The Compassionate Practice of Psychotherapy Part IV: The Nature of Courage in Psychotherapy

This is a transcript of an intensive training seminar given by Edward M. Podvoll, M.D. at the Karme Chöling meditation center in Vermont on October 1–4, 1982. It has been lightly edited by Jeffrey Fortuna and Skye Levy.

Part I: Foundations of Clinical Recovery

Part II: A Design for Treatment: Mind and Environment

Part III: Intensive Psychotherapy: Intimacy and Exchange

Part IV: The Nature of Courage in Psychotherapy

Listen to Part IV

Transcript of Part IV

Dr. Podvoll: While talking about the practice of psychotherapy there has been no doubt that working with people is a practice that requires effort, personal discipline, and the continuous rehearsal to do such a thing properly. Training to do this is not a matter of learning how to drive a car—learning the gears, techniques, or strategies. That kind of training is missing the point and everyone who has been involved in that kind of psychological training knows something is wrong. The real point is involved with training ourselves, and having experiences ourselves, and knowing precisely what that experience is about. If we are going to tell the truth to people and have the courage to do that it has to come from what we have experienced ourselves.

It has been obvious all along that how we tell the truth to people is our practice and that takes a bit of work, a bit of effort. Genuine psychotherapy is basically meditation in action. The first line of the brochure for Maitri Psychological Services reads, “Maitri Psychological Services is a therapeutic action group.” What we mean by that, at least to ourselves, is that it is a group intensely involved with the practice of meditation in action, of how to expand our personal practices into interpersonal work. No matter what we know or don’t know about strategic therapies, it is meaningless without personal work, without a direct relationship to our own mind and body and communication. When that is going on first and alongside of our interpersonal work, something different happens. 

Once we had a meeting with His Holiness, the 16th Gyalwa Karmapa, and we asked him how the Naropa Institute psychology program could accommodate so many different schools of thought, so many faculty members having been trained in different ways. He said, “Meditation discipline is like a beautiful, rich, golden brocade that you set out on a table and no matter what you put on top of that brocade, it becomes more brilliant and beautiful.” That is the idea. Our personal discipline can actually accommodate many trainings and skills, and they are more highlighted and made vivid by our personal practice.

It takes some work to do that and we should not shy away from it. We should not procrastinate about that. We are talking about evolving very simple and honest ways of working with people. That honesty only comes from a personal honesty with ourselves. It cannot come second. The courage we are talking about now is the courage to actually practice the honesty of meditation. It is easy to practice in this environment of Karme Choling—with its blazing autumn trees as a brocade, practice becomes joyful. When we go home to practice it is more lonely. When we are practicing alone in our room we might wonder whether we are crazy or not. It is important to have some memory that the practice could be delightful and gentle, as compared to when we are alone in our agency or institution where there might not be anyone else talking this way. There is an aspect of courage in doing this and I am not talking about anything theoretical. It is the way I began to integrate meditation practice and clinical work. It was lonely to do such a thing. It is possible that people will think you are doing something weird or exotic. I recall a letter I received from an old friend after I had written a little paper relating meditation to professional work. He said, “Be careful about exposing this stuff you’re doing. People are going to think you have gone crazy.” I felt very lonely reading that letter. Nevertheless, places like Karme Choling and Naropa Institute were available.

It is interesting that Mr. California is going through the same thing in his own way. For some reason I told him, “Wouldn’t it be wonderful if you could convince your mother that you were not crazy all this time?” And he agreed. If there were only someway he could justify himself to his mother that would mean a lot. It seems that the thing he is most afraid of is also leaving Her behind. That is, leaving the delusion, and facing the humiliation and despair of appearing crazy to other people. He will have to say, “I made a mistake. I was wrong. It didn’t work. Let's forget it.” That does not seem to be what he can do now. He would love to have his mother’s acceptance that he is not insane and that everything he has been through has not been in vain, worthless, and degraded. He does not want his parents to think he is insane and that seems to also be part of what all of us are afraid of. That is part of the loneliness we are all working with.

On the other hand, this loneliness is not necessarily as bad as we think. All our patients are living with this in one form or another. To the extent that we can taste that, understand that, we might be useful. We can tell them the truth about loneliness, that it is also rich and vivid and clear at the same time. When we come here to study contemplative psychotherapy we could feel that we are doing something outrageous and risky. But that does not seem to be the case anymore. Many people are doing the practice of meditation and combining it with their therapeutic work. We are hardly alone in doing that. It is clear that people want to go further with this kind of work and want to do it now.

It is once again the same issue of not procrastinating. But in this case it is the flip side of the patient’s idea of procrastinating. We feel we cannot procrastinate getting more down to earth, away from theories, and into the ordinariness of working with people. The patient is trying to leave the earth in order to become extraordinary. He is basically stuck. It will take courage on his part not to collapse in despair and nihilism, and yet not to go forward with what he is increasingly recognizing as an absurdity. It is a time for looking around to see what is true and what is not true. There are favorable signs: he is working with his mind in order to head it off from wandering into endless cosmic speculations with the reminders that he gives to himself: “Keep it simple, no theories.” He is becoming less passive and pseudo-gentle in his relationships and less fearful at expressing the intelligence of aggression. His body seems to be less of an alien conspiracy.

The patient’s courage to continue this way is interlocked with the courage of his friends, the team members. We also must renounce our theories about him, including what sanity is and what recovery should be like. We can rely only on the ground experience of recovery, and of going out beyond ourselves with that. The courage of the patient and the courage of the therapist are inseparable. How on earth can we transmit the necessary attitude and skills to someone struggling with an addiction of any kind unless we know the ingredients of courage from our own experience? That is where the courage to practice mindfulness-awareness discipline comes in: the courage to experience aloneness, renunciation, and the true nature of projections.

We don't know if Maitri Psychological Services is the most ideal treatment situation in its present form. It probably has many refinements to go. But it is going in the right direction and we cannot just wait for the most ideal situation to be there. That is another aspect of courage: not waiting for things to get better before going forward.

We can start exactly where we are. Moments of recovery are spontaneously occurring. Courage means not hesitating to relate to those moments. We do not have to go back to the infantile origins of illness and how those manifest in the therapeutic relationship. How finally the multitude of habitual patterns of transference, or whatever, are eroded like water erodes rock. We, and they, do not have the time for that, if it works at all. The meditation discipline and personal practice of relating to our own clarity and recovery implies all the time that we do not have to wait for the nightmare to be over. We can awaken right within it. That is what we are trying to transmit to the people we work with.

We are only doing what people have wanted to do for a long time. Journals and books are filled with concepts and theories about what is called “empathy.” The issue of empathy and actual contact with people can only arise from our own experience. Meditation is the fertile ground for the development of empathy. Somehow no one has talked about that in western psychotherapy. But we are talking about actually cultivating empathy, cultivating exchange. Because of that skill arises in working with people. We need to do that. It is a big project. Psychotherapy is not like driving a car, which anyone could do. It has to be a practice. The more we can practice and discuss it together, the easier and more delightful that will be.

“Recovery” emphasizes the notion of process. Perhaps we are involved with a redefinition of the notion of recovery. It is not remission. It is not normalcy. It is not just the abeyance of symptoms but it is what everyone we work with wanted from the beginning, when they engaged in a course of illness. They were looking for something beyond the falsity of constricted personality. There is a hint of brilliant sanity and they want to recover that. Recovery from illness is recovery of intrinsic health. That is the logic of the language we have been using. Recovery is possible beyond maintenance, making do, or remission. That is not enough. If we settled for that as the end result of the therapeutic encounter, that is courting trouble. People begin a course of illness in search for something better than where they started from. They don’t want to go back to where they started from. From the point of illness, there is no one to recover. That has been left behind. No one who has had a psychotic episode has ever said, “I just want to get this over with and be just like I was.” No one ever wants to be just like they were or else the whole thing would never have started.