The Healing Relationship:
What Psychotherapy Offers Yoga and Buddhism
By Dr. Miles Neale
Yoga and Buddhism encompass sophisticated psychologies and sciences of mind that have withstood the test of time and human endeavor. Their highest aims, defined as moksha and nirvana, respectively, refer to nothing less than the complete elimination of suffering and achievement of unwavering bliss (ananda). Such lofty goals far surpass anything conceived of in the Western traditions of therapy, which aim merely to help patients adjust to, rather than transcend, the ordinary difficulties of human existence. Furthermore, the various Indian and Indo-Tibetan methodologies of meditation, breath-work, and yoga postures, which are designed to orient the mind and nervous system toward health and healing, have captured the Western imagination and have received extensive scientific support for their effectiveness. Given all this, what could the relatively modern and humble institution of psychotherapy have to offer the far more ancient and far-reaching counterparts in the East?
There was a time when small groups of students would gather around the guru to receive teachings and instructions, live together in close community, and foster deep bonds. Under the watchful eye of the master, students had the opportunity to learn and develop over the years in proximity to their idealized role models. The devotional connection to the guru has always been the defining characteristic of the bhakti path of Indian Yoga and the tantric approach of Tibetan Buddhism. But times have changed. It is common now for a master teacher to have hundreds of students, to be traveling between continents on teaching tours, to give extensive instruction once or twice a year and then have limited contact with students for long stretches of time. When was the last time you were able to speak openly and honestly with your teachers about life's everyday challenges, such as love and sex, anger, sadness, hopes and dreams? When is there time to feel intimately connected and personally witnessed when the guru is inundated and the distance between encounters feels so remote?
On the one hand, because of globalization and advances in technology we are privileged to have greater exposure to a large number of realized teachers and saints, who quench our thirst for knowledge and offer beacons of possibility for the ideals we aspire to. On the other hand, students of the modern era are deprived of the rare opportunity for close mentoring and the intimacy of consistent individual contact. With this lack of proximity a very essential ingredient in spiritual development is lost-the healing relationship, long prized throughout history.
In the 100 years since the emergence of psychotherapy in Europe and America, one thing is resoundingly clear: the relationship between therapist and patient is the bedrock of psychological growth and healing. Scientific evidence from psychotherapy literature constantly indicates that there is no significant difference in effectiveness between therapy approaches and techniques. It appears that all orientations yield approximately the same level of benefit, primarily because they all involve working on the mind and heart with another human being. It has become clear that care, unconditional positive regard, emotional regulation through mirroring and self-esteem building through role modeling are the essential aspects of the healing relationship, facilitating a patient's self-exploration, self-understanding, and behavioral change. So how is this relationship used for therapeutic gains, and what can it offer students of Yoga and Buddhism that they may be missing in our rapidly changing world?
Just as master Patanjali's triad of discipline, study and devotion define the path of kriya yoga leading to freedom, and as the Buddha's path to cessation of suffering is predicated on the three higher trainings of wisdom, meditation and ethics, so is Freud's method of achieving psychological integration based on a trio of essential phases involving remembering, repeating, and working through.
Remembering is a phase in therapy when a patient consciously explores his or her past, recollects traumatic events in childhood, and identifies specific interpersonal patterns that result from those negative experiences. The idea is that we all have learned to relate to people in ways that have been shaped and conditioned by our experiences with family members and primary care givers. These relational patterns may be healthy and/or pernicious. While these old habits lay largely beyond our conscious awareness, they nevertheless remain active forces in determining our current experiences and behavior. If we can consciously recognize the particularly harmful patterns as they arise in the present moment, we have an opportunity to redirect them towards more satisfying and harmonious outcomes.
The emphasis on developing awareness for the purpose of conscious action is shared by all three approaches of yoga asana, Buddhist meditation, and psychotherapy. The difference is that in therapy awareness is developed interpersonally, observing the dynamics between individuals, whereas in asana and meditation awareness is developed intrapsychically, with the individual observing their own body and mind process.
The second phase, repeating, occurs in the context of a patient's transference towards the therapist. Transference is a common psychic function defined as the repetition of a maladaptive relational pattern or traumatic emotional experience that occurred in the past with a person in the present. An example is being constantly angry with your boss because you experience him or her as intentionally undermining you, similar to the way you may have felt dismissed by your parents when you were a child. Because we are largely unaware creatures of habit, we are constantly transferring, or projecting, the past experiences onto the present. One of the functions of a therapist is to help the patient become consciously aware of these patterns by highlighting them as they occur in the present moment. The occurrence of repetition or reenactment is a golden opportunity in therapy: as the past afflictions become activated, they are more readily observed and studied within the safety of the relational crucible.
Working through is the final phase in Freud's sequence, wherein lies the bulk of the therapeutic process. Once the transference projection has been identified and grounded in the immediate experience, the patient has an opportunity to forge an alternative way of relating with the therapist through conscious experimentation. This can lead to a kind of emotional alchemy known as the corrective emotional experience, which displaces the old way of relating and lays the foundation for future, more rewarding interpersonal patterns. We might call the entire therapeutic enterprise a process of relearning, reprograming, or reparenting.
Let me provide an example to illustrate reparenting through the therapeutic alliance, concealing the details of one of my patients to protect confidentiality. John is a 35 year-old Wall Street banker, and an avid yoga and meditation practitioner who has never been in a serious relationship. He came to me with a history of severe depression and crippling anxiety, including panic attacks and a hospitalization for suicidal thoughts. We explored the content of his thought process, which included irrational fears, obsession with failures, and overgeneralizations about perceived threatening people and situations-all grounded in a set of core beliefs that he was "inadequate," "incapable," and "unlovable."
Such thoughts and beliefs made John feel generally overwhelmed by life and fundamentally afraid of new tasks or meeting new people. As a result of his fear, he was often nervous, hesitant, apologetic, overly accommodating, and highly avoidant, as well as quick to make an exit at social events or abandon tasks that were too challenging. Consequently, people found him aloof, unapproachable, unreliable, or at best failed to notice him. John's world was growing ever smaller. This cycle of irrational thoughts, adverse emotions, and reactive habits predicted his interaction with others, and created a self-fulfilling prophecy that rendered him utterly alone.
During therapy we explored his family history to determine the origins of his negative thought patterns and core beliefs (schemas) and identified that he had an extremely anxious and punitive mother who would often criticize him and sought to control him in order to mitigate her own distress and would manipulate him through guilt. His mother's harsh and unrelenting style caused John to feel unworthy and incapable, afraid to share his internal world, unable to ask for help, which severely impeded his ability to trust himself and others. Couple this with a passive father who failed to rescue him or provide a role model of masculine assertiveness and inner strength, and it is no surprise that John felt he was alone in a world devoid of justice, love, and hope. Naturally the goal of exploring parental dynamics is not to assign blame on to our parents, but to gain clear understanding of the transgenerational trauma we inherit.
Though John practiced meditation and yoga for many years and was good-hearted and healthy, his overall personality as a fearful, shame-ridden person remained unaffected. As a therapist who works exclusively with yogis, I have observed how spiritual practices can be used to avoid troubling patterns and unpleasant experiences, rather than dealing with them, in a phenomenon known as spiritual bypassing. What John most needed was a new way of being and relating to others that could only be achieved through a safe, nurturing relationship. After years of careful consideration, it has become clear to me that many of our "issues" and "problems" in life are the result of misapprehending others (due to transference), emotional missattunement, and failures in relationships. In order to truly heal these wounds, a corrective emotional experience in the relationship may be required.
Within the first six months of therapy, we explored John's history and his transference dynamics with me. We observed that in order to preserve the integrity of our relationship, and to reassure or calm me as he did his own mother, his manner of relating was subservient, compliant, guarded, and accommodating. Week after week, he struggled to disclose his perceived shortcomings and fears, anticipating that I would align with his deep sense of failure and reinforce his shame through further criticism and judgment. Occasionally, during a presentation at work or a weekend with his mother, John's symptoms would worsen. Yet he had difficulty reaching out to me, trusting me, because he was afraid I would get overwhelmed and overburdened. We later discovered that even though he came regularly to therapy, he secretly assumed he would never get better and that I would eventually abandon him. Such shame and fear of rejection is common within all of us, but exacerbated in those with chronic depression and anxiety stemming from greater degrees of trauma.
The period between six and twenty-four months of therapy was a fertile time for working through. My consistent availability, calm presence in the face of his anxiety, unconditional acceptance in the face of his shame, firm guidance role-modeling a new father-figure, and consistent validation and love role-modeling a new mother-figure contributed to John's journey of reparenting.
The healing relationship between John and me worked in a positive feedback to improve his sense of worth, confidence and trust, experiences that he lacked in childhood. Today, John is much happier and self-assured, far more emotionally stable and interpersonally skilled, excelling in his career, and finally starting to date. His progress has less to do with my ability or style as a therapist, and more to do with the power of love and the healing capacity of a deep human bond.
I'm not suggesting that love and relationships alone can set us free. If that were true those who are dating and married would already be enlightened! What I am saying is that yoga and meditation could be greatly enhanced, and the process of spiritual maturation expedited, by a close mentoring relationship as intended in the teacher-student (guru-shishya) institution of ancient India. But in an era when great gurus have precious little time with their students, a "good enough" therapist and the healing relationship developed in psychotherapy can provide a surrogate of enormous benefit.
Dr. Miles Neale
New York City
July 25, 2011