. 141). He also suggests persons should free associate about resistance, dialogue with it, paint it, and embody it (p. 141). Not all students are willing or able to engage in formal therapy, and Rubin's suggestions would be quite helpful for students working just with meditation teachers.
Chapter Eight is about spirituality and psychoanalysis. Here Rubin takes off his psychoanalyst gloves and discusses what he sees as some of the flaws in the training of analysts, including submissiveness and perfectionism. He sees meditation as offering skills in affect tolerance and deautomatization. He also sees it as fostering greater freedom, flexibility and inclusiveness of self-structures.
Chapter Nine explores the integrative possibilities of psychoanalysis and Buddhist mindfulness meditation. I found this chapter particularly stimulating and thought provoking. Rubin sensitively explores a number of issues that are operative in such an integration. However, for the most part, the larger value scheme that is being served is analytic and not Buddhist. The ultimate goal of this integration is the improved functioning of the individual, not liberation from cyclic existence. Rubin sees value in the Buddhist qualities of calm, concentration, tranquillity and equanimity for the analytic enterprise (p. 157). He faults Buddhism for neglecting factors such as investigation, which for him means a theory of childhood development, psychopathology, self-pathology, and so on (p. 157). I find the Buddhist phenomenological exploration of experience to be a significant "investigation," while I agree with Rubin in what it lacks. Rubin suggests that understanding of transference and countertransference might be a significant contribution to Buddhist teacher-student relationships, and this is certainly a valid and important point. He describes several situations where sexuality and hierarchy led to untoward outcomes that perhaps could have been avoided by better attention to relational dynamics. Rubin tends to be univocal in his condemnations here.
I would at least like to entertain the possibility that not every instance of hierarchy needs to be criticized and not every instance of sexuality in a religious context is abusive. Having been a professor of religious studies before becoming a psychotherapist, I would at least like to crack the door on the possibility that not every interpersonal interaction is what it appears to be and that there may be alternate meanings to behavior, at least in some instances . If Abraham were to report his instructions to sacrifice Isaac to his therapist, should the therapist feel witness to a great religious drama or call Children's Protective Services? Could there be an Abraham and Isaac episode in our era of psychological reductionism and media over-exposure? This is not said as an apology for abuse; far from it. Rather, it is to suggest that certain problematic events, perhaps few in number, may allow positive interpretations. I say this knowing full well that an esoteric ethic is an extremely slippery slope, where the Charlie Mansons and Jim Joneses of the world claim privileged access to secret wisdom more frequently than not. Yet the apparent brutality of Abraham's willingness to sacrifice his son out of faith is a powerful and positive religious symbol. Univocal interpretations of human behavior cannot appreciate the religious significance of Abraham's actions.
Rubin concludes this chapter with a rich and detailed case presentation of Albert. While I don't agree with some of the ways in which Rubin characterizes Buddhist teachings of selflessness, his account of how this client internalized Buddhist teachings in ways that paralleled preexistent self-pathology is very helpful. Rubin is self-revelatory, honest and forthright about how he dealt with his own reactions towards Buddhism with respect to his client. This was clinically excellent. Within it all, Rubin adds an extremely interesting, albeit brief, critique of psychoanalysis, especially its use of the term 'object', it's lack of both a moral compass and attention to responsibility. Rubin sees Buddhism as positively contributing to analysis in its concern for others and its concern for moral commitment. (Here he takes a position against his earlier characterizations of Buddhist practice when considering selflessness taken to its logical conclusions.)
Rubin's case presentation relates to the role of introspection and explores the influence from various spheres on his client's life. Rubin's work serves as a model for ways in which practitioners and clinicians need to begin to look deeply at values inculcated from developmental, spiritual, and clinical realms of experience. Rubin's detailed discussion of how he assisted Albert in self- construction exhibits sophisticated and sensitive attunement for this critical psychological task. Rubin was able to consider the positive contributions that mindfulness made while voicing his concerns that Albert's apprehension of Buddhist practice may have hindered his emerging selfhood.
Placing Buddhist mindfulness practice into some type of contrary position with psychological development of selfhood, as Rubin does, provokes consideration. He refers to these as non-self- centered and self-centered subjectivity, respectively (p. 185). Just because words and phrases such as 'self' and 'not-self' from different cultural and historical contexts sound dichotomous does not mean they are so in fact. The tasks of 1) developing psychological selfhood, and 2) realizing that phenomena lack ontological selves are not strictly contradictory or dichotomous but rather relate one to the other in a variety of complex ways, a complexity to which Rubin actually alludes in the details of his case presentation. For example, pursuit of spirituality seems motivated by a quest for freedom, yet it may perpetuate self- punishing tendencies (p. 167). Mindfulness, which ultimately helps us explore the nature of our personal experience and its lack of a metaphysical self, can produce personal understanding and awareness in a psychological sense (p. 172). This contributes to the development of the psychological self. Unfortunately, Rubin moves away from details in his conclusion. Identifying therapy as leading to "self-centeredness" is too narrow and suggestive of selfishness to encompass healthy psychological selfhood, and the notion that mindfulness leads to "unselfconsciousness" is too vague, general and suggestive of romanticized spontaneity to do justice to this endeavor (p. 186). Furthermore, placing these in a dichotomous relationship seems to mitigate the complexity to which Rubin himself earlier referred.
In the conclusion of this chapter, I found it curious that Rubin articulated the goal of psychotherapy as the creation of a view of the self as a "concrete, substantial entity" (p. 186). Here he is describing the goal of therapy in the philosophical terms which are used to describe precisely that type of self that some Buddhist philosophical systems deny is present in phenomena. The metaphysical self which cannot be found in phenomena, as Peter Harvey points out in The Selfless Mind, is not only an inherent substantial essence, it is also "unconditioned, permanent, totally happy" (p. 51). No therapists are working with their clients to achieve anything like this. Kohut himself, in The Analysis of the Self (New York: International Universities Press, 1971), identifies the self as a psychoanalytic abstraction (p. xv), a view much closer to the Buddhist position that self is a concept.
I feel that by using philosophical language to describe the goal of psychotherapy, Rubin confuses the issue and creates a false dichotomy between a therapeutic goal of creating a view of the self as a substantial entity and Buddhist theories which hold that there is no such self in experienced phenomena. The subjective coherence sought through self-psychology or psychodynamic therapy does not involve philosophical positioning as its major element. The subjective emotional tasks involved with furthering the capacity to identify motives and feelings and allow for their expression in meaningful activity are the therapeutic enterprise. Conventional coherence over time and space is not experientially dropped by practitioners of Buddhist insight, except during temporary phases of practice, and such coherence is the culturally mandated task of psychotherapy. To use the analogy of a car, Buddhism will support getting your car (or chariot in days gone by) together and affirm that it works, but if you wish to consider the ultimate nature of 'car', you will discover it is just a concept. The psychological self that results from psychological work is not destroyed through realizing the ontological absence of a permanent, substantial self, and one does not come to first hold to such a substantial self as a result of psychological work; such holding is part of the human condition. Looking at the model of various Buddhist sages, with their capacity to work in the world and be effective, signs of a healthy psychological self seem actually enhanced.
The last chapter of Rubin's book is an extended reflection on a possible synthesis of psychoanalysis and Buddhism using Gramsci's phrase "pessimism of the intellect and optimism of the will" as the focus of discussion. In brief, Rubin believes these major disciplines offer each other an abatement of their somewhat one-sided presentations of the human condition and its possibilities.
In sum, this is an important work, with serious reflections concerning the psychological aspects of Buddhist practice. It is unfortunate that Buddhist soteriological concerns were treated somewhat dismissively, though this is understandable given that psychotherapy is a behavioral science with empirical claims, and soteriology, to date, has been beyond that sphere. I think that Rubin has made a significant contribution to dialogues about Buddhism and psychotherapy by illustrating how Westerners who adopt Buddhist practice do so in ways that sustain and complicate preexisting psychological disorders. There remains the vexing issue of the diverse levels and meanings of the term self. In some instances, it seems that Rubin was conflating Buddhist teachings on the absence of ontological self with categories of modern self-psychology. The psychological use and meaning of this term needs to be clearly distinguished from its philosophical and ontological use and meaning in Buddhist contexts. The type of ontologically permanent, substantially existent self that Buddhism holds as a benchmark for a true self is not created by psychotherapeutic intervention. Such a self is not found in our experience. It is an object of negation. The type of self that self psychologists talk about is something to be developed: a pattern of aspirations, goals, and capacity to create. This is not extinguished by Buddhist practice; the Buddha created a vibrant organization through his goal-directed activity. Buddhist practice is meant to facilitate understanding the insubstantial, impermanent nature of all the constituents that are active in creating such goal-directed activity.
I recommend this work to psychologists curious about Buddhism, scholars of Asian religion interested in the application of mindfulness in modern psychological settings, and to practitioners who have some background in psychological literature. It merits reading.
