Riding Two Horses

Anne A. Simpkinson


Anne A. Simpkinson on the increasing numbers of dharma teachers who are also therapists. What happens when your teacher is your shrink?

For the past several decades, Westerners have generated new forms of Buddhism that reflect their own values and social contexts. A meditation hall where the cushions are arranged in an egalitarian circle—a nod to Native American council meetings—has a different feel from a classical Japanese zendo where the seating spells out the pecking order of the monastery. In the West, as many women as men are practicing today; this, and the increasing presence of women teachers, put another new face on Buddhism.

Yet the impact of psychotherapy on Buddhism, arguably the most consequential Western influence, has not been fully appreciated or explored. From Zen's first appearance in the West, mental health professionals have been drawn to Buddhism: Both disciplines offer cures to heal sicknesses that may be as real as a torn limb, but have no physical manifestation. (The Buddha has classically been referred to as the supreme doctor, the medicine Buddha, the healer.) Both disciplines are committed to the alleviation of mental anguish, and both rely on the individual heart and mind as the essential instrument for transformation. Some psychiatrists, like Carl Jung and Karen Horney, helped open the dharma gates for the West. More recently, many Western teachers of Buddhism have been forthcoming about seeing therapists themselves. A growing body of literature compares the Buddha's Eightfold Path and psychotherapy, accompanied by lively debates about where the distinctions lie, if anywhere.

But now a new phenomenon has emerged: dharma teachers who are also therapists, working with students who are also their clients. The increasing numbers of teachers taking on this dual role are bringing a certain urgency to the discussion of boundaries. Is the potential for abuse in the realms of power, sex, and money also doubled? Is the benefit to the student-client doubled?

Less than ten years ago, Asian teachers at best tolerated therapy and at worst denigrated it. Many saw it as a method that was hopelessly locked into the very activity that fettered any hope of liberation: sitting around and telling your personal story—again and again. Trudy Goodman, a meditation teacher, psychotherapist, and co-founder of the Institute for Meditation and Psychotherapy in Cambridge, Massachusetts, recalls being at a conference in the late eighties where one teacher referred to “unfortunate individuals who may need psychotherapy in order to come to dharma practice.” Lama Surya Das, an American-born teacher, remains astonished by a Tibetan lama's remark, twenty years ago, that “It's better to give your $75 to the dharma center and tell your problems to a tree.”

Today, though, even teachers who have come to the West from remote points in India, Tibet, or Sri Lanka may speak of dharma practice and therapy as complementary. The American Zen teacher Robert Aitken Roshi has been open about his own therapy. Decades of practice left him still struggling with relationship issues. “It was clear to me that I was not relating to some students and some students were not relating to me. And their complaints had a certain pattern,” he recalls. “I wanted to get at the inner causes and motivations that were responsible for this kind of conflict.” Aitken Roshi remained in therapy for several years and today sees therapy as a valuable means of enhancing Zen practice.

Jack Kornfield, one of the three Americans most identified with introducing insight (Vipassana) meditation from Southeast Asia to the United States in the early seventies, not only went into therapy when he returned but also earned a degree in psychology. In those days, he once explained, Americans had so little experience with meditation that they held unrealistic expectations of spiritual practice and idealized images of enlightenment. “We thought spiritual highs would take care of everything else in life,” he said. But after practicing for twenty years or more, many people have discovered that they are still angry, still deluded, plagued with self-hatred, and more attached to comfort than ever. The painfully slow acknowledgment of their inability to free themselves from these entanglements might lead to therapy. For many, though, the decision to enter or return to therapy is often fraught with a sense of having “failed” at their practice. And the dual-role phenomenon is pushing the envelope.

The psychotherapy establishment, for example, strongly recommends that mental health professionals not have any relationship with clients outside the therapy room. The National Association of Social Workers specifically states that social workers should not engage in “dual or multiple relationships” with clients or former clients because of the “risk of exploitation or potential harm to the client.” Jack Engler and Daniel Goleman, psychologists who have been engaged in the dialogue between Buddhism and psychotherapy for decades, categorically declare in their 1992 book, The Consumer's Guide to Psychotherapy, that any involvement a therapist has with clients outside therapy “taints what goes on in therapy.” They warn that a dual relationship can make it difficult for a therapist to act in the client's best interest and urge the client to “protect your therapy by not involving your therapist in your life outside therapy, innocuous as it may seem.”

Yet more and more therapists not only see the value in partnering Buddhist meditation and psychotherapy but also view the two as innately connected.

Caroline Alioto is also Lama Palden, a senior dharma student of the late Tibetan master Kalu Rinpoche and founder of the Sukasiddhi Foundation, which is currently establishing a retreat center in northern California. Professionally, she is a licensed marriage counselor and family therapist. She works with some of her meditation students in what she calls “spiritual counseling” to address the psychological issues that crop up as obstacles to a student's spiritual development.

Palden grew up in the sixties in northern California, where she was steeped in a heady countercultural brew of liberal politics, alternative therapies, and spiritual pursuits. As a teenager, she trained in dance with Anna Halprin and practiced meditation. In college she studied comparative mysticism and at twenty-two began a daily practice in earnest. Three years later, in 1977, she met Kalu Rinpoche. In 1982 she started a three-year retreat under him, and in 1986 he and other leaders of the Kagyu tradition formally recognized her as a lama. At that point, not wanting to be dependent on the dharma to make a living, she earned a master's degree in counseling and psychology from Santa Clara University. She went on to study the Diamond Heart approach, a path developed by A. H. Almaas, in which psychological knots are identified as blocking spiritual energy. In this view, psychological work is not just an adjunct to spiritual work, but an essential component of true liberation.

“I feel strongly that spirituality, spiritual practice, and psychological reflection are extremely complementary to each other because I don't think you can actually split the psyche into two,” she says. Her client base mainly consists of people who have already done a lot of therapy and have meditated a long time. For them, her style of therapy, which she describes as “deep psychological-spiritual integration work,” is the next step.

Tara Brach, founder and senior teacher of the Insight Meditation Community of Washington, D.C. (IMCW), is a practicing psychotherapist in Bethesda, Maryland. She, too, believes that the distinction between emotional and spiritual work is an artificial one. She works with some of her meditation students in therapy, and some of her clients attend weekly meditation sessions that she leads in a local Unitarian church. Brach takes a position that many consider to be the cutting edge of a new American Buddhism, namely that emotional healing is, very simply, part of the spiritual path. It's neither the underside of the path nor the shadow side, nor must it come before spiritual work, which was once a widely held belief predicated on differentiating between emotional and spiritual work and elevating spiritual work “over” therapy and emotional work. Although Brach acknowledges potential hazards in the donning of two hats, she says it's worth it. “I've created a mix that can be messy for myself. But I like being more engaged interpersonally, not locked into any one role.”

Unlike Brach and Lama Palden, New York psychiatrist Ken Porter is not a full-fledged teacher, but as a long-time, Vipassana practitioner, he has been experimenting with teaching meditation to some of his clients. If they want to pursue meditation, he gives them information on retreats and local sanghas and sitting groups, including the one in which he sometimes serves as a practice leader. Porter teaches clients to meditate because while he acknowledges many possible healing avenues-the Freudian approach of making the unconscious conscious, self psychology's use of empathy, relational psychology's emphasis on establishing a real relationship between client and therapist-he is convinced that the “deepest healing is a spiritual one.” Meditation brings that element into therapy.

Human beings tend to divide life into polarities, Porter reflects. He cautions that to see psychotherapy and spirituality as one thing is simplistic, yet to keep the two completely separate is equally reductionistic. He invokes the middle path as a guide to setting boundaries. His rule of thumb is to protect the relationship and approach decisions thoughtfully on a case-by-case basis.

Setting boundaries is vital to the therapy establishment, which wants to create a safe house for the psyche, a refuge in which clients can reveal deeply intimate secrets, feelings, and dreams. To that end, therapists are trained to create firm boundaries related to physical and social contact and to be aware of and work with transference, the psychological dynamic in which we project old feelings and experiences onto people in current situations. One result of transference is that clients rarely see the therapist as she or he actually is.

Psychologist Jeffrey Rubin, in his book Psychotherapy and Buddhism: Toward an Integration, stresses that in transferential relationships, clients do not just attribute qualities to the therapist, but attempt to engage the therapist in a familiar but unhealthy, sometimes destructive, dance. Unconsciously, the client tries to induce the therapist into behaving as if he or she is the client's parent. When a therapist gets hooked by such dynamics, neither the client nor the therapist can resist repeating earlier, unsatisfactory experiences.

But transference is not confined to the therapy room. An element of transference plays out in all our relationships. No matter how sophisticated or analyzed we are, we all resurrect emotional patterns in the hopes of coming to peace with old angers, fears, hurts, and humil-iations. The sangha, like any group of people, is subject to unconscious machinations. The teacher-student relationship, with its echoes of the parent-child dynamic, the presence of a charismatic leader, and unchecked assumptions about spiritual authority all create an environment that breeds projection and transference.

Trudy Goodman, now based in Santa Fe, sees transference operating when meditation practitioners “withhold their truth for fear of displeasing the teacher. I've seen this acted out around different teachers.” She likens it to sibling rivalry, where children want to be the favorite. Surya Das, who founded the Dzogchen Foundation in Cambridge, Massachusetts, says he's surprised at how powerful he becomes in the eyes of his students. He points out that individuals can lose their capacity for discernment when they join a sangha or monastery. “Everybody starts to talk the same, to imitate the teacher. It's like taking refuge in the herd instinct. Such behavior disempowers students by eroding their autonomy-they literally give themselves away, thinking or hoping that someone else has all the answers.”

For those who wear two hats, projection provides double-strength “messy” compost with which to fertilize growth. But for the detractors, the intensification affirms the need for separation. Although Aitken Roshi is an enthusiastic advocate of therapy, he adamantly opposes dharma teachers serving as therapists because of the confusion he says it creates. “There's conflict of interest at a very deep level. Nobody really understands what transference is. Even the wisest psychologist, even the wisest Zen teacher, doesn't really understand it because it's different for every student and must not be monkeyed with. I don't think any of us know how to handle transference in those two dimensions. It's like riding two horses at once.”

Goodman does not advocate assuming two roles, either. She argues that it is challenging under any circumstances to remain “mindful of our motivations, to slow down and track the intricate and complex movements of desire and aversion, the currents of conscious and unconscious intention.” When one person is both spiritual teacher and therapist, “it's more difficult to concentrate on what is happening in both realms.” It's incumbent on that person to double up on vigilance with regard to their projections, especially in evaluating a student-client's dependency on them. Goodman says that whenever she's incontrovertibly certain that she's indispensable, she's actually mistrusting and disrespecting both the client's process and the dharma.

“When I begin to feel reluctant about referring somebody for therapy or dharma practice because I'm convinced that no one else could do as good a job as I—because I know them best, or because they trust me so much—it's often a sign that I'm in my countertransference,” referring to times when a therapist gets lost in her own issues.

A therapist may easily imagine that because she's doing good therapy work, she should take on a client as a student. A client might think it simply convenient and comfortable to join the therapist's sangha or attend a retreat led by the therapist. But that ultimately leaves the student-client in a highly vulnerable position. While the therapeutic “safe place” provides the protection of continuity in the face of life's vicissitudes, the dual role invites someone to put all their eggs in one basket. A break with one's therapist or teacher is jarring. A break with a teacher-therapist leaves the student-client simultaneously bereft of two significant support systems. The potential for danger in this situation, Goodman says, is another reason for the client to form a separate relationship with a teacher. “I believe it promotes growth to have two different relationships,” she says, “where there can be some checks and balances.”

The need for checks and balances recently surfaced at Sharpham College for Buddhist Studies, in Devon, England, when the issue of a teacher's serving as therapist hit a flashpoint: It became, in the words of Stephen Batchelor, the school's director of studies, “a defining moment in the year in terms of group process.” In 1997, some students had been in therapy with a lecturer who was also a teacher of meditation. Feedback indicated that the students viewed the experience as valuable. In 1998, however, among the new class of students, several voiced concerns about their “psychological safety.” Students who were not in therapy feared that the therapist-teacher had access to private information about them, gained through their classmates in therapy sessions. They felt that breach “would cloud the whole nature of the group's relation with the teacher,” Batchelor reports.

After consulting three professional therapeutic boards, the college trustees adopted a policy that forbids dual relationships. Batchelor is satisfied with the decision, but he's of the opinion that “you can push this boundary thing to absurdity.” He is puzzled by those who hold that teachers “should not have any other relations with students, not even meeting them at the local pub for drinks—that every relationship has to be hermetically sealed. I feel this is going way too far; yet it's very difficult to know exactly where the line can be drawn.”

In sorting out the pros and cons of a dual relationship, pastoral counselors and spiritual directors in the Christian and Jewish traditions offer instructive parallels. Pastoral counseling consists of therapeutic intervention in a religious framework. Spiritual direction is concerned mainly with strengthening one's relationship with God. Practitioners in both fields struggle not only with the implications of transference but also with the practicality and ethics of separating roles. Sandra Lommasson is director of the Bread of Life Center for Spiritual Formation in Davis, California. Her article “Looking at Dual/Multiple Relationships: Danger or Opportunity,” which appeared in Presence: an International Journal of Spiritual Direction, lists the roles a spiritual director might fill, including retreat leader, teacher, staff to governing boards, and so on—functions not unlike those of a senior teacher in a Buddhist sangha. Lommasson questions the idea that spiritual and/or therapeutic work is best served when “protected in a 'pure relationship' uncontaminated by other types of contact.” Relationships are “messy and not neatly defined,” she observes, and “it is in such messiness that the Spirit incarnates and invites us to make ourselves available to the surprising work of the holy.”

When Phyllis Smolkin, a social worker in Chevy Chase, Maryland, wanted therapeutic help to deal with issues related to her failing father, she decided to see Brach, whom she knew through the Vipassana meditation center, precisely because Brach blends spirituality and psychotherapy. Smolkin says she appreciates the way Brach often includes psychological concepts or perspectives in her dharma talks and the way her therapy sessions take meditative practice into account. Other student-clients mentioned this same benefit: that the therapist/teacher—by incorporating practice concerns into therapy—deepens, expands, and clarifies their spiritual path.

But how does the student-client reimburse the teacher-therapist? Typically, dharma teachers do not charge for teachings, sits, or retreats though they accept dana offerings, and if a facility has been established students are usually asked to pay monthly dues according to their circumstances. Therapists, on the other hand, routinely charge. So what happens when a meditation teacher begins to see a student for therapy sessions?

If one of Lama Palden's meditation students wants to have a spiritual consultation or check with her about practice, she sees him or her on a dana basis. Students who come to her for therapy, however, pay a fee set according to a sliding scale.

Brach meets with students who have practice concerns before and after her weekly meditation class, on the phone, or at retreats. While a dana offering can be made for the class and retreats, frequently students pay nothing at all. But with therapy, she says, it's a different terrain. There's a weekly commitment of a specific amount of time and she charges her regular fee.

Ken McLeod, a meditation teacher in the Tibetan tradition who, like Lama Palden, trained with Kalu Rinpoche, says that it's a misconception that students normally don't pay for teachings. He points out that, traditionally, a spiritual seeker would pay handsomely for an initiation because payment was viewed as an expression of how much he or she valued the teachings. The Black Hat ceremony [of the Tibetan Kagyu sect], for example, requires a set fee—whether in rupees, bags of rice, or cash. Once the payment is made, however, anyone who happens to be in the vicinity can take part in the ceremony. That reflects Asian tradition, in which royal patrons or the community support monks.

McLeod also points out that in Tibetan Buddhism there are three ways to repay a teacher for spiritual guidance: material offerings, service, and spiritual practice. If a person comes and is sincere, a teacher will work with him or her regardless of money. But the teacher's expectations of the student are high and demanding. According to McLeod, when teaching is free, too often people just hang around a meditation center absorbing energy, not really doing spiritual work.

For that very reason, about half the spiritual directors in the United States and Canada charge for their services: They're acutely aware that in our society people don't value what is given away for free. Pastoral counselors—clergy certified by the American Association of Pastoral Counselors (AAPC) and trained in theology and psychotherapy—work for salary or fee. On staff at institutions or in private practice, they deal with problems stemming from life crises in a religious context. And, as Barbara Gyomory, AAPC's director of meetings and publications, says, “Yes, they charge; it's their livelihood.”

It's clear that meditation and psychotherapy have much to offer each other. It's equally clear that the question of whether to blend roles may be moot insofar as a movement in that direction is already under way. So in the end, how is one to decide whether to become involved in a dual relationship—and how does one guard against the potential dangers it might pose? Therapists say that the burden is on them: They must take responsibility for not abusing or exploiting their client-students. They recognize that they hold the balance of power and should exercise it with compassion and professional integrity.

But practitioners cannot close their eyes and leave their teacher-therapist to guard the boundaries and define the parameters of propriety. For such a relationship to work, students must keep their antennae poised for any experiences in which they don't feel safe or clear. They need to be able to express their doubts and misgivings. While relying on the teacher-therapist for spiritual and therapeutic direction, the student-client must be fearless and impeccable in regard to handling the relationship. This is a continuous challenge. Surya Das, speaking for the teacher's responsibility, says, “The most important variable is the person who is wearing the two hats. It's not about having two or three hats; it's about the head they are on.” The practitioner has to be the final judge of whether that head is on straight.

Anne A. Simpkinson edited Common Boundary, a magazine that explored the relationship of psychotherapy, spirituality, and creativity for fourteen years. She also co-edited two anthologies, Sacred Stories and Nourishing the Soul (HarperSanFrancisco, 1993 and 1995), and co-authored Soul Work: A Field Guide for Spiritual Seekers (HarperPerennial, 1998). Currently she is senior producer of the spirituality section of beliefnet.com, a website that covers religion, spirituality, and morality/ethics.

Illustration by Thomas Libetti

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