At my best, I see psychotherapy in the same light. Many people who come to therapy are disgusted with themselves for one reason or another, much as the Buddha was in his own time and in his own way. This disgust can take many forms: shame, fear, anxiety, or feelings of unworthiness are common expressions of it, but the possibilities are endless. Some people even develop what is called a “reaction formation” and seem the opposite of disgusted. They come across as prideful or conceited and unwilling to admit their faults or self-doubts. But these individuals are often just propping themselves up, creating a false front to mask their vulnerabilities, and somewhere inside they are troubled because they know they are not being real.

One of the first things I discovered was that there was really no playbook for how to be a therapist. As with meditation, it had to be figured out from the inside. There was no script to

follow when sitting with a patient, no “right way” to handle things, only a set of ethical guidelines and a trust that listening “with a third ear” would help shape a useful response and serve a useful purpose. Each person, each visit, and each issue required an improvisatory spirit that kept me on my toes, much as I had felt when practicing mindfulness on my first silent retreats. I have had wonderful teachers, supervisors, and therapists, but, even in my first days, while still in training, once the door closed and I was alone with my patient, no one knew what I might do or say, least of all myself.

The Buddha’s teachings run counter to this tendency to find fault. He normalized feelings of inadequacy and threw responsibility back onto the individual to sort them out. He taught mindfulness as a method of probing the self and found that impartial attention to moment-to-moment experience yields surprising but predictable insights into the self’s

contingent and relational nature. These insights, which precipitate spontaneously out of concentrated attention and mindful reflection, make abundantly clear that our habitual efforts to defend ourselves against our intrinsic groundlessness make things even worse.

But, as important as it is to understand the sources and details of one’s pain, understanding is rarely enough. My patients come to therapy wanting the burden of their accumulated experience lifted. Yes, they want to make sense of their lives, but that is not usually their fundamental or exclusive aim. First and foremost, they are trying to get over their accumulated trauma in order to feel less fearful, isolated, forlorn, helpless, alone, anxious, or depressed. They might not be able to say it so clearly, but they are reaching for things

beyond thought, trying to make contact with essential capacities that have been sacrificed in their efforts to adapt, adjust, comply, cope, or conform.

Our minds are like children, and mindfulness, like a good therapist or a good-enough parent, “holds” them so that they can grow up and come to their senses. With enough practice, and enough patience, breakthroughs occur. These take many idiosyncratic forms but they are

generally of two types.

On the one hand, there is a loosening of identification with the known self; people see their self-concepts as just concepts that have arisen and accumulated in response to the particular challenges and conditions of their lives but that have no ultimate stigmatizing reality. On the other hand, there is a return to simply “being.” This is set in motion when awareness becomes dominant, when the observing mind becomes stronger than that which is being observed. As this observational capacity develops, a change sometimes occurs. Instead of one part of the mind observing another—“me” watching “myself”—the whole thing collapses and just “is.