Meditation and Psychotherapy: An Effective Combination

Abstract

This column discusses concepts of an integrated psychotherapeutic approach to patient care and explores some of underlying principles that make it beneficial. It may come as a surprise to some practitioners, but as early as 1977, American Psychiatric Association was suggesting that could facilitate therapeutic and it encouraged research to evaluate its possible usefulness (Task Force on Meditation, 1977). That statement was made because a growing number of clinicians, particularly psychoanalysts, were working with meditation and psychotherapy together and finding it a powerful combination (Carrington & Ephron, 1975; Shafii, 1973). So, one might wonder, what's happened? How could an approach that seemed so promising and is so effective still be considered somewhat on fringe? The answer, in part, may go back to some of originators of psychoanalytic theory. Freud, while unfamiliar and inexperienced in meditation, believed it evoked a regressive state and considered it pathological rather than a productive integrative approach (Epstein, 1984). His attitude was adopted by many of his followers and tended to perpetuate a tradition that equated meditation with religious, irrational, and infantile thinking. A small minority of neo-Freudian psychoanalysts did approach concepts of meditation and psychotherapy with an open mind (Homey, 1945; Kelman, 1960), but they did little to change deeply entrenched view that these two approaches stood very much apart. Current research into effectiveness of meditation on a whole range of medical and psychological problems has begun to call into question this old separatist view, as more and more data support use of meditation for any number of psychological problems ranging from anxiety to schizophrenia (Kutz, Leserman, et al., 1985). Over time, considering growing number of practitioners who are using and researching this combination, use of meditation in therapeutic process may become an important tool to support change and increase insight. This column discusses some of advantages of combining meditation with psychotherapy and provides a description of what a sitting meditation practice looks like and how it can be generated in therapeutic session. A brief clinical example is given to show how principles can be integrated into a whole. The term meditation may mean any number of things and approaches, from focusing on breath to repeating a mantra. Whether one is practicing transcendental meditation, mindful meditation, or another kind of meditation, a number of principles are basic. First, there is a focusing of attention (Kabat-Zinn, 1982). This focusing is achieved by restricting attention to a single repetitive stimuli, such as a word, sound, prayer, phrase, sensation of breath or a visual (Kutz, Borysenko, et al., 1985, p. 2). At same time, participant maintains a passive attitude and becomes a silent witness to his/her thoughts, accepting whatever they may be with a nonjudgmental attitude (Castleman, 1996). When attention wanders, meditation continually refocuses on meditative stimulus. When strong feelings arise, meditator notices feeling and allows himself or herself to be with feeling as it occurs, observing it until it subsides, then returning to object of attention (Astin, 1997). As ability to meditate and focus increases, a number of physiological changes have been shown to occur in participant. Benson (1974) termed these changes the relaxation response and noted they include a decreased heart rate and breathing rate and a lowering of blood pressure. Further studies also have shown changes in EEG brain-wave activity as well as increased hormonal levels of cortisol and serotonin (MacLean et al., 1997). Beyond these significant physiological changes, there is a change in perception of meditator. …