REFLECTIONS

Transpersonal Psychotherapy

SEYMOUR BOORSTEIN, M.D.*

The history, theory, and practice of Transpersonal (or Spiritual) Psychotherapy

are presented. The author describes his own evolution from a traditional
psychoanalyst to a psychotherapist who uses the tools and wisdom from
spiritual traditions to enhance traditional psychotherapy while, at the same
time, improving the self system of the therapist. Dangers as well as benefits of
the spiritual approach are outlined.
The creation and holding of a spiritual or transpersonal context is described
and ways to ascertain, in the clinical situation, the appropriateness of such an
approach are explained.
The use of bibliotherapy to help transform and expand the worldview of
the patient is outlined. Prayer and meditational systems also have a healing
role in this approach. To illustrate the uses of Transpersonal Psychotherapy in
practice, four cases are presented: 1) a paranoid schizophrenic man, 2) a
well-functioning borderline person, 3) a very poorly functioning borderline
person, and 4) a high-functioning neurotic man who had been in psychoanaly-
sis.

In this paper, I will start by providing a general overview of what the

transpersonal or spiritual focuses on, and then I will explain how I have
tried to use the transpersonal in clinical ways to help my patients. (The
terms transpersonal and spiritual are used interchangeably.)
To say something significant about psychotherapy in general in a paper
of this length is almost impossible, and to focus on transpersonal psycho-
therapy is even more challenging. Just as there is no meeting of minds as to
what psychotherapy is, I believe there is even less agreement about what
Transpersonal Psychotherapy is in its specifics. (A selection of the abun-

*Associate Clinical Professor of Psychiatry, University of California School of Medicine. Mailing

address. 45 Laurel Grove, Kentfield, C A 94904.
A M E R I C A N JOURNAL OF PSYCHOTHERAPY, Vol. 54, No. 3, Summer 2000

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dant variety of spiritual approaches can be found in my book, Transpersonal

Psychotherapy [1].)

OVERVIEW

In 1992, in an article in the Journal of Transpersonal Psychotherapy, Lajoie

and Shapiro (2) reported on their survey of more than 200 definitions of
transpersonal psychology and concluded that the field is "concerned with
the study of humanity's highest potential, and with the recognition, under-
standing, and realization of intuitive, spiritual, and transcendent states of
consciousness" (p. 91).
Some aspects of a spiritual approach to the healing of emotional
problems have been practiced for thousands of years by shamans and
medicine men. Aside from Jung's work in this area earlier in the twentieth
century, I would date the more "modern" struggles with the transpersonal
to the past thirty to thirty-five years.
It was in the 1960s that research with LSD and other psychedelics
suggested that there were alternate states of consciousness or realities
available to be experienced. Also around that time, many young Americans
went to Asia and brought back to the western world meditative and
spiritual systems they had encountered and practiced there.
It was an era of great experimentation and exploration into altered mind
states and alternate belief systems of what reality is. Throughout the past
three decades or so, there has been an increase in vigorous theorizing,
thinking, and practicing in transpersonal studies, resulting in what to me is
the emergence of the field of transpersonal psychotherapy in its own right. I
want to emphasize however that, because of the difficulties of dealing with
areas of knowledge and experience beyond the usual boundaries of body-
ego and beyond the limitations of space and time, the field is still in its
infancy. To speak of extending ones sense of identity beyond [trans] the
individual [personal) to encompass wider aspects of humanity, thinking,
and the cosmos, is difficult for most people. This is especially true of
therapists who were taught using hard sciences as their model for the
understanding and approach to life's problems.
I believe that a special tribute to Ken Wilber is called for because of his
efforts over the past twenty-three years to clarify the many complexities in
the areas of consciousness, transcendent states, psychology, meditation,
and other spiritual systems.
Historically, the main theoretical approach to transpersonal knowledge
has been based on the Perennial Philosophy model of Aldous Huxley in
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which one believes in and can experience the nonseparateness and intercon-
nectedness (one-ness) of all things.
More recent writers, such as Jorge N. Ferrer, feel that the over-emphasis
on the personal-experience approach to the transpersonal can lead to
spiritual narcissism. I believe that the use of spiritual knowledge for
self-inflation feeds narcissism, and under narcissism's influence, spiritual
leaders, even some who are considered advanced practitioners of respected
spiritual systems, may take advantage of their followers (sexually or finan-
cially). With spiritual narcissism comes the nonintegration of the transper-
sonal into everyday life. "It cannot be repeated too often that, regardless of
the quantity, spiritual experiences do not 'produce a spiritual life" (3).
Ferrer's emphasis is on understanding the transpersonal as something to
participate in rather than own. Thus, the awareness of the sacred can be
present in an individual, a relationship, a community, or even a place (e.g.,
so-called sacred locations, such as Lourdes). ^

VALUE O F TRANSPERSONAL PSYCHOTHERAPY

In the preparatory stages of writing this paper, I asked myself: Of what

value is transpersonal psychotherapy? What does it offer that a more
traditional psychotherapy does not? How might it change the therapist and
the patient in ways that are less likely with traditional psychotherapy? As I
pondered these few questions, I felt that they call for a book-length
endeavor to be explored fully. But let me try to, at least, outline some of the
major points.
To enter into the realm of the transpersonal involves a specific world-
view that then offers certain very hopeful and positive directions. Philoso-
phers and religious and spiritual leaders have struggled for thousands of
years with the question of the purpose of life.
To pursue the spiritual dimensions of life presents an immediate
problem for the scientist. My belief is that these dimensions lie outside of
our space-time dimension or are perhaps intertwined or enfolded within it
in ways that we cannot yet understand. I do not believe that we currently
have instrumentation that can measure or validate these other dimensions.
Are they perhaps the "other dimensions" that the quantum physicists who
are studying the String Theory postulate? (4).
Meditation, psychedelics, and Holotropic Breathing (5) are a few of the
methods by which these other dimensions can be accessed. Can conscious-
ness exist without a body to enclose it? Data on Near-Death Experiences
(6), Remote Viewing and Healing-at-a-Distance (7), Reincarnation (8), and
the Spectrum of Consciousness (9) suggest that it can. Again, we run into
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the problem of "scientific" validation of events that I believe are happening

outside of or beyond our usual understanding of our space-time dimension.
Even the solidity, stability, or dependability of our space-time dimension
is in question with Einstein's relativity theories in which we see that those
things we assume are constant (space and time) are not as constant as we
thought.
Many of the great religious and spiritual systems, along with certain
philosophic stances, suggest that our perception of what we call popular
reality is flawed, that what we see as dual or separate is not really that way,
that on some level all things are interconnected. Another way of saying this
is "God is One" or "Everything is God" or "The manifest world and
Ultimate Source (God, the Divine, Emptiness, etc.) are all one." Since
language itself is dualistic, it is difficult even to talk or write about
transpersonal matters. We are talking about a possibly nondualistic system
with dualistic language, and that presents problems from the start.
The Dalai Lama has taught that it would probably be best if we could
experience both dimensions simultaneously. Most of us usually live in
space-time with occasional moments of awareness of a spiritual dimension.
I feel that therapists can be inspired to have greater empathy and caring
for their patients when they believe in their interconnectedness. This can be
especially helpful with patients who are more challenging to us and toward
whom we have less-than-caring feelings. The spiritual dimension(s) is most
often associated (in its ultimate stages) with positive feelings, such as love.
(This is not to say that there are not "Dark Night of the Soul" periods also.)
Before going on, I need to mention a not uncommon danger of having
this worldview. For people in a lot of psychological and/or physical pain,
these other dimensions can present an enticing escape to avoid doing the
psychological and/or physical work of mastering the problems of existence
in our space-time world.
Early on in the New Age Movement (1960s and 1970s), there was a
common sentiment that the spiritual dimension was primary and therefore
most or all of one's energies should be used in its pursuit. Narcissistic
self-inflation was (and still is) a real dangerous consequence of holding this
view of " I am on the God Squad." There are now spiritual teachers and
theoreticians who feel that the glimpses (or more) of the transcendent
dimensions should be used to help transform this dimension or, to say it
another way, to bring heaven onto earth. This view is an antidote to
narcissistic proclivities and can greatly increase one's healthy engagement
with this dimension of life.
Patients can use as ego-ideal models many of the spiritual teachers
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present and past, especially in how they handle(d) adversity, anger, and
forgiveness. Death for self and loved ones, with all of its surrounding issues,
becomes softer and a bit less frightening.
My current working hypothesis is that the core nature of consciousness
is positive and loving, and that negative mind states arise with the concern
of survival of the body. We are genetically neuronally programmed for
survival, and when this is threatened, in reality or metaphorically, our
fight/flight survival mechanisms kick in and give rise to the usual negative
mind states we see, such as anger, depression, and withdrawal.
Personal Background
At this point in the paper, I need to stop for a brief excursion into how I
came to be involved in this area. Whereas traditional psychotherapy can be
taught to any reasonable student of human psychology, Transpersonal
psychotherapy cannot. The arena of the transpersonal cannot be ap-
proached just intellectually—like love, it has to be believed in and/or
experienced to some extent.
In 1959, I finished a traditional psychiatric training program at the
Menninger School of Psychiatry and subsequently finished my traditional
psychoanalytic training at the San Francisco Psychoanalytic Institute in
1969. Until 1970, I would have described myself as an atheist and dour
realist, i.e., pessimist. In the early 1970s in California, there was the
phenomenon of weekend New Age workshops in which everything was
promised from enlightenment (whatever that vague term meant) to the
development of all kinds of paranormal powers. On a whim, I attended a
meditation course given by a physician for physicians only. The goal of this
course was to develop the power to make diagnoses at a distance, having
only a name and address. I believed that it could not be done. To my
amazement, at the end of the workshop, I made five consecutive correct
diagnoses, including a missing middle finger, cancer of the lower left bowel,
and tuberculosis of the upper lung. My traditional scientific paradigms
were deeply shaken by this experience. I had obtained knowledge outside
any traditional modes of informational transfer, and over the next five years
I explored everything I could to try to make sense out of what I experi-
enced.
In time I realized that the development of paranormal powers was a
secondary phenomenon to the spiritual search for the more ultimate
questions and answers about existence. This is the arena where religion (the
more traditional, organized groups) and spiritual approaches and disci-
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plines have struggled for the ultimate answers to spiritual questions — Why
are we here? Is there a purpose to existence? Where did we come from?
I believe that traditional psychotherapy is basically pessimistic (though
called "realistic") in its outlook. There is the oft-quoted line attributed to
Freud that psychoanalysis attempts to convert "neurotic misery to ordinary
misery." Transpersonal psychotherapy attempts to open awareness to this
and to other psychic realms where joy, love, serenity, and even ecstasy are
present. As I have stated, without a basic belief in and/or experience of
these transpersonal or spiritual realms, I do not think one can be a
transpersonal or spiritual psychotherapist.
My belief in the separateness of the lines of development of our
emotional and spiritual life has led me to a very specific approach that I find
useful. (I must again reemphasize that just as traditional psychotherapy has
many approaches, so many other transpersonal therapists may have ap-
proaches different from mine. I discuss my personal therapeutic approach
in more detail in Clinical Studies in Transpersonal Psychotherapy [10].)
Where applicable, I use the technologies developed by religious and
spiritual traditions to access transpersonal realms to help in the healing of
the more common painful psychological states. In addition, I work within a
certain spiritual context wherein I conceive of every patient as a part of me
in a much larger picture (the "no-boundary interconnectedness" of which
Huxley's Perennial Philosophy speaks). I maintain this contextual stance
whether or not the patient has a religious or spiritual belief system. Should
the patient have such a system, then I will in all likelihood share my belief
system. If the patient does not have such a belief system, I will usually keep
this context quietly to myself. To my surprise, I find that this does not affect
the patient's transference work in any significant way, and it does improve
the working alliance.
Spiritual approaches may be helpful in the healing of traditional
psychological problems. I use the more readily available psychological tools
as my primary methods to approach my patients' conditions. This also
includes the use of medication when appropriate. If there are genetic
and/or biochemical proclivities toward, for example, depression or anxiety,
then meditation or other spiritual practices may have little or no effect on
relieving the conditions. There is now enough data to suggest that although
a spiritual approach may help one live more comfortably with a depression
or anxiety condition, it may take a psychotropic, "biochemical helper" to
eliminate the condition. I believe that life is difficult enough as is, and if
there is any way to lessen the suffering, I think we should do it. I do not see
any virtue in needlessly struggling with relievable pain.
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I personally know of some spiritual teachers and long-term (twenty-five

to thirty years) spiritual aspirants who use the SSRIs (e.g., Prozac or Zoloft)
to lessen their depression and anxiety, which thereby greatly deepens their
spiritual practice. There is still a feeling among some spiritual practitioners
that to use medication means you have failed in overcoming your problems
with spiritual tools. Happily this view is beginning to change.
APPLICATION OF TRANSPERSONAL APPROACH
Having laid some of the background material in place, I can come to the
second part of this paper. Specifically, how do I use the transpersonal
approach to help those who come to me as patients? Let me list my tools
and then go into how and when I use them.
Spiritual Context
Foremost is the spiritual context within which I hold all of my patients. I
have no doubt that this helps me stay in a caring mode—especially with
difficult patients. To convey to a patient that you see him or her as being a
piece of the Divine is incredibly powerful to begin to counter a life-long
view of worthlessness. It can only be done when appropriate for the given
patient, and it will not be effective if the therapist does not actually believe
it in his/her mind and experience it in his/her heart. This approach can also
do wonders in the area of inspiring changes in behavior — especially those
of a narcissistic nature. Another way of conceptualizing this would be in the
development of newer and healthier ego-ideal models. I might ask patients
if what they are doing or want to do is honoring the Divinity within them.
In psychological (self psychology) terms, this can be seen as a type of
mirroring.
Again, where appropriate, I might share with my patients that I pray for
them on a daily basis. There are now three well-researched and formatted
double-blind medical studies (two studies of postoperative healing in
patients recovering from coronary bypass surgery and one study of hospital-
ized AIDS patients) clearly showing that prayer can affect biological
processes, although we do not have a clue as to how it works (11-13). Does
prayer work for me and my patients? I don't know, but most of my patients
do get better. And it helps keep me oriented in a more positive (spiritual)
mind-frame.
Before proceeding, I want to clarify how I determine if adding a
transpersonal or spiritual component will be of value. Somewhere in the
first visit I inquire if the patient is an atheist, theist, or agnostic and if he
currently has a spiritual or religious practice or belief system. Because of
their backgrounds, some patients are antireligious or antispiritual, and in
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those situations I will usually maintain a silent spiritual context of my own.

On occasion, where there is no antipathy, I might suggest that the patient
look at Ken Wilber's first book No Boundary (14), a nonsectarian approach
to the ideas inherent in the Perennial Philosophy. Some patients are bored
or uninterested in the contents, and with those I cease and desist. Other
patients become very excited and interested in knowing more, and with
those individuals adding a spiritual component will usually be very helpful.
Of course, those who already have these belief systems are also helped by
the addition of certain spiritual ideas and practices.

TOOLS OF HEALING
I would like to discuss here in more detail some of the tools I have
borrowed from spiritual or religious traditions to aid in the psychological
healing of patients who come to see me.
In addition to my holding a spiritual or transpersonal context that,
when appropriate, I share with my patients, I use spiritual bibliotherapy,
which is suggesting appropriate books for patients to read. This can help
with certain types of neurotic anxieties and existential angst and gently
invite the reader to contemplate the larger questions of existence. It also
can lead to a more productive engagement with life, both more immediate
and even planetary (e.g., work in worldwide ecological issues as well as
helping the social needs of other human beings). Books describing the lives
of certain advanced spiritual beings can be an inspiration and serve as
ego-ideal models (15).
I divide the use of spiritual bibliotherapy into two general categories:
1. For actual transformation, I found that for many patients reading A
Course in Miracles (16) has been very helpful in opening their thinking
about their lives' dilemmas, how to view them and what they or their own
intimates can do about them. (This book should be read at about a one- to
two-pages-a-day pace and then contemplated.) A Course in Miracles is a
metaphysical text exploring our nondual nature with exercises and medita-
tions that can be used for spiritual changes without the need for a teacher,
eliminating any problems that might stem from difficulty with authority
figures.
2. For expanding ones worldview, I recommend books that attempt to
open readers to a much larger, positive picture concerning their existence,
such as, The Grace in Dying by Singh, on death (17); Lessons from the Light
by Ring, on the existence of consciousness without the need for a living
body (18); Where Reincarnation and Biology Intersect by Stevenson, on the
"movement" of consciousness from one lifetime to another (19); many
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writings of Ken Wilber on the intellectual investigation of consciousness

(20); The Cosmic Game by Grof, on the cosmological implications of LSD
research (21); The Self-Aware Universe by Goswami (22) and Schrodingers
Kittens and the Search for Reality by Gribben (23), on the findings and
theorizing by astrophysicists and quantum mechanic physicists supportive
of the notion of the interconnectedness idea of the Perennial Philosophy.
A major advantage of transpersonal writings is that they tend to bypass
the transference problems inherent in any "teaching" or "instruction." The
patient can close the book at will. The amount of spiritual literature
pouring into the public domain is significant — one need only look at The
New York Times Best Sellers List to get a sense of this. The transpersonal
therapist can help direct the patient to some specific topic or book that
would be helpful.

MEDITATION

I do not consider myself a meditation teacher, so, when I think it appropri-

ate, I will refer a patient to the many meditation centers in my area. There
are basically two types of meditation:
1. Concentration Meditation, in which a word or phrase or breath-
watching is used to block out any other thoughts. Herbert Benson showed
in his work at Harvard (24) that doing Transcendental Meditation ®, a
focused meditation, had many physiological benefits. My experience is that
concentration meditation, as it is also called, can effectively block out more
disturbing thoughts and feelings and thus "splint" the mind for a while
enabling some healing to occur. Words or phrases from a religious or
spiritual tradition can be used or, as expounded by Benson, the use of
secular words can be equally effective (e.g., the word "One").
2. Open Meditation, in which one keeps one's awareness on whatever
changing phenomena arise in the mind. This will frequently lower psycho-
logical defenses to formerly repressed material and enhance the awareness
of one's psychological patterns as they constantly manifest. Especially in the
early stages of meditation the psychological dimension arises very often.
With some grace, luck, and perseverance, one can get glimpses of realities
behind, above, inside, etc., within which our space-time dualistic nature
interacts.
Reading about spirituality can instill a sense of belief, and certain
experiences (e.g., meditation) can give a sense of knowing that these other
dimensions exist.
I also use certain techniques (literature and mantras) to foster forgive-
ness and coping with anger. There are specific forgiveness meditations from
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many of the great religious or spiritual traditions — the Hebrew Bedtime

Shema (25); Christian-based phrases modeled on Jesus' sayings and ac-
tions, e.g., Lords Prayer: "Forgive us our trespasses as we forgive those
who trespass against us," and from the Buddhist meditation teacher Joseph
Goldstein: "If I have offended or harmed anyone knowingly or unknow-
ingly, I ask their forgiveness and if anyone else has offended or harmed me
knowingly or unknowingly, I forgive them." The last three words can be
very difficult to think or to say, but repetition of the prayer can greatly
soften the situation.
Right Speech (from the Buddhist tradition) emphasizes not only telling
the truth, but saying it in such a way that the listener is happy to hear it. If
we all could do this, the world would be transformed very quickly. The
Hebrew tradition also teaches about Lashan Hara (the "evil tongue") and
how to avoid it.
ADDITIONAL TOOLS

Other tools to help with psychological pain and transformation include

Holotropic Breathwork, LSD (where legal), past-life-regression hypnosis,
yoga, visualizations, and psychodrama.
When I first began to experiment thirty years ago with adding a spiritual
component to my standard psychotherapy approach, I subscribed to the
popular misconception that one had to be a fairly well-integrated person to
use these spiritual tools. My experience has led me to feel that this idea is in
error. When used judiciously, with some monitoring for negative side
effects, I believe that these practices can be used for any of the classical
diagnostic categories. Obviously a person in the throes of a crisis situation
or one who is so disorganized as to make communication difficult would be
a poor candidate for a transpersonal approach. In general, patients will try
to use these practices in an integrative way, and monitoring the situation is
always important. These issues were brought home to me in my work with
George.
Vignette 1
I met George, a paranoid schizophrenic, in 1961, when he was forty-three.
(His mother and two siblings were also diagnosed a paranoid schizophren-
ics.) At that time he required hospitalization for paranoia and inability to
function. I worked with George for the next thirty-eight years (he died
recently) on varying schedules from weekly to every third month, depend-
ing on his ability to function.
If he ever stopped taking his antipsychotic medication (Mellaril, 75
mg/day) he would become disorganized and need hospitalization. When he
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retired from work at age sixty-five, I suggested, in a purely experimental

mode, that he "take a look at" A Course in Miracles (16) and see if he found
it helpful. Retrospectively, A Course in Miracles would be considered too
sophisticated and complex a book for someone who was poorly educated
(as George was) and only a few steps away from psychological disorganiza-
tion (George lived a schizoid existence in a trailer park).
To my great surprise, what happened was that his paranoid, psychotic
thinking became more kind. After reading A Course in Miracles (which
speaks often of forgiveness), he told me that he now understood why his
neighbors dog was defecating on the steps to his trailer. He told me it was
because " I wasn't sending enough loving thoughts to my neighbor."
Reading A Course in Miracles apparently helped him organize his psychotic
thinking in a more kindly way.

Vignette 2
Barry, a thirty-two-year-old bus driver, had been fairly well integrated (good
marriage, two children, reasonably normal developmental history) when he
began to have paranoid persecutory ideation and was unable to relate to
coworkers and family. This came about because of the psychological
trauma that aroused great guilt and shame when as a volunteer paramedic
he made a mistake and another person suffered greatly.
Diagnostically, borderline psychotic personality would be closest. Be-
cause he drove a bus, his union contract would not allow him to take any
psychotropic drugs. With medication ruled out, I suggested in an experi-
mental way that he do a mantra meditation from his religious background.
He chose to say the "Glory Be" from the Catholic liturgy: "Glory be to the
Father, the Son, and the Holy Spirit, as it was in the beginning is now and
ever shall be, world without end. Amen." In addition to supportive
psychotherapy, he used A Course in Miracles for concentration meditation
purposes, rather than for contemplation. Thus the persecutory delusional
thoughts were kept at bay and did not overwhelm him as they had before.
In a relatively short time (a few months) the paranoid ideation totally
disappeared, and he was able to resume his work and family life. I felt that
the meditation "splinted" his mind and permitted the other therapeutic
forces of family and therapy to help him mend.
Meditation has now reached mainstream America. It is written about in
Time and Newsweek and is being incorporated into the approaches of
many traditional religious groups. In addition, the work of Jon Kabat-Zinn
has introduced meditation (in this case, a version of Buddhist Mindfulness
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Meditation) into mainstream medicine as an adjunct helping agent for

chronic and/or painful medical conditions (26).
As I mentioned briefly before, there are basically two kinds of medita-
tion—focused (e.g., on one s breath or repetition of a mantra) or open, not
focused (e.g., Buddhist mindfulness or Dzogchen practice). (For greater
detail on meditation, see Daniel Golemans The Meditative Mind [27].)
Some of these meditational systems have been in existence for thousands of
years and evolved to help the practitioners see the dimensions beyond what
we call popular reality. My clinical observations agree with Wilber's theory
that emotional and spiritual lines of development are separate, and I
therefore feel quite comfortable borrowing spiritual tools to help those who
may have emotional distress. In the same vein, I feel it is appropriate to use
psychotherapeutic tools to free up spiritual practitioners from psychologi-
cal problems that are preventing them from putting energy into their
spiritual quest.
Vignette 3
David, age forty-one, was sent to me by a psychoanalyst colleague for
treatment under the Vocational Disability Act. He had murderous and
suicidal ideation along with alcohol and marijuana abuse. The diagnosis
given to him by the Disability Board was "borderline personality" and his
symptoms were precipitated by his supervisor having an affair with David s
ex-wife. Given that I was authorized to see him only once a week, I did not
know where to begin.
Initially bibliotherapy connected us, and a mild tranquilizer helped with
his periods of great rage. He was intrigued by what he read of Buddhist
mindfulness meditation, and I (retrospectively, naively) sent him to a very
reputable teacher for a ten-day retreat. He developed extraordinarily
strong concentration, actually using the nonfocused meditation for focus-
ing purposes. This practice, along with certain forgiveness meditations,
resulted in his becoming symptom-free within a year, and he was able to
return to work alongside his former (nemesis) supervisor. I had an eighteen-
year follow-up (including confirmatory talks with his wife) that indicated
that all gains were maintained, and he was continuing his daily use of
focusing meditation. In fact, recently at his company he was named
Employee of the Year.
Vignette 4
I want to describe in greater detail the case of Bruce, a forty-nine-year-old
engineer in a good marriage with three grown children, who functioned at a
high psychological level. Bruce s case history demonstrates the possible
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interplay of the "personal" and the "transpersonal." What was unique was
that fifteen years earlier Bruce had been in traditional, psychoanalytically
oriented psychotherapy with an excellent psychoanalyst. For many years in
therapy, Bruce had successfully worked out many aspects of his neurotic
anxiety and lack of self-confidence.
He was referred to me by a mutual friend because of my spiritual
interests, hoping that I might have some "new" approach to Bruce s lifelong
problems with melancholia and low level of sadness. His father's recent
death and the approach of his fiftieth birthday raised for him many
questions about his life. Was it meaningful or trivial? Could there be more?
The Catholicism of his early life did not seem to provide enough answers.
Despite his mother 's Catholic orthodoxy, Bruce left the church in early
adulthood. His mother had died a few years before his father and was
remembered by Bruce as being severely hypercritical, angry, and sexually
seductive. With both parents dead, Bruce felt he was next in line, and the
issues surrounding death became very important to him.
I believed that his earlier psychotherapy was very effective, but, as is
usually the case, clearly some areas were not adequately explored. Taking a
careful developmental history revealed that his mother had been very ill
with postpartum complications necessitating that Bruce be kept in the
Catholic Hospitals nursery where care was given along rigid schedules with
little or no time spent on caressing and fondling—just feeding. Because of
his mother's postpartum condition (she nearly died), Bruce spent very little
time with her.
The melancholia and sadness had been minimized by Bruce in his
earlier therapy. I underestimated their significance, although I suspected
they related to this very early deprivational state. His long-term marriage
was described as satisfactory and, because of the description of his earlier
psychotherapy, I erroneously assumed that there were no significant oedi-
pal issues at play.
We started treatment with the idea that existential issues were the
primary concerns of his mid-life distress. I recommended that Bruce read
some of Ken Wilber's books dealing with big-picture issues, such as
pointed to in Aldous Huxley's The Perennial Philosophy (28). Aside from
this spiritual material being offered, most of our interactions were on the
"free association" model, which he was introduced to in his first psycho-
therapy. This included exploring, where necessary, distortions or projec-
tions stemming from the transpersonal material. His associations were
mainly positive in nature and were reflected in a strong working alliance.
Bruce was enthusiastic about my suggesting he read A Course in
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Miracles, which I had felt would be of interest to him because of his

Christian background. This book validated for him his spiritual pursuits
and began to strongly mitigate his criticism of self and others by its
emphasis on forgiveness.
I had suggested that he try vipassana (mindfulness) meditation. Sitting
long weekends gave him a sense of camaraderie along with growing
compassion and empathy for the other sitters, his fellow travelers. Vi-
passana meditation, along with the softening of his hypercritical style,
greatly improved his relationship with his wife and sons and so he decided
to discontinue therapy.
Bruce s mindfulness-meditation practice continued, and he came back
to see me after a ten-day retreat brought up material that had never before
emerged in his therapies. In general, mindfulness meditation tends to lower
or dissolve psychological defenses, resulting in the exposure of what lies
underneath. For the high-functioning person like Bruce, this was a big plus.
(I should mention that sometimes, despite the best efforts of reasonably
sophisticated meditation teachers, students with underlying psychotic pro-
cesses come to a meditation retreat and the ensuing lowering of psychologi-
cal defenses unmasks a full-blown psychotic process. These psychotic
processes usually respond rapidly to antipsychotic medication. In general, I
believe that meditation is unwise for individuals with underlying psychotic
processes.)
Because of being a bit overweight, Bruce had decided to eat less than
usual. After feeling hungry for a few days and having minimal external
stimulation in the silence of the meditation retreat, he began to be flooded
with primitive and ego-driven fantasies and cravings for breasts. He had
occasional bouts of anxiety about his ability to restrain himself when
passing an attractive woman. This craving ended when he had an intense
happy dream of a reunion with a healthy, nurturing mother. There were
many poignant associations to the dream that Bruce and I felt were feeling
memories related to the early nonnurturing nursery experiences during the
first few months of his life.
He attended another ten-day mindfulness-meditation retreat during
which time he again (having done so in his first psychoanalytic psychothera-
pies) repeated his oedipal constellation, but this time with a much more
intense affect. On the retreat he found himself to be attracted to a woman
he had seen on previous retreats (but had never spoken to) and felt she was
involved with a certain fellow meditator. Bruce began having erotic fanta-
sies about her as well as very aggressive fantasies about her supposed male
friend. Simultaneously, he feared the man would attack him while doing
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some kitchen chores (in silence) with his "competitor." Bruce was very
frightened that he would take a large kitchen knife and stab this man.
Earlier psychotherapy and meditation training enabled Bruce to see the
bizarreness of his preoccupation. He was in a happy marriage and knew
absolutely nothing about the "couple" onto whom he had projected his
oedipal conflicts. This conflict was again worked over, but now in the light
of heightened affect. New material came to light regarding his mother s
seductiveness, and resentment he felt toward his father for being weak and
not protecting him. As this new material was worked through, his marriage
became warmer, more affectionate, and spontaneous.
Clearly Buddhist mindfulness meditation did not originate twenty-five
hundred years ago for psychotherapeutic purposes. But assuredly therapeu-
tic effects occur frequently in the retreat setting where, in the silence,
psychological problems bubble up, moral inventories are taken, and con-
flicts are worked out.
Designed to permit the practitioner to gain insights into "reality" and
certain truths about it, meditation can have a wide variety of emotionally
growth-producing effects within what we call popular reality.
In this paper, I have tried to show that psychotherapeutic and spiritual
tools can be used simultaneously to improve and hasten the healing of
patients. It is my hope that this article will invite other psychotherapists to
explore the transpersonal or spiritual realm to see if there might be some
beneficial effects for them and their work with patients.

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