Towards a Buddhist Psychotherapy
C. George Boeree, Ph.D.
Shippensburg University

What follows is my effort at showing the relevance of Buddhism to western psychotherapy, especially existential therapy. Although it may not sit well with purists, I hope that this article captures the spirit of the Buddha's message.
The Four Noble Truths sound like the basics of any theory with therapeutic roots:

1. Life is suffering. Life is at very least full of suffering, and it can easily be argued that suffering is an inevitable aspect of life. If I have senses, I can feel pain; if I have feelings, I can feel distress; if I have a capacity for love, I will have the capacity for grief. Such is life.
Duhkha, the Sanskrit word for suffering, is also translated as stress, anguish, and imperfection. Buddha wanted us to understand suffering as a foundation for improvement. One key to understanding suffering is understanding anitya, which means that all things, including living things, our loved ones, and ourselves, are impermanent. Another key concept is anatman, which means that all things -- even we -- have no "soul" or eternal substance. With no substance, nothing stands alone, and no one has a separate existence. We are all interconnected, not just with our human world, but with the universe.
In existential psychology, we speak of ontological anxiety (dread, angst). It, too is characterized as an intrinsic part of life. It is further understood that in order to improve one's life, one needs to understand and accept this fact of life, and that the effort one makes at avoiding this fact of life is at the root of neurosis. In other words, denying anxiety is denying life itself. As the blues song points out, "if you ain't scared, you ain't right!"
Impermanence also has its correlate in the concept of being-towards-death. Our peculiar position of being mortal and being aware of it is a major source of anxiety, but is also what makes our lives, and the choices we make, meaningful. Time becomes important only when there is only so much of it. Doing the right thing and loving someone only have meaning when you don't have an eternity to work with.
Anatman -- one of the central concepts of Buddhism -- is likewise a central concept in existential psychology. As Sartre put it, our existences precede our essences. That is to say, we are a kind of "nothingness" that strains to become a "something." Yet only by acknowledging our lives as more a matter of movement than substance do we stand a chance at authentic being.

2. Suffering is due to attachment. We might say that at least much of the suffering we experience comes out of ourselves, out of our desire to make pleasure, happiness, and love last forever and to make pain, distress, and grief disappear from life altogether.
My feeling, not quite in line with some Buddhist interpretations, is that we are not therefore to avoid pleasure, happiness, and love. Nor are we to believe that all suffering comes from ourselves. It's just that it is not necessary, being shot once with an arrow, to shoot ourselves again, as the Buddha put it.
Attachment is one translation of the word trishna, which can also be translated as thirst, desire, lust, craving, or clinging. When we fail to recognize that all things are imperfect, impermanent, and insubstantial, we cling to them in the delusion that they are indeed perfect, permanent, and substantial, and that by clinging to them, we, too, will be perfect, permanent, and substantial.
Another aspect of attachment is dvesha, which means avoidance or hatred. To Buddha, hatred was every bit as much an attachment as clinging. Only by giving those things which cause us pain permanence and substance do we give them the power to hurt us more. We wind up fearing, not that which can harm us, but our fears themselves.
A third aspect of attachment is avidya, meaning ignorance. At one level, it refers to the ignorance of these Four Noble Truths -- not understanding the truth of imperfection and so on. At a deeper level, it also means "not seeing," i.e. not directly experiencing reality, but instead seeing our personal interpretation of it. More than that, we take our interpretation of reality as more real than reality itself, and interpret any direct experiences of reality itself as illusions or "mere appearances!"
Existential psychology has some similar concepts here, as well. Our lack of "essence" or preordained structure, our "nothingness," leads us to crave solidity. We are, you could say, whirlwinds who wish they were rocks. We cling to things in the hopes that they will provide us with a certain "weight." We try to turn our loved ones into things by demanding that they not change, or we try to change them into perfect partners, not realizing that a statue, though it may live forever, has no love to give us. We try to become immortal, whether by anxiety-driven belief in fairy-tales, or by making our children and grand-children into clones of ourselves, or by getting into the history books or onto the talk shows. We even cling to unhappy lives because change is too frightening.
Or we try to become a piece of a larger pie: The most frightening things we've seen in this century are the mass movements, whether they be Nazis or Red Guard or Ku Klux Klan or... well, you name them. If I'm just a little whirlwind, maybe by joining others of my kind, I can be a part of a hurricane! Beyond these giant movements are all the petty ones -- political movements, revolutionary ones, religious ones, antireligious ones, ones involving nothing more than a style or fashion, and even the local frat house. And note the glue that holds them together is the same: hatred, which in turn is based on the anxiety that comes from feeling small.
Finally, existential psychology also discusses its version of ignorance. Everyone holds belief systems -- personal and social -- that remain forever untested by direct experience. They have such staying power because built in to them is a catch-22, a circular argument, that says that evidence or reasoning that threatens the belief system is, ipso facto, incorrect. These belief systems can range from the great religious, political, and economic theories to the little beliefs people hold that tell them that they are -- or are not -- worthy. It is a part of therapy's job to return us to a more direct awareness of reality. As Fritz Perls once said, "we must lose our minds and come to our senses!"

3. Suffering can be extinguished. At least that suffering we add to the inevitable suffering of life can be extinguished. Or, if we want to be even more modest in our claims, suffering can at least be diminished.
I believe that, with decades of practice, some monks may be able to transcend even simple, direct, physical pain. I don't think, however, that us ordinary folk in our ordinary lives have the option of devoting those decades to such an extreme of practice. My focus, then, is on diminishing mental anguish rather than eliminating all pain.
Nirvana is the traditional name for the state of being (or non-being, if you prefer) wherein all clinging, and so all suffering, has been eliminated. It is often translated as "blowing out," with the idea that we eliminate self like we blow out a candle. This may be a proper understanding, but I prefer the idea of blowing out a fire that threatens to overwhelm us, or even the idea of taking away the oxygen that keeps the fires burning. By this I mean that by "blowing out" clinging, hate, and ignorance, we "blow out" unnecessary suffering.
I may be taking a bit of a leap here, but I believe that the Buddhist concept of nirvana is quite similar to the existentialists' freedom. Freedom has, in fact, been used in Buddhism in the context of freedom from rebirth or freedom from the effects of karma. For the existentialist, freedom is a fact of our being, one which we often ignore, and which ignorance leads us to a diminished life.

4. And there is a way to extinguish suffering. This is what all therapists believe -- each in his or her own way. But this time we are looking at what Buddha's theory --dharma -- has to say: He called it the Eightfold Path.
The first two segments of the path are refered to as prajña, meaning wisdom:
Right view -- understanding the Four Noble Truths, especially the nature of all things as imperfect, impermanent, and insubstantial and our self-inflicted suffering as founded in clinging, hate, and ignorance.
Right aspiration -- having the true desire to free oneself from attachment, hatefulness, and ignorance. The idea that improvement comes only when the sufferer takes the first step of aspiring to improvement is apparently 2500 years old.
For the existential psychologist, therapy is something neither the therapist nor the client takes lying down -- if you will pardon the pun. The therapist must take an assertive role in helping the client become aware of the reality of his or her suffering and its roots. Likewise, the client must take an assertive role in working towards improvement -- even though it means facing the fears they've been working so hard to avoid, and especially facing the fear that they will "lose" themselves in the process.

The next three segments of the path provide more detailed guidance in the form of moral precepts, called sila:
Right speech -- abstaining from lying, gossiping, and hurtful speech generally. Speech is often our ignorance made manifest, and is the most common way in which we harm others. Modern psychologists emphasize that one should above all stop lying to oneself. But Buddhism adds that by practicing being true to others, and one will find it increasingly difficult to be false to oneself.
Right action -- behaving oneself, abstaining from actions that hurt others (and, by implication, oneself) such as killing, stealing, and irresponsible sex.
Right livelihood -- making one's living in an honest, non-hurtful way. Here's one we don't talk about much in our society today. One can only wonder how much suffering comes out of the greedy, cut-throat, dishonest careers we often participate in. This by no means means we must all be monks: Imagine the good one can do as an honest, compassionate, hard-working accountant, business person, lawyer, or politician!
I have to pause here to add another Buddhist concept to the picture: karma. Basically, karma refers to good and bad deeds and the consequences they bring. In some branches of Buddhism, karma has to do with what kind of reincarnation to expect. But other branches see it more simply as the negative (or positive) effects one's actions have on one's integrity. Beyond the effects of your selfish acts have on others, for example, each selfish act "darkens your soul," and makes happiness that much harder to find. On the other hand, each act of kindness, as the gypsies say, "comes back to you three times over." To put it simply, virtue is its own reward, and vice its own hell.
The nature of moral choice has been a central concern of existentialism as well. According to existentialists, we build our lives through our moral choices. But they view morality as a highly individualistic thing -- not based on simple formulas beginning with "thou shalt not..." and handed down to us directly from God. Actually, moral choice is something involving a real person in a real situation, and no one can second guess another's decisions. The only "principle" one finds in existentialism is that the moral decision must come from a certain position, i.e. that of authenticity.
Perhaps I should also pause here to explain what is meant by the existential idea of authenticity. The surface meaning is being real rather than artificial or phony. More completely, it means living one's life with full acceptance of one's freedom and the responsibility and anxiety that freedom entails. It is often seen as a matter of living courageously. To me, it sounds suspiciously like enlightenment.
There is another similar ethical philosophy I'd like to mention: the situated ethics of Joseph Fletcher. He is a Christian theologian who finds the traditional, authoritarian brand of Christian ethics not in keeping with the basic message of Christ. Needless to say, he has raised the hackles of many conservative Christians by saying that morality is not a matter of absolutes, but of individual conscience in special situations. He believes that, if an act is rooted in genuine love, it is good. If it is rooted in hatred, selfishness, or apathy, it is bad. Mahayana (northern) Buddhism says very much the same thing.
It is always a matter of amusement to me that my students, unaware of all the great philosophical and religious debates on morality, all seem quite aware that intentionally hurting others (or oneself) is bad, and doing one's best to help others (and oneself) is good. If you look at Buddha's pronouncements on morality -- or Christ's -- you find the same simplicity.

The last three segments of the path are the ones Buddhism is most famous for, and concern samadhi or meditation. I must say that, despite the popular conception, without wisdom and morality, meditation is worthless, and may even be dangerous.
Right effort -- taking control of your mind and the contents thereof. Simple, direct practice is what it takes, the developing of good mental habits: When bad thoughts and impulses arise, they should be abandoned. This is done by watching the thought without attachment, recognizing it for what it is (no denial or repression!), and letting it dissipate. Good thoughts and impulses, on the other hand, should be nurtured and enacted. Make virtue a habit, as the stoics used to say.
There are four "sublime states" (brahma vihara) that some Buddhists talk about. These sublime states are fully experienced by saintly creatures called boddhisattvas, but the rest of us should practice them every moment of every day as an exercise in self-improvement. They are loving kindness to all you meet, compassion for those who are suffering, joy for others without envy, and equanimity or a peaceful, evenly balanced attitude towards the ups and downs of life.
Right mindfulness -- mindfulness refers to a kind of meditation involving an acceptance of thoughts and perceptions, a "bare attention" to these events without attachment. It is called vipassana in the Theravada (southern Buddhism) tradition, and shikantaza in the Ch'an (Zen) tradition. But it is understood that this mindfulness is to extend to daily life as well. It becomes a way of developing a fuller, richer awareness of life, and a deterent to our tendency to sleepwalk our way through life.
One of the most important moral precepts in Buddhism is the avoidance of consciousness-diminishing or altering substances -- i.e. alcohol or drugs. This is because anything that makes you less than fully aware sends you in the opposite direction of improvement into deeper ignorance.
But there are other things besides drugs that diminish consciousness. Some people try to avoid life by disappearing into food or sexuality. Others disappear into work, mindless routine, or rigid, self-created rituals.
Drowning oneself in entertainment is one of today's favorite substitutes for heroin. I think that modern media, especially television, make it very difficult to maintain our balance. I would like to see a return to the somewhat Victorian concept of "edifying diversions:" see a good movie on PBS or videotape -- no commercials, please -- or read a good book, listen to good music, and so on.
We can also drown awareness in material things -- fast cars, extravagant clothes, and so on. Shopping has itself become a way of avoiding life. Worst of all is the blending of materiality with entertainment. While monks and nuns avoid frivolous diversions and luxurious possessions, we surround ourselves with commercials, infomercials, and entire shopping networks, as if thery were effective forms of "pain control!"
Right concentration -- meditating in such a way as to empty our natures of attachments, avoidances, and ignorance, so that we may accept the imperfection, impermanence, and insubstantiality of life. This is usually thought of as the highest form of Buddhist meditation, and full practice of it is pretty much restricted to monks and nuns who have progressed considerably allong the path.
But just like the earlier paths provide a foundation for later paths, later ones often support earlier ones. For example, a degree of "calm abiding" (shamatha), a beginning version of concentration, is essential for developing mindfulness, and is taught to all beginning meditators. This is the counting of breaths or chanting of mantras most people have heard of. This passifying of the mind is, in fact, important to mindfulness, effort, all moral practice, and even the maintaining of view and aspiration. I believe that this simple form of meditation is the best place for those who are suffering to begin -- though once again, the rest of the eightfold path is essential for long-term improvement.
Most therapists know: Anxiety is the most common manifestation of psychological suffering. And when it's not anxiety, it's unresolved anger. And when it's not anger, it's pervasive sadness. All three of these can be toned done to a manageable level by simple meditation. Meditation will not eliminate these things -- that requires wisdom and morality and the entire program -- but it will give the sufferer a chance to acquire the wisdom, morality, etc!
Beyond recommending simple meditation, therapists might recommend simplification of lifestyle, avoidance of sensationalistic or exploitative entertainment, a holiday from the news, a retreat to a monastery, or a simple weekend vacation. One of my favorite expressions is "less is more!"

As I mentioned earlier, some Buddhists have an expression "nirvana is samsara," which means that the perfected life is this life. While there is much talk about great insights and amazing enlightenments and even paranormal events, what Buddhism is really all about, in my humble opinion, is returning to this life, your very own little life, with a "new attitude." By being more calm, more aware, a nicer person morally, someone who has given up envy and greed and hatred and such, who understands that nothing is forever, that grief is the price we willingly pay for love.... this life becomes at very least bearable. We stop torturing ourselves and allow ourselves to enjoy what there is to enjoy. And there is a good deal to enjoy!
My Buddhist friends often use the term "practice" for what they do. They encourage each other to "keep on practicing." Nobody is too terribly concerned if they aren't perfect -- they don't expect that. As long as you pick yourself up and practice a little more. A good basis for therapy.