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BUDDHISM AS A MENTAL THERAPY By DR. ENG-KONG TAN MBBS MPM FRANZCP Presented at YBAM 35th Anniversary Seminar, August 2005 and published in “Eastern Horizon” Jan 2006, Issue no.18 & 19, Part I & II SYNOPSIS In the last two decades there has been a renewed interest in bringing together Buddhism, a 2500 year old Eastern Tradition, with the century old Western Psychotherapies. This paper will first give a brief historical overview of literature published, comparing Buddhism and Therapy since the 1960’s. Buddhism has come to the west mainly through interests in the practice of meditation. The physical, psychological and spiritual benefits of meditation are well documented today. With the advent of recent brain research using new technologies, including the fMRI, there is now clear evidence that changes occur in the brain during meditation. This has also come at a time when leading researches are now able to postulate the development and growth of our minds as well as an emerging neuroscientific basis of psychotherapies. There have been many Buddhist Influenced Therapies through the years. Most recently the Mindfulness Based Therapies, pioneered by Professor Jon Kabat-Zinn (1) is now spreading far and wide, both geographically around the world as well as in usage in many physical and psychological conditions. Finally, the author will point out some similarities and differences between the two traditions. The paper will conclude with what might constitute a postgraduate course in Buddhism and Psychotherapy for the future. 2 BRIEF HISTORICAL OVERVIEW In the late 1950’s, a conference was held on Zen Buddhism and Psychoanalysis under the auspices of the Autonomous Medical School of Mexico. The conference was attended by about fifty psychiatrists and psychologists from both Mexico and the United States. There were many papers presented and in 1986 Erich Fromm (2) published his book entitled, “Psychoanalysis and Zen Buddhism”. It consisted mainly of his thoughts following extensive discussions during the conference with Zen Master D.T. Suzuki. In the last chapter he drew out the similarities in the psychoanalytic journey of “de-repression” and the Buddhist spiritual quest for enlightenment. Similarly, Alan Watts (3) in his often quoted book on “Psychotherapy East and West” highlighted the common ground between Western Psychiatry and Eastern Philosophies. He concluded that in varying ways and degrees both Eastern Philosophies, particular Buddhism, and Western Psychotherapy engage the individual in experiments that vividly reveal the fallacy of an isolated ego and instead these two traditions can give man a healthier sense of identity. In 1988 Daniel Goleman’s (4) “The Meditative Mind” provided westerners a comprehensive text covering the art and science of meditation from the world’s great religions. In the second half of the book he wrote mainly on Buddhist meditations, including mention of the Abhidhamma as an Eastern Psychology. Since 1990, with the publication of Professor Jon Kabat-Zinn’s Mindfulness Based Stress Reduction hospital program, in his book captivatingly entitled “Full Catastrophe Living”, there has been a resurgence of interest in using Buddhist mindfulness meditations in a variety of medical conditions, including panic attacks, anxiety, depression, and chronic pain. Mindfulness Based Practices are now taught to 2 3 medical students early in their career to help them in their stressful occupation as well as to initiate them on the usefulness of meditation for their patients. Mindfulness meditation is now firmly ensconced as an evidence based scientific technique which can be applied to an increasing array of physical and psychological illnesses. In 1992 Jack Kornfield (5) published ”The Path with Heart”, This is a guide book showing in detail with great humour and insight the way to practice Buddhist universal teachings for westerners. Kornfield partly dedicated the book to his Buddhist teachers from Tibet, Thailand, India and Burma. In 1996 New York psychoanalyst and psychotherapist Jeffrey B. Rubin (6) published his book, simply entitled “Psychotherapy and Buddhism-Towards an Integration”. He concludes that Psychoanalysis and Buddhism can be integrated so that their unique strengths and emancipatory potential can be realised. Since 1997, the Dalai Lama has met regularly with select groups of scientists to discuss bridges and interfaces between biology, cognitive science, neuroscience, psychology and philosophy – the disciplines of most immediate relevance to the Buddhist tradition. In its third “Mind and Life Series”, the question was raised as to how our mind could heal our body. The record of this conference between Buddhist teachers and western scholars was published as a book called “Healing Emotions”, edited by Daniel Goleman (7). Most recently, following the tragedy of September 11, 2001, the Mind and Life Institute produced its latest book published in 2003 entitled “Destructive Emotions – and how we can overcome them” (8) . This book attempts to answer why seemingly rational, intelligent people commit acts of cruelty and violence and what could be the root causes of destructive behaviour. Most recently, in May 2005 Christopher Germer (9) and colleagues wrote and edited a practical book 3 4 providing a comprehensive understanding of mindfulness and its contemporary clinical applications. This book is now an essential source for anyone interested in meditation and other scientifically grounded approaches to augmenting psychotherapy. FROM MEDITATION TO BUDDHISM Buddhism has come to the west via meditation. In 1975 Herbert Benson (10) wrote, “The Relaxation Response” in which he reported on the physiological and psychological changes in various forms of meditation. He listed reduced heart rate, respiratory rate, blood pressure and oxygen consumption. Serum lactic acid (which is harmful to brain cells) levels also decreases and there is a general calming of the sympathetic nervous system. Significantly skin resistance increases, the alpha and theta waves of the EEG are increased and that reflect a generalised calmer state of the brain. There is also increased synchronicity in EEG. We now know that this “relaxation response” during meditation is the neurobiological and physical basis to the therapeutic actions of meditation. The regular meditator has increased self knowledge, sense of responsibility and concentrative powers. The Buddhist meditative techniques increases trust, ethical conduct, a sense of generosity, compassion and loving capacities in the practitioner. In particular, meditation increases our self control, it gives us access to our underlying feelings and imageries in our mind. Through meditation we can integrate and accept our past and we can also confront issues of time, meet with changes and deal with loss and death. Meditation also helps our body/mind integration and is particularly useful for psychosomatic conditions. 4 5 In terms of the psychological processes in meditation, there is an increasingly enhancing circular activity occurring from mindfulness to increased self functioning to the development of a stronger sense of self which helps affect modulation. This then contributes to greater self organisation which produces further insights into self knowledge which in turn increases our emphatic attunement. This attunement then increases our access to our unconscious material in our mind which can then again be processed mindfully during meditation. BUDDHIST INFLUENCED THEAPIES There are three main treatment programs that teach mindfulness to the patients. Mindfulness Based Stress Reduction (MBSR) was started by Professor Jon KabatZinn for treating chronically ill patients at a university hospital. MBSR is in a group format, typically eight weekly, two and a half hour sessions. Homework includes forty five minutes of meditation per day, six days per week. The main practice is sitting meditation and mindful yoga. The program also includes a body scan meditation during which patients lie down and observe sensations throughout the body. Mindfulness in everyday life including walking, standing and eating. So far, an initial twelve thousand patients have been studied over two years. During the program, the physical and psychological symptoms are reduced by approximately 40%. During a four year follow up the improvements were maintained and 93% of the patients were still following part of the program. These impressive results have encouraged other clinicians to include mindfulness training in their therapeutic armamentarium. Mindfulness Based Cognitive Therapy (MBCT) was developed to prevent relapse of chronic depression by (11 Segal) and associates. It is a manualised treatment that 5 6 teaches mindfulness practices of MBSR, without the yoga. The Three-Minute Breathing Space is taught as a core skill. The mindfulness aspect in MBCT is learning to see that “thoughts are not facts” and that we can let them come and go, rather than trying to argue them out of existence, as we might do in traditional Cognitive Behavioural Therapy (CBT). Dialectical Behaviour Therapy (DBT) was conceived by Marsha Linehan (12) to help patients with Borderline Personality Disorder who have difficulty regulating emotions. Mindfulness skills in DBT are considered core skills, they are taught over two or three group sessions and they are derived from the Zen tradition and the practices of Thich Nhat Hanh (13) (1976). They include counting the breath, adopting a serene, half smile, focusing awareness on present activity, labelling feelings, letting thoughts slip in and out, practicing non judgement, doing one thing at a time, practicing radical acceptance of feelings, and imagining that the mind is like a big sky, when thoughts and feelings pass by like clouds. The focus of DBT is on helping patients improve their interpersonal relationships. Hakomi is a body-centred psychotherapy formulated by Ron Kurtz (14) . Its basic method is to create a relationship which allows the patient to establish mindfulness, evoke experiences in that mindful state, and process the experiences evoked. So firstly the therapist creates a safe, healing relationship in order to enable mindfulness. The therapist and patient uses mindfulness to enhance sensitivity. This sensitivity is needed in order to go deep, to evoke experiences experiencing core emotional attitudes and beliefs. In processing, the therapist uses the experiences evoked to help the client to understand and change. Core material is not accessible through the intellect but through mindfulness and education. Hence Hakomi works in mindfulness states of consciousness. 6 7 Thomas Morita is the founder of Morita Therapy, a treatment used in Japan that borrows heavily from Zen. According to Morita, patients’ problems resulted from their being captives of their own “subjectivity” and egocentricity. The cure drew on Zen and encouraged acceptance of things as they are. Core Process Orientated Psychotherapy was founded by Maura Sills (15) . Core Process training is very much founded on the transformative nature of awareness. The Buddhist psychotherapist is engaged with and is available to the patient. It includes fundamental Buddhist principles of interdependency and the three factors of existence, ie, unsatisfactoriness of life, impermanence and the illusory nature of self. The Core Process Buddhist psychotherapist directly offers to co-journey with the patient through their psychological, developmental and spiritual experience. The therapist’s compassion is emphasised as the most needed quality for this kind of work. This form of psychotherapy is based on the transformative power of the therapeutic relationship. Each therapeutic session is a practice, in the sense of a Buddhist practice, in the relationship between client and therapist. FOUNDATIONS OF BUDDHIST MEDITATION It is far too easy for the Western Psychotherapist to forget about the origins and context of mindfulness in Buddhism. There is an inherent danger of using mindfulness just as a technique without at least some understanding of its deep philosophical, psychological and spiritual underpinnings in Buddhism. The Western Psychotherapist needs to know that Right Mindfulness is embedded in the Eight Fold Path towards Nibanna. The Maha Satipattana Sutta elucidates the Four Foundations of Mindfulness. These are the four stages of realisation, or four types of path consciousness. Each path consciousness eradicates some mental defilement’s 7 8 completely so that after reaching the fourth path of consciousness, all of them are altogether eradicated for the realisation of Nibanna. First there is mindful contemplation of the body in the body. When a Buddhist practitioner contemplates or keeps himself mindful of the body in the body he is “ardently clearly comprehending and mindful”. “Ardently” means energetic, putting forth effort. It is not an easy thing to keep our mind on the object. “Clearly comprehending and mindful” when applied to the body includes mindfulness of breath, body postures, body functions and the material elements of the body. Mindfulness is something like a stone hitting a wall. Venerable U Silananda (16) uses this metaphor to illustrate how, in order to throw a stone, we must put out energy. Like the stone hitting the wet mud wall, mindfulness hits the object of contemplation. When we have such mindfulness, combined with energy or effort, our minds stay with the object for some time. Not unlike the stone, after hitting the wall, when it is a wet mud wall, stays with the wall. That staying with the mind with the object is what we call concentration. So when we have mindfulness, we achieve concentration. When this concentration is highly developed we will also have wisdom and the understanding of the nature of things. We have clear comprehension of things. We will begin to see that mind and body are impermanent, unsatisfactory and insubstantial. The second area of contemplation involves feelings – pleasant, painful and neutral. The third area of contemplation is on our thoughts which includes the gradual eradication of thoughts of greed, hatred and delusions. Finally we contemplate mindfully on the “dhammas”, loosely translated as mental formations. These include the Five Hindrances, the Five Aggregates of clinging, the six Internal and six External Sense-bases, the Seven Factors of Enlightenment, and the Four Noble 8 9 Truths. The first of the Seven Factors of Enlightenment is again mindfulness. When we practice mindfulness meditation we remember to note objects that come to us at the present moment. Mindfulness manifests to meditators as guarding, something like a guard preventing meditators from falling into heedlessness. When mindfulness arises in meditators, they know that there is mindfulness in them. This means we have mindfulness and take note of it, saying to ourselves, “mindful, mindful, mindful”. The cause for the arising of this mindfulness is. Wise reflections means reflecting that, “I will be mindful, I will gain wise reflection knowledge, I will experience joy”. There are also three factors that lead to the arising and cultivating of mindfulness. 1. Mindfulness with a clear comprehension: We must try to be mindful of whatever we are doing, our postures, our going back and forth, etc 2. Avoiding people with confused minds. 3. Associating with people who have mindfulness and above all inclination toward mindfulness. This means that in all postures, whatever we are doing, we should try to be mindful. When the patient is introduced to mindfulness and mindful practices in meditation, he has an opportunity to enquire further. This will lead him to want to understand mindfulness in its entirety, including its central place in the Buddhist path. It is therefore not surprising that many westerners who are first drawn to meditation have opportunities to subsequently appreciate the Buddhist way of life and the Noble Eight Fold Path. Significantly, there is no need for the westerner to change or drop their previous religious beliefs as Buddhism can be absorbed alongside whatever existing cultural and spiritual beliefs are held. 9 10 MINDFULNESS IN THERAPY So how is mindfulness defined, how is it used and how does it affect some western psychotherapies? One of the best definitions of therapeutic mindfulness comes from Jon Kabat-Zinn. He defines it as “the awareness that emerges through paying attention on purpose, in the present moment and non-judgementally to the unfolding of experience moment by moment”. You can see embodied in this definition the central concept of impermanence. The patient comes to realise that whatever pain or pleasure he suffers arises and passes. The patient begins to change his relationship to his pain. Pain is unavoidable in life but the degree to which it causes us suffering can be adjusted considerably. In Vipassana meditation when we meditate on the pain, when we mindfully immerse ourself and merge with the pain, we find to our pleasant surprise that the pain dissolves and disappears, at least for awhile. We also gain some degree of mastery over the pain. Of course for mindfulness to exist we first have to have a calm mind. Many patients first require relaxation techniques and some even self hypnotic techniques to first quieten the mind. During mindfulness the patient experiences his ability to track what is happening in his mind. This requires that the patient tolerates not knowing from moment to moment. The patient learns how to surrender to the moment and he lets go his previous incessant need to control everything, as if the way to reduce anxiety is to be in control. He learns paradoxically that to let go control one experiences more peace. He learns to honour what unfolds in his mind. In the psychotherapy journey, during moments of mindfulness, the patient simply allows the material in his unconscious to surface through the repression barrier into consciousness. The therapist and patient can then process the material to resolve whatever emotional deficits and conflicts arising. Hence, when mindfulness is introduced into therapy 10 11 the patient is able to use that time and space created in the mind for reflecting, reviewing and renegotiating past patterns. Also mindfulness produces insights. In Vipassana, the insights are the Three Characteristics of Existence: suffering (dukkha), impermanence, (anicca) and the illusory nature of self (anatta). In psychotherapy the insights are in the area of making sense of the symptoms and their underlying causes. During mindful periods both the therapist and the patient also begins to experience with great patience, the arising of compassion which leads to self acceptance and which in turn nurtures the patient. During mindfulness, initially the loving presence of the therapist is a healing force for the patient. Further along in the therapy journey, the patient begins to be able to use his own loving presence as a healing force for himself. British psychoanalyst, Donald Winnicott (17) theorises in terms of the infant or the child initially needing his mother. Gradually the child develops his capacity to be alone by having internalised the presence of the mother in his mind. This is in fact how the mind of the child develops and grows. Symptoms arise when the mind is stunted in its development. Hence the mental state of emotional caretakers are of paramount importance for the crucial development and growth of children’s minds. In the consultation room, it goes without saying, that the mental health of the therapist is an extremely important factor contributing to the outcome of therapy for the patient. The question has often been asked as to what accounts for successful therapy. There has been considerable research in this area. It has been consistently found that the patient’s factors are the more decisive. In particular, the patient’s strength of social supports and his level of motivation accounts for approximately 40% of treatment outcome! The therapeutic relationship in itself contributes 30% to the therapy outcome. Interestingly, the therapist’s methods and techniques only account for 11 12 about 15% and the remaining 15% is attributable to placebo factors, including the expectancy of change. In terms of the therapeutic relationship, the therapist’s state of mind during the sessions is of vital importance. Therapists who meditate regularly and are able to access mindfulness readily should be able to do better. A Buddhist practicing therapist can use mindfulness meditation to increase his general sense of wellbeing. He could perceive his office as a meditation room. He is aware of meditative moments in the session which in themselves are therapeutic. Also when the therapist is experiencing especially intense counter transference feelings, he needs to be quite mindful of these feelings and to sort out for himself which are due to his own issues versus those triggered off by the patient. The therapist can use mindfulness meditation to compassionately increase his self acceptance and to be empathically attuned to his own state at any one moment whilst at work with the patient. SIMILARITIES AND DIFFERENCES There are many similarities between healing aspects of Buddhism and therapeutic actions of psychotherapy. The fundamental Four Noble Truths of the Buddha could be parallelled with the treatment strategy of psychotherapies. The First Noble Truth of suffering is exemplified by the patient and his identified symptoms. The Second Truth of the origins of suffering is the therapist’s task to work out with the patient, the causes, including underlying deep seated causes of his suffering. The Third Noble Truth of the cessation of suffering is often represented by the hope the patient has which brings him into therapy whilst at another level the patient could be dreading therapy. Also the therapist has to have hope even when the patient might be going through a stage of helplessness and hopelessness in the turbulent face of therapy. 12 13 Buddhism, properly understood is a very positive and hopeful religion. Experienced therapists often know that it is their faith in the work they do that often gives them hope to continue helping their patients even when their patients are feeling hopeless about themselves. The Fourth Noble Truth which is the pathway out of suffering by following the Eight Fold Path is the healing prescription from the Buddha. For the psychotherapist it is the treatment methods and plans, often worked out in collaboration with the patient. However, it is equally important that we are clear about the differences and divergences between the two traditions. Although both may be fruits, one is an apple and the other an orange and apples and oranges are not the same. There are real differences in the therapeutic processes and final outcome for the individual taking the journey on each of these traditions. A Buddhist seriously practicing his meditations, knowing that is his only way to Nibanna, to the end of suffering, experiences increasingly refined awareness through his regular meditations. He is actually re-training his consciousness and his whole being is being re-conditioned. In psychotherapy we are merely attempting to replace thoughts, feelings and actions with healthier alternatives. It is true that it is a kind of re-conditioning of the mind which we hope results in better behaviours, including improving interpersonal relationships. Psychotherapy becomes an end when we are, in a sense, able to rewrite our personal narrative. It is true to say that when we can make meaning of our beginnings in our childhood and are able to tell our life story calmly and coherently, chances are we have attended to our developmental deficits and resolved our underlying conflicts. 13 14 There are also sharp divergences between the two traditions. The Buddhist meditative path is a solitary experience. selflessness. It is slow, painstakingly hard work towards The psychotherapy journey emphasises relatedness in analytically orientated psychotherapies. It is the transference, countertransference relationship between patient and therapist that is observed and worked through. Most patients come for therapy because they have a poorly developed or fragile sense of self. The psychotherapy experience helps them develop a stronger, cohesive sense of self. This sense of self is assumed to be present by Buddhist Meditation Masters when they take their disciples on the meditative journey. It is not surprising therefore, that without proper screening of applicants sometimes some individuals disintegrate into frightening psychotic experiences when the meditative process itself disinhibits the fragile sense of self which then decompensates. TWO TRADITIONS WORKING TOGETHER Much has been observed and written about a therapist’s counter transference towards his patients and how to manage them. There is the Vinaya Pitaka, the Division of Rules for Monks and Nuns, teachings recorded by the 500 arahants who participated in the first Buddhist Council three months after the death of the Buddha. Reciting in unison, these teachings for Sangha were handed down from generation to generation by word of mouth until about 500 years after the death of the Buddha when they were written down for the first time on palm leaves in Sri Lanka. The world has obviously changed since the time of the Buddha. Perhaps members of the Sangha might find it useful in their discussions with psychotherapists to explore the possible complications and dangers in the relationship between therapists and patients 14 15 which in many ways are not dissimilar to meditation especially teachers and their devotees. Western psychotherapy is only just beginning in the last 50 years, to tap into the rich philosophy, psychology and healing aspects of Buddhism. Provided matters progress as smoothly as they have been, partly because of the non-expansionist views of Buddhists, slowly but gradually western psychotherapy might make further use of Buddhist concepts and practices to help their patients. For instance Metta, or loving kindness meditation is now already being practiced in mindfulness based therapy. We would not be surprised that western psychotherapists, as they become more and more comfortable to acknoledge the Buddhist origins of these useful therapeutic/healing practices may progress on to teach mindfulness meditation in the remaining three sublime states of Karuna (compassion), Mudita, (sympathetic joy) and Upekha, (equanimity). Indeed, there is so much more to compare and contrast between western psychology and the Abhidhamma and for each tradition to benefit from the other. A BUDDHISM AND PSYCHOTHERAPY COURSE It is interesting to speculate what a future postgraduate university course in Buddhism and psychotherapy might constitute. Perhaps it could begin with an understanding of who comes to therapy and who comes to Buddhism. There is a different and overlapping population here. The latest psychological theories of the human mind which also contributing to more recent analytically oriented psychotherapy models need to be understood and compared with the Buddhist view of the structure of the mind and mental processes. from the Abhidhamma Pitaka, the Division of the Higher Teachings from the Buddha. Analytical and philosophical issues in western psychotherapy is an expanding fields of study currently .There is 15 16 much to gain in having active dialogue with members of the Sangha on the Buddhist morals and ethical systems. While western psychotherapy helps the development of the self, the Buddhist practice takes us beyond that on the spiritual path. Eng-Kong Tan(18) , in a keynote address entitled “Psychodynamic Psychotherapy for the New Millennium” builds up a case and strongly suggests that the next analytically based model or theory could be a paradigmatic shift to include a a spiritual basis for our materially improved but increasingly lonely society. Jacques Lacan, a famous French analyst stated that psychoanalysis can bring man to understand “Thou art that” whereas the real journey begins with Buddhist meditations to see the ultimate liberation. It will be useful to compare what works in therapy and what heals in Buddhist practices. Further research from within the field of neuroscience will provide new information on the scientific bases of meditation and this could help us appreciate and use the particular Buddhist meditation most effective in the alleviation of physical and psychological illnesses today. This in turn will lead the patient to further explore, understand and practice the Middle Path, The Buddhist Way of life, without sacrificing his own cultural and belief systems. FUTURE DEVELOPMENTS There is much for Buddhist psychotherapists to look forward to as research and discourse continues in and between the two traditions. Scientifically what we now know about the brain is still preliminary. Clinicians are aware that we still need many more methods and techniques to help increase therapeutic outcome. Doctors, psychiatrists and psychotherapists are aware that we can rarely cure, sometimes we can alleviate a lot of symptoms but always we can comfort the patient. We still have many more questions and answers in using mindfulness and other aspects of Buddhism for our patients. We need to determine and further discover which aspects 16 17 of Buddhism works in the consultation room and for whom. We need to research the impact of a meditative therapist’s therapy outcome. To have psychological techniques at our disposal drawn from a 2500 year old tradition, which appears to change the brain, shape our behaviour for the better, and offer intuitive insights about how to live life more fully, is an opportunity psychotherapists should boldly seize and fully utilise. Jeffrey Rubin recommends working towards a “contemplative psychoanalysis” or more simply a meditative psychotherapy. He suggests that such a meditative psychotherapy of the future might explore both what psychotherapy can ex contribute to Buddhism and other spiritual traditions and what Buddhism might teach psychotherapy. A therapy that sensibly draws from the spiritual practices of mindfulness and through understanding of non attachment due to impermanence and a non narcissistic relationship to our own thoughts, beliefs and lives from a true appreciation of the illusion of self combined with psychotherapy methods of investigating self experience and interpersonal relatedness may prove to be the best therapy ever!. The major contributions from Buddhism to psychotherapy lies simply in the fact that when we are less clinging to an overly self centred sense of self, we feel released from the constraining grips of a self alienating egoism and we begin to experience a greater capacity for empathy and tolerance. and a heightened sense of connection with compassion for others. This spiritual and self/forgetful state, this non narcissistic/spiritual state occurs naturally when one is deeply emersed in nature, creating harmony or intense moments of intimacy. These are experiences with heightened senses of living. There is a growing and disturbing sense of alienation in our society. Buddhism fosters a sense of connection with and tolerance for the other and may prove to be a crucial aspect of our collective mental health, as long as it is also open to the methods, techniques and questions posed by psychotherapy. A 17 18 psychotherapy that is not only about developing a strong and healthy sense of self but is also informed by health promoting perspectives of Buddhism might contribute to a more centred and peaceful life. Book References: 1. Kabat-Zinn, Jon (1990) Full Catastophe Living. Delta Books, New York. 2. Fromm, Erich (1986) Psychoanalysis and Zen Buddhism. Unwin Paperbacks. 3. Watts, Alan (1961) Psychotherapy East and West. Vintage Books, New York. 4. Goleman, Daniel (1988) The Meditative Mind. Crucible Press, England. 5. Kornfield, Jack (1994) A Path with Heart. Rider Books, London. 6. Rubin, Jeffrey B. (1996) Psychotherapy and Buddhism. Plenum Press. N.Y. 7. Goleman, Daniel (1997) Healing Emotions. Shambhala. London. 8. Goleman, Daniel (2003) Destructive Emotions – and how we can overcome them. Bloomsbury, Great Britain. 9. Germer, Christopher K. et al (2005) Guildford Press. N.Y. London 10. Benson, Herbet (1975) Relaxation Response. 11. Segal, Z.V., Williams, Z.M.G. & Teasdale, J.D. (2002) Mindfulness-Based Cognitive Therapy for Depression: A new approach to preventing relapse. New York. Guildford Press. 12. Linehan, M. (1993) Cognitive-behavioural threatment of borderline personality disorder. N.Y. Guildford Press. 13. Hanh, T.N. (1976) The Miracle of Mindfulness. Boston. Beacon Press. 14. Kurtz, Ron (1990) Body-Centred Psychotherapy - The Hakomi Method. Life Rhythm. California. 15. Sills, Maura (1999) “Licking Honey from the Razor’s Edge” in “The Psychology of Awakening” edited by Watson G. Batchelor and Clexton G. Rider. London. Mindfulness and Psychotherapy. 18 19 16. Silananda, U. Venerable (2002) The Four Foundations of Mindfulness. Wisdom Publications. Boston. 17. Winnicott, Donald (1964) The Child, The Family and The Outside World. Penguin Books. England. 18. Tan, Eng-Kong (2001)“Psychodynamic Psychotherapy for the New Millennium”, Malaysian Journal of Psychiatry, March 2001, Vol.9,No.1,pp 1-4 Recommended Websites: 1. 2. 3. 4. 5. Mindfulness-based stress reduction: www.umassmed.edu/cfm Dialectical behavior therapy: www.behavioraltech.com Mindfulness teacher talks: www.dharmaseed.org Journal for mindfulness practitioners: www.inquiringmind.com Buddhism and science: www.mindandlife.org 19