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by Nicole Arkin, LMFT
Ever since training at The Psychotherapy Institute in Berkeley CA, I have been drawn to Dr. Mark Epstein’s unique perspective on the interface between psychodynamically oriented psychotherapy and Buddhism. His books Thoughts Without a Thinker (1995) and Going to Pieces Without Falling Apart (1998), reflecting his pursuit of both Eastern and Western paths, were particularly meaningful to me as I was trying to bridge the two worlds myself.
During this period, I started attending longer meditation retreats and becoming more devoted to my own meditation practice. Increasingly, I felt my Buddhist practice creep into my therapy sessions. I was especially struck when a client said, “Why is it we are taught to be nice to everyone else but never given the instructions on how to be nice to ourselves?” I found myself framing this struggle psychodynamically in terms of object relations and Kalsched’s theory of traumatic dissociation (The Inner World of Trauma, 1996). Noting her aggressive ways of relating to herself, I hoped the therapeutic relationship could in time be internalized and help her to develop a less harsh inner world. But I also thought about the ways mindfulness and compassion practices could give her a kinder container, not unlike the therapeutic dyad, in which to hold her own struggles. I began to notice that I often leaned toward psychodynamic theories in how I framed clients’ struggles but more toward Buddhist practice as marking the direction in which I wanted to head with my clients, namely toward the Brahmaviharas (the divine abodes of compassion, loving kindness, equanimity, and sympathetic joy). I began to wonder about the place for spirituality in the therapeutic dyad and worry that somehow it was “against the rules” to have my spiritual practice enter so deeply into my work.
In Epstein’s newest book, The Trauma of Everyday Life, he continues to look at the interface between psychotherapy and Buddhism, this time focusing on the concept of trauma. Rather than looking at trauma as a singular and particular event that only affects certain people, he sees trauma as something we all inevitably face, not only in the three “divine messengers” of aging, sickness, and death, but also in smaller traumas such as loneliness. He parallels the first noble truth of dukkha (sometimes translated as the basic unsatisfactoriness of life or simply as suffering) with the psychological concept of primitive anxiety. Both dukkha and primitive anxiety are inescapable. And both are endurable, with meditation capable of holding the mind as Winnicott describes a mother holding and making sense of an infant’s primitive anxieties.
Epstein points to impermanence as another shared human reality in the chapter “Everything is Burning.” Recently, a client of mine who had been sexually assaulted several years prior was forced to face this reality. What was difficult for her at this point wasn’t the assault itself, but the way it broke down her fixed ideas of the world, namely, that everyone acted compassionately and that things were predictable. As I empathized with how abruptly disillusioning this was for her, I also noticed the way her experience illustrated Buddhist concepts. The words from the poem “Praying (Attempt of April 19th, 2004)” by Jorie Graham ran through my head: “Let her weep… Do not give false hope. Tell her to tell the others.” Trauma, Epstein says, robs victims of the “absolutisms,” the reassuring certainties of daily life. In this case, it might also create a more expansive perspective for my client, eventually connecting her more deeply to others and to the universality of suffering.
Rather than treat trauma as something to get rid of or “move past,” as psychology often frames it, or as an experience to “rise above,” in Buddhist terms, Epstein stresses instead the importance of how we relate to these traumas. He makes the important point that it is not that the pain or trauma is pathological in itself but rather that the absence of adequate attunement and responsiveness to this suffering can create pathology. Therapy and Buddhist mindfulness offer ways of relating to, holding, and being with our suffering. Both, in a sense, are relational homes that allow us to probe our experiences and feelings with attunement and responsiveness. And both allow the implicit memories of trauma to be made more explicit. Epstein chronicles the Buddha’s own life story in terms of relational trauma, particularly in the ways he reacted to the early loss of his mother. He points to the Buddha’s initial attempts to flee and dissociate from his experience and his eventual emphasis on investigating the mind by including the entire range of thoughts, feelings, and physical sensations, leaving nothing out.
The Buddha’s most fundamental discovery, according to Epstein, was that the mind (perhaps more accurately translated in Western terms as mind-body-heart) could in itself be the relational home that is needed to process trauma. At this point in reading his book, I wondered, What then is the place for therapy, for another person? As an answer, I recalled not only how much I have needed my own therapist but also how important the support and encouragement of Buddhist teachers have been for me in the development of my internal home. Epstein clarifies that there is still a need for therapy. The relational home inside is a direction to head toward, something that we are in the process of creating for ourselves internally, as well as for others and with others.
Trauma can perhaps be seen as having both an intensely personal nature and a universal one, with both lenses being important and useful, depending upon the timing, situation, and person. Epstein’s stress on the universal aspect of trauma seems especially useful for those of us who feel alone in our suffering. He concludes that “trauma, if it doesn’t destroy us, wakes us up to our own relational capacities. Not only does it make us suffer, but it makes us more human, caring and wise,” ultimately reminding us of our fundamental connectedness.
-First Published in The Viewpoint, The Psychotherapy Institute’s newsletter, Sept/Oct 2013