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2005 45: 483Journal of Humanistic PsychologyDavid T. Andersen

MovementEmpathy, Psychotherapy Integration, and Meditation: A Buddhist Contribution to the Common Factors

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10.1177/0022167805280264Empathy, Psychotherapy Integration, and MeditationDavid T. Andersen

EMPATHY, PSYCHOTHERAPYINTEGRATION, AND MEDITATION:A BUDDHIST CONTRIBUTION TOTHE COMMON FACTORS MOVEMENT

DAVID T. ANDERSEN, Ph.D., has practiced medita-tion in the Buddhist tradition (first vipassana andthen Zen) for 35 years. He earned an Ed.M. from Har-vard University and a doctorate in clinical psychol-ogy from the Derner Institute at Adelphi University.He is presently a school psychologist in Norwalk,Connecticut, and an adjunct professor in the Psy-chology and Education Departments at Sacred HeartUniversity. He is also a licensed clinical psychologistwith a private practice in Stamford, Connecticut.

Clinicians from several theoretical approaches have explored thecommon ground between Buddhism and Westernpsychotherapeutic models. In this article, the synthesis of Buddhismand psychotherapy is considered from the context of psychotherapyintegration. Toward that end, the Buddhism and psychotherapy lit-erature and the psychotherapy outcome research is reviewed with afocus on the findings of therapy equivalence and common factorsamong treatment approaches. Empathy and the relationship vari-ables factor are discussed; it is argued that Buddhist meditationcontains a dialectic between striving and self-acceptance. An essen-tial aspect of meditation is seen as identical to an essential compo-nent in therapeutic personality change. It is argued that therapistempathy and meditation promote a self-directed empathy thatenhances the interdependence, integration, and cohesion of self.Several approaches to the integration of psychotherapy and Bud-dhist meditation are compared to the views presented here, and rec-ommendations are offered for the clinical application of meditationtraining.

483

AUTHOR’S NOTE: Please address requests for reprints of this article to David T.Andersen, Ph.D., 83 Morgan St., Apt. 5-C, Stamford, CT 06905; e-mail: [email protected].

Journal of Humanistic Psychology, Vol. 45 No. 4, Fall 2005 483-502DOI: 10.1177/0022167805280264© 2005 Sage Publications

Keywords: empathy; psychotherapy integration; meditation

To study Buddhism is to study the self.To study the self is to forget the self.To forget the self is to be enlightened by all things.To be enlightened by all things is toremove the barriers between oneself and others.

—Zen Master Dogen [1200-1253C.E.] (1976), p. 39

Even a casual reader of Buddhist literature might recognizethat a recurring theme in Western Buddhism has been the integra-tion of psychotherapy and Buddhist practice. Clinicians fromdiverse therapeutic approaches have described (in books, maga-zines, and professional journals) their integration of insights, con-cepts, and techniques from Buddhist meditation into their theoryand practice of psychotherapy (Brazier, 1995; Epstein, 1995, 1998;Linehan, 1993; Magid, 2002; Rubin, 1996). Although each of theseintegrations should be judged in its own context and on its ownmerits, another way to understand and evaluate this trend, andanother way to make use of it, is to view the synthesis of meditationand psychotherapy within a larger perspective. There is currentlya movement within mainstream clinical practice toward psycho-therapy integration. A growing number of psychologists have com-bined or synthesized concepts and methods from one or more ther-apeutic models to generate new theories and more effective modelsof intervention (Stricker & Gold, 1996).

Motivated by practical concerns (the need to empirically justifyinsurance coverage for therapy) and the findings from the decades-long history of psychotherapy outcome research, psychologistsworking in the field of psychotherapy integration have looked forevidence for the effectiveness of psychotherapy and have sought toidentify commonalities among therapeutic approaches. In addi-tion, psychotherapy integrationists have addressed questions thathave been raised, from research findings and clinical experience,about how therapy actually affects psychological change.Althoughit is likely that most clinicians who practice meditation would notsuggest that the two disciplines are interchangeable, it may bethat meditation has something to contribute to the discussion of

484 Empathy, Psychotherapy Integration, and Meditation

David T. Andersen 485

what makes therapy work. In this article, I review the literature onthe integration of Buddhism and psychotherapy and the findingsfrom research on psychotherapy outcome. In addition, I argue thatan essential aspect of meditation is identical to an essential compo-nent in therapeutic personality change. More specifically, I main-tain that therapist empathy and Buddhist meditation promote aself-directed empathy that enhances the interdependence,integration, and cohesion of self.

Finally, I compare my view of meditation and psychotherapywith views expressed in the literature and provide a rationale forthe use of meditation in clinical training.

BUDDHISM AND PSYCHOTHERAPY

The movement to compare, contrast, and, ultimately, to inte-grate concepts and techniques from the Buddhist practice of medi-tation into Western psychotherapeutic models has a long history.Freud (1930) originally broached this subject when contacted bythe French Nobel Laureate Romain Rolland about the usefulnessof meditation. Referring to Rolland’s “oceanic experience” whilethe poet had studied with a well-known meditation teacher inIndia, Freud dismissed meditation, viewing it as a primitivedefense and a regression to an infantile narcissism. Other psycho-analytic writers agreed with Freud’s pessimistic andreductionistic view of meditation, arguing that meditation is bestunderstood as an artificial schizophrenia (Alexander, 1931) or asan expression of narcissistic megalomania (Masson & Hanly,1976). A notable exception to this negative perception of medita-tion was offered by Eric Fromm. In Zen Buddhism and Psycho-analysis (Fromm,Suzuki,& DeMartino,1960),Fromm argued thatZen and psychoanalysis have much in common, including an abid-ing distrust in conscious thought and a belief that self-knowledgeleads to self-transformation. Fromm also suggested that Zenpractice may actually be better equipped than Westernpsychotherapeutic approaches in helping people more effectivelymanage the modern problems of emptiness and self-alienation.

In an article that makes an early connection between empathyand meditation, Schuster (1979) argued that the choiceless aware-ness characteristic of mindfulness meditation and the Zen practice

of shikan-taza (just sitting) is likely to enhance the capacity forempathy. Schuster suggested that meditation practice would helptherapists adopt an open and nonjudgmental awareness, makingit possible for an intuitive, direct, and authentic grasp of theclient’s experience.

Clinicians examining the relationship between meditation andpsychotherapy have focused on the question of meditation and egodevelopment. Wilber (1993) has suggested a sequential use of med-itation and psychotherapy, arguing that ego-focusedpsychotherapies address a level of awareness where meditation isnot a relevant intervention. In similar arguments, Wellwood(1983) and Engler (1993) have suggested that there are differentgoals for therapy and meditation:The former addresses the need todevelop a strong ego whereas the latter is concerned only withissues of transcendence. Meditation from this perspective (egodevelopment) would be contraindicated for persons strugglingwith poorly developed internal representations of self and other orfor those who have difficulty maintaining the integrity and coher-ency of self. Engler (1993) captured the essence of this positionwith his oft-quoted statement “You have to be somebody before youcan be nobody” (p. 119).

In contrast to the view that meditation and psychotherapyaddress different levels of development, Epstein (1995, 1998) hascogently argued against the notion that meditation is only appro-priate for persons with a fully developed personality. Epsteinpointed out that not only would this criterion place meditationbeyond the reach of most people but also that the capacity for theego to maintain its strength and integrity is enhanced by the mind-fulness aspect of meditation. When the contrasting experiences ofdelight and terror are held within a mindful attention, meditatorslearn to accept, tolerate, and contain fantasies of omnipotencewhile they viscerally experience the essential impermanence of aseparate self. Moreover, Epstein (1995, 1998) suggested that mind-fulness meditation may have a part to play in the remediation ofdeficits in the development of a healthy sense of self. Referring toWinnicot’s notion of a false self and Balint’s concept of an implicitexperience of a basic fault,Epstein (1995) argued that mindfulnessmeditation helps patients deconstruct and then relinquish thepathology caused by faulty relationships (intrusive or indifferent)with primary caregivers. Writing from a self-psychological per-spective, Magid (2002) seemed to agree, suggesting that the day-


to-day practice of meditation, even when not accompanied by par-ticipation in extended retreats, promotes the development of inter-nal structures that provide the capacity to more fully tolerate,contain, and organize emotional experience.

In a thoughtful and comprehensive restatement of his ideas,Engler (2003) acknowledged and agreed with the criticism of hisdevelopmental model of psychotherapy and meditation. Englernoted that his therapy-first approach emerged primarily from hiswork with patients who were drawn to the Buddhist concept ofanatta (a core Buddhist tenet that denies the existence of a sepa-rate self) as a way to bolster narcissistic defenses, avoid personalresponsibility, rationalize fears of intimacy, or otherwise maintaindistance from unwanted affect. In addition, Engler acknowledgedthat meditation, indeed, enhances the development of egostrengths, most notably the capacity for affect tolerance and self-observation. Engler also agreed with his critics (Epstein, 1995;Kornfield, 1993) that meditation practice should not be seen as dis-continuous with the development of a healthy sense of self and agreater capacity for intimacy. Finally, Engler argued that medita-tion and psychodynamic psychotherapy produce therapeuticeffects in a sequential process, first by changing cognition throughinsight, then affect, and ultimately, the core sense of selfhood.

Working primarily from a behavioral perspective, Linehan’s(1993) integration of Buddhism and psychotherapy focused on thecapacity for meditation to regulate emotional experience.Linehan’s dialectical behavior therapy (DBT), an empiricallybased approach to the treatment of borderline personality disorder(BPD), is based on dialectical theory, a philosophical position con-sistent with Buddhist philosophy in its emphasis on process andchange and the inherent interdependence of all phenomena.Linehan saw BPD as a dialectic failure; that is, the extreme think-ing and emotional dysregulation characteristic of BPD denote afailure to achieve a synthesis of dichotomous and opposing inter-nal forces. For patients diagnosed with BPD, Linehan usedmeditational techniques to help regulate emotional experience sothat the fundamental dialectical failure of this disorder, the inabil-ity to implement strategies for behavioral change in the context ofself-acceptance, can be brought to a successful and adaptivesynthesis.

Writing from a psychoanalytic perspective, Rubin (1996, 2003)looked at the synergistic effects of meditation and noted that inte-


gration should be a reciprocal process. Citing the scandals of thepast two decades involving the abuse of power at Buddhist centersand his own clinical experience in working with patients who med-itate, Rubin argued that meditation practice, by itself, is some-times insufficient in uncovering and then working through archaictransference phenomena. Rubin suggested that meditation andpsychoanalysis convey different and incomplete epistemologies ofself. Whereas meditation focuses on the here and now, existential,atheoretical, and dereified perceptions of experience, psychoana-lytic theory examines the ways in which personal history distortsor confuses the experience of self, other, and even the experience ofBuddhist practice itself. It is Rubin’s point that combining the twoapproaches might help strengthen the weaknesses in both.

In a research design that is likely to become an important trendin the integration of Buddhism and psychotherapy, Schwartz(Schwartz & Begley,2002) used the tools of neuroscience to supporthis integration of cognitive therapy and mindfulness meditation.Recognizing that the neural pathways associated with obsessive-compulsive disorder (OCD) result in the perseveration of errormessages in the orbital frontal cortex, Schwartz developed a treat-ment that integrates the reframing of these error messages withthe techniques of mindfulness meditation. When dropout rates aretaken into account, Schwartz’s treatment has been shown to bemore effective, and is likely more humane, than the behavioraltechniques of exposure and flooding most frequently used for thisdisorder. Moreover, Schwartz has demonstrated that meditationand psychotherapy produce neuroplasticity, the capacity for thestructure and functioning of the brain to be shaped by experience.

Finally, Teasdale and his colleagues (Segal, Teasdale, & Wil-liams, 2001) demonstrated that meditation, when combined withcognitive therapy, can significantly reduce the rate of relapse forpatients experiencing multiple (three or more) episodes of depres-sion. In Teasdale’s approach, mindfulness meditation helpspatients experience problematic thoughts as simple mental eventsthat do not necessarily reflect accurate interpretations of experi-ence. Moreover, this implicit reframing (in meditation) of problem-atic cognition allows for the activation of competing thoughts thatprovide rational, adaptive, and healthy responses (in the form ofcounterarguments) to the depressogenic cognitive patternscharacteristic of major depressive disorder.


In summary, the literature on meditation and psychotherapyincludes the integration of meditation with cognitive, behavioral,and psychodynamic therapeutic approaches. Meditation is viewedas helping patients repair deficits in the development of self-structures, increase insight into repetitive patterns of internalconflicts, expand the capacity for affect regulation, and increasethe ability to identify and then correct maladaptive cognition.Although Schuster (1979) made a connection between empathyand meditation (a primary concern of this article), he concentratedon the effects of meditation on therapist empathy. In this article, Iexpand the discussion of empathy, psychotherapy, and meditationby focusing on the integrative function of empathy and argue thattherapy and meditation effect psychological change by enhancingthe capacity for self-directed empathy. In the following section, Ireview the research on therapy outcome, emphasizing the findingsof outcome equivalence and the common factors among therapeu-tic approaches. In addition, I argue for the importance of empathyin therapeutic personality change.

RESEARCH ON PSYCHOTHERAPY OUTCOME

Over several decades, Hans Eysenck (1952, 1993) maintainedthat there was no credible evidence that psychotherapy actuallyhelps people who struggle with mental health concerns. Eysenckargued that in spite of the implicit belief among clinicians in theeffectiveness of psychotherapy, the research on therapy outcomewas inconclusive; many studies showing the effectiveness of psy-chotherapy were poorly designed or the results did not demon-strate that psychotherapy is more effective than placebo treat-ments. More recently, insurance companies, who have assumedpayments for the provision of clinical services, have required thatpsychologists provide empirical data demonstrating theeffectiveness of psychotherapeutic treatment.

Findings from several well-controlled studies on psychotherapyoutcome and from a succession of meta-analytic evaluations con-sistently demonstrate that psychotherapy is an effective treat-ment for people with mental health concerns (Weinberger, 2002).In addition, this research demonstrates that no therapeuticapproach is better than any other in affecting psychological


change. These findings are widely referred to as the “Dodo bird”verdict in which “Everyone has won and all must have prizes”(Rosenzweig, 1936, p. 412).

The evidence for therapy outcome equivalence strongly sug-gests that the factors alleged to be working by each model are notthe actual or only factors causing psychological change(Weinberger, 2002). Indeed, researchers have identified five com-mon or nonspecific factors that account for the variance in thedependent measures used in therapy outcome studies. These fac-tors are relationship variables, expectancies, confronting prob-lems, mastery, and the attribution of outcomes (Weinberger, 2002).Of these five nonspecific conditions of treatment, the strongestpredictor of successful outcome has been, indisputably, the rela-tionship variables factor (Luborsky, Crits-Christoph, Mintz, &Auerbach, 1988; Orlinsky & Howard, 1986; Stubbs & Bozarth,1994).

Although the therapeutic relationship includes several dimen-sions, its central component remains true to the classic Rogeriantheory of the necessary and sufficient conditions for successfultreatment (Bozarth, 1997). Rogers (1957) identified three core con-ditions of successful psychotherapy: therapist empathy, uncondi-tional positive regard, and genuineness. Bozarth asserted thatthese three conditions are seamlessly connected because thecapacity for empathy is essential to the therapist’s attitude ofunconditional positive regard toward the client and to the thera-pist’s ability to be genuine or congruent in the therapeutic rela-tionship. Although many researchers have criticized or dismissedthe core conditions in Rogerian theory as conceptually inadequateor as neither necessary nor sufficient conditions for successfultreatment (Gelso & Carter, 1985; Luborsky, Singer, & Luborsky,1975; A. K. Shapiro, 1971), Bozarth, Zimring, and Tausch (2002)argued that this dismissal has not been empirically based.Although the initial rejection of Rogerian theory was based only ona methodological critique of a small number of studies, not onestudy has been published supporting the assertion that the coreconditions are not sufficient. More important, in Bozarth’s(Bozarth et al., 2002) review of five decades of research on therapyoutcome, he noted that the therapist-client relationship, combinedwith the client’s resources, have been shown to account for 30% to40% of the variance in successful treatment. In addition, Bozarth


and his colleagues found that the conditions of empathy,unconditional positive regard, and congruence are the therapistvariables most often associated with successful treatment.

Finally,psychologists have suggested that the qualities of atten-tion characteristic of a mindful awareness constitute a commonfactor in successful psychotherapy (Martin, 1997). Horowitz (2002)defined mindfulness by combining concepts derived from Buddhistphilosophy and the literature of social psychology. Horowitzviewed mindfulness as a flexible awareness that is centered pri-marily on those feelings, thoughts, and sensations that are occur-ring in the present moment. Mindfulness is also characterized by acompassionate understanding of others that leads to a greatercapacity for self-observation. As I demonstrate in the following dis-cussion of empathy in clinical practice, this definition of mindful-ness is consistent with the view of empathy in the humanistic-experiential approaches to psychotherapy.

EMPATHY IN CLINICAL PRACTICE

In clinical practice, the self-psychological and humanistic-experiential approaches have generated the most interest, theo-retical and empirical, in the influence of empathy on the therapeu-tic process. Self-psychologists view empathy as a process of vicari-ous introspection where the empathic responses of therapists areguided by their ability to imagine what it would be like to have thepatient’s experience. In their identification with the patient, thera-pists introspect, or pay attention to, what they imagine the patientwould be feeling (Kohut, 1984). In this model, empathy is a toolthat the analyst employs to generate “experience near” (and there-fore more accurate) clinical information. Although vicarious intro-spection does not include the communication of emotional experi-ence, patients are likely to feel accepted by the therapist becausethe logic of their internal frame of reference is not challenged orsubmitted to objective standards of reality testing (B. Magid, per-sonal communication, October 7, 2002).

In contrast, empathy in humanistic and experientialapproaches is cast in cognitive and affective terms (Bohart &Greenberg, 1997). In their review of empathy in humanistic-experiential psychotherapies, Bohart and Greenberg (1997) noted


that empathy has been defined as the nonjudgmental understand-ing of the client’s immediate frame of reference that helps the cli-ent to become more compassionate and empathic toward the self.The communication of therapist empathy helps clients replacenegative evaluations of self with the capacity to accept and inte-grate previously disowned experience. In addition, in somehumanistic-experiential approaches empathy is seen as necessaryto the construction of the therapeutic alliance and the repair ofdamaged patterns of experiencing. I would also argue that thecombination of affect and cognition provides empathy with an exis-tential or ontological base; that is, the understanding and accep-tance of the client proceeds from and deepens the therapist’s abil-ity to simply be with and stay with experiences as they arise in thetherapeutic hour.

To summarize, an important difference between empathy in theself-psychological and humanistic-experiential traditions seemsto turn on the concept of acceptance. In self-psychology, empathy isprimarily a cognitive process that does not normally include anaffective component. If the patient feels accepted by the analyst, itis because the analyst has not attempted to contradict the patient’sversion of events. In contrast, in humanistic-experiential tradi-tions therapist empathy is defined as the nonjudgmental under-standing of the client’s immediate experience that helps the clientrecognize, accept, and integrate disavowed aspects of self.Although acceptance and empathy are not viewed as synonymous,acceptance is implied in the definition of empathy and in the waythat empathy is understood to function.

Although research has consistently shown a significant connec-tion between therapist empathy and successful outcome (Bohart &Greenberg, 1997), the reason that empathy and the larger con-struct of relationship variables are associated with successfultreatment has not been demonstrated empirically (Wienberger,2002). Because there is evidence that Buddhist meditationenhances the capacity for empathy (S. L. Shapiro, Schwartz, &Bonner, 1998), and because, for Buddhists, meditation has beenused for centuries as a direct route to the ending of suffering, it isreasonable to suggest that meditation may have something in com-mon with, and something to contribute to, the experience oftherapeutic personality change.


EMPATHY IN MEDITATION:EMPATHY IN PSYCHOTHERAPY

In Buddhism, particularly but not exclusively in Zen (Magid,2002; Watts, 1957), there is an ongoing dialectic between the needto make effort in meditation and the need to sit in meditation with-out effort. Lacking the motivation to sit, the will to endure uncom-fortable feelings, and the uncomplicated desire for meditation tomake things better, it is not likely that a person will begin and thenmaintain a meaningful meditation practice. Yet it is also true thateffort in meditation perpetuates a conflicted and dualistic experi-ence of self. The desire to transcend experience or to change it inany way is based on the dualistic assumptions (which may, attimes, be implicit) that the self is acceptable only in parts or thatenlightenment exists somewhere else separate from where andwho you are in the present moment.

Even when meditation has moved beyond the counting ofbreaths and the labeling of thoughts, the dialectic continues as themeditator attempts to be present to the flow of moment-to-momentexperience. For those thoughts, feelings, and sensations that areacceptable, the distance or the division between the observer ofexperience and experience itself may diminish until the actualinterdependence and nonseparation of the two become plain. How-ever, for those thoughts and feelings that are not acceptable, anumber of defenses are used to distort or deny the self ’s connectionto (and ownership of) experience. These defenses include the strat-egies of denial, displacement, rationalization, dissociation,projection, and the isolation of affect.

However, what is the antidote to defensive strategies when theyare employed? How is the attachment to the gap between theobserver and the observed undone? I would argue that in psycho-therapy, the antidote to a fragmented self begins with the experi-ence of empathy. When patients are understood and accepted, thiscapacity for cognitive and affective attunement is internalized bythe patient and then directed toward the self, toward thosethoughts and feelings that have been, in one way or the other,avoided or disowned. Writing from a relational therapeutic per-spective, Jordan (1997) suggested that therapist empathy helpspatients adopt an empathic attitude toward their own thoughts


and feelings that then allows for the reintegration of split-off expe-riences. Barrett-Leonard (1997) also saw self-directed empathy asa central component in effective psychotherapy. Barrett-Leonardwrote that

the impact of recognizing and accurately articulating the message ofsignals from a deep, precognitive level of inner being seems to radi-ate through the whole person-organism. At that moment the dualself is one, there is a peak of integration. It is a unity not of structurebut of immediate process of inner connection and communication.(p. 109)

In addition to its integrative functions when it is internalized,therapist empathy also mobilizes the patient’s internal resourcesand faculties for development. Magid (2002) suggested that oneway that therapist empathy affects psychological change is byreconnecting patients to an inner line of development thatpromotes the strength and cohesion of the self. Whereas self-psychologists refer to this as the use of self-objects in the develop-ment of a cohesive self, humanistic psychologists understand thisprocess in terms of an underlying tendency toward self-actualization.

In meditation, I would also argue that the antidote to disownedor fragmented experience begins with self-directed empathy. How-ever, the self-directed empathy in meditation is not internalizedfrom relationships as much as it is born out of the capacity for com-passion in the midst of impossible suffering; that is, when everydefense is seen as a dead-end street and when the meditator recog-nizes the impossibility of disowning, repairing, or even transcend-ing unwanted thoughts and feelings, effort in meditation ends andempathy begins. When the self, with all of its strengths, flaws,damage, and disorganization is understood and accepted, the needto maintain distance from disowned experiences is replaced by thedirect awareness of the ontological reality of interdependence andnonseparation. To state it another way, as awareness deepens inmeditation, it becomes clear that the separation from experience isheld in place by anxiety and fear. In turn, the separation from expe-rience diminishes (and ultimately is relinquished) when the effortto get rid of anxiety and fear is replaced by the compassionateacceptance of the self, just as it is.


MEDITATION AS MATURE DEVELOPMENT

It should be noted that meditation as choiceless awarenessstands in sharp contrast to Freud’s view of religious or transcen-dent experience. Whereas Freud (1930) viewed meditation as aregression to a primitive narcissism brought on by feelings of vul-nerability and helplessness, the nondualistic experience in Zenpractice is seen here as an expression of developmental maturity(Magid, 2002). More specifically, from the Zen perspectivenonseparation occurs in the midst of the self ’s cohesion andstrength and not as a result of the ego’s vulnerability to anxietyand disintegration. Furthermore, the perception that meditationis a regression to an undifferentiated narcissism is not consistentwith the theory and actual practice of meditation in the Buddhisttradition. In Zen, meditation works to increase the capacity to bewith and stay with experience so that affect, even when it isprecognitive and implicit, becomes an increasingly differentiatedexperience. In other words, before the interdependence ornonseparation between the observer and the observed can be expe-rienced, feelings and the thoughts that people have about feelingsare attended to, recognized, and then more accurately representedin awareness. It should be underscored that meditation as self-directed empathy, in that it is a combination of understanding andacceptance, plays an essential role in each aspect of this process.

There has been preliminary empirical support for meditationincreasing the capacity to accurately recognize the emergence ofemotional experience. In a series of investigations generated, inpart, from an ongoing dialogue between Western scientists and theDalai Lama, Goleman (2003) reported initial findings from studiesconducted by Paul Ekman, a researcher on the facial expression ofemotion. In previous studies, Ekman (2001; Matsumoto et al.,2000) found that even when people attempt to conceal their feel-ings, there are still quick and fleeting microexpressions of emo-tions that can be reliably detected in facial expressions. Thesemicroexpressions of emotion occur prior to the conscious control ofthe person having the emotion and happen so quickly that they arefrequently misidentified or not perceived by others. When Ekmanpresented two Western Buddhist monks (both accomplishedmeditators and recent participants in multiple year-long medita-tion retreats) with a video used in his research design, the monks


accurately identified microexpressions of emotion at a level twostandard deviations higher than the score previously rated as themost accurate. Moreover, the monks scored significantly higherthan any other group taking this test, including lawyers, policeofficers, customs agents, psychiatrists, and secret service agents(the group previously identified as the most skilled in this task). Ifmeditation does indeed increase the capacity for empathy, and ifthe recognition of emotional experience is an essential aspect ofself-directed and interpersonal empathy, Ekman’s researchsuggests that meditation practice might be useful in the training ofclinical psychologists.

THE PARADOXICAL EFFECTS OFEMPATHY AND SELF-ACCEPTANCE

It may be somewhat surprising that, paradoxically, the accep-tance or nonseparation from fragmentation and disorder has theeffect of transforming the self, making it resilient, cohesive, andcapable of participating fully in the intersubjective reality of rela-tionships. However, the paradoxical or ironic effects of anxiety areactually quite common to clinical practice. Wachtel (1993) notedthat anxiety—and the behaviors that it generates—frequentlybring about the very thing that a person wishes to avoid. For exam-ple, making an effort to sleep frequently keeps one awake, andrepetitively washing hands to avoid germs often causes infections.Conversely, the relinquishing of anxiety characteristic of self-acceptance and the nonseparation from experience changes therelationship between the self and its problems,conflicts,and fears.

The paradoxical effects of self-directed empathy are also consis-tent with ideas that have been essential to the development of thefamily systems approach to clinical practice. In “The Cyberneticsof ‘Self ’: A Theory of Alcoholism,” one of the first papers to connectsystems theory to clinical issues, Bateson (1972) argued that thefundamental epistemological flaw of Occidental civilization turnson the underlying separation between subject and object; for alco-holics in 12-step programs, Bateson maintained that thisdisjunction is dissolved in a process that I would suggest is similarto the concept of self-directed empathy. When the alcoholicembraces the first two steps of Alcoholics Anonymous (whichrequire the accurate and direct recognition of the condition of alco-


holism and the utter futility of individual effort in bringing aboutan end to this condition), the problematic epistemology of dualismis changed into an experience of interdependence andnonseparation. In other words, in the systems theory of self-regulation, the compassionate acceptance of self, just as it is . . . inthe very condition of alcohol dependence . . . brings about a changein that dependence.

EMPATHY, MEDITATION, AND PSYCHOTHERAPY

Finally, I would argue that empathy and meditation have sev-eral common features, including a remarkable similarity in howthe development of these two processes are described. Althoughempathy in therapy is communicated interpersonally and medita-tion is, for the most part, an intrapersonal process, the develop-ment of empathy seems to run a parallel course to the developmentof Buddhist meditation. Without intending to make a connectionamong empathy, meditation, and psychotherapy, Gendlin (1974)nevertheless provided one. In instructions given to novice thera-pists on how to have empathy in therapy, Gendlin wrote,

These days we introduce listening on a experiential base. We do notfirst give therapists the puzzling instructions to repeat what theirclients say. Rather we convey what it is like to get into yourself, toaccord yourself a friendly hearing, to allow, without rebutting, thecoming up of anything that will be there inwardly. We convey that inrelationship to oneself, one must not immediately argue with whatcomes, or put oneself down for it, or explain it; rather one mustgently allow it to be there, just exactly in what ever way it comes upto be felt. When this attitude is understood, listening is presented ashow one would help people take that attitude toward themselves,within themselves. (p. 220)

As a Buddhist reader would note, Gendlin’s (1974) instructionson empathic listening given to beginning therapists are practicallyidentical to instructions normally given to novice meditators. Inaddition, Gendlin seems to argue that interpersonal empathyemerges from self-directed empathy, which would then suggestthat the capacity for empathy might be enhanced by meditation.Although there have been some data to support this view (Lesh,1970; S. L. Shapiro et al., 1998), so far the research has not beenconsistent (Pearl & Carlozzi, 1994). For psychologists looking to


more accurately identify the causes of successful psychotherapy,and for researchers interested in the transformative effects of Bud-dhist meditation, further investigation of the relationship betweenmeditation and empathy would seem to be warranted.

CONCLUSION

In summary, in this article, meditation and psychotherapy areviewed as enhancing the capacity for self-directed empathy. It isalso suggested that the experience of self-directed empathy isimportant to constructive personality change, and it may contrib-ute significantly to the relationship between therapist empathyand successful psychotherapy. In addition, it is my view that medi-tation is best understood as a resolved dialectic between strivingand self-acceptance where the synthesis of these opposing forcesresults in the integration (or interdependence) of self withdisowned or fragmented experience.

I should also note that unlike Linehan’s (1993) therapeuticapproach, where dialectal tension exists between the need for self-acceptance and the behavioral strategies (including meditation)that promote emotional regulation, the view expressed herefocuses on the tension between change and self-acceptance thatexists within the practice of meditation. Moreover, meditation asself-directed empathy differs from Schwartz and Begley (2002)and Teasdale’s (Segal et al., 2001) integration of mindfulness med-itation with cognitive therapy and from Engler’s (2003) model oftherapeutic personality change. In contrast to the view in the cog-nitive model of mental health that inaccurate thoughts and beliefscause maladaptive affective states and that the correction of theseinaccurate perceptions leads to successful therapeutic outcomes,the view here is that emotions often drive the cognitive process andthat negative thoughts attach to destructive emotions. In a view ofemotion that is consistent with the central role given to affect inhumanistic psychology (Greenberg, 2002), I suggest that the self-directed empathy generated in meditation and psychotherapyinfluences cognition through the integration of affect.

The primacy of affect in mental health concerns also suggests arearranging of Engler’s (2003) schematic of therapeutic change.Whereas Engler argued that therapy and meditation have a cura-


tive effect by first changing cognition (through insight), thenaffect, and then self-knowledge, I argue that the change process inmeditation takes a different course, beginning with affect, thenself-experience, and then cognition. Charlotte Joko Beck, anelderly, austere, and well-respected meditation teacher, refers tothis as the subject-object problem in Zen (Beck & Smith, 1993).Beck suggested that meditation has its most profound affect, notwhen problematic thoughts are recognized and then disengagedfrom (as attention returns to some other object) but rather whenunderlying feelings are experienced without separation or rejec-tion. Indeed, it is a common occurrence in meditation that rumi-nating or repetitive thoughts cease and the mind becomes effort-lessly alert, quiet, and integrated when underlying feelings aredirectly acknowledged, understood, and accepted.

And finally, if research continues to demonstrate that medita-tion enhances the capacity for empathy and that therapist empa-thy is associated with successful psychotherapy, psychologistswould do well to integrate research findings with their clinicaltraining.Noting that there are courses that teach meditation with-out religious affiliation, it would make sense for therapists to con-sider training in mindfulness techniques. Moreover, graduate pro-grams might offer meditation training for doctoral candidates inclinical psychology, perhaps as an elective course of study. In addi-tion to increasing the capacity for empathy, there is a large body ofresearch (Benson, 1975; Benson et al., 1982; Davidson et al., 2003)demonstrating the ability for meditation to reduce stress and tosignificantly improve emotional resiliency. For example, inDavidson’s study (Davidson et al., 2003) an 8-week course in mind-fulness meditation was shown to improve immune system perfor-mance and was associated with important changes in brain func-tioning. The predominance of brain activity in meditators, ascompared to a wait-list control group, changed from areas of thefrontal lobes linked to increased levels of anxiety, anger, anddepression to areas of the frontal lobes associated with relaxation,curiosity, enthusiasm, and higher overall levels of positive affect.For overworked graduate students experiencing the stress thatthe initial study of psychopathology often engenders, the self-directed empathy of meditation practice might improve theefficacy of clinical training while helping students integrate theemergence of disowned or fragmented experience.


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