An inventory of the modern psychotherapist's office: Comfortable chair or couch--check. Old magazines--check.
While many people still can't envision paying money for someone to stick them with needles, others are embracing Eastern traditions such as acupressure, herbal remedies and meditation.
In the past few decades, interest in complementary and alternative therapies has continued to grow. A 2004 report from the National Center for Complementary and Alternative Medicine (NCCAM) indicates that 36 percent of Americans are using some form of complementary or alternative medicine, including herbal supplements, meditation, acupuncture, chiropracty and yoga.
"The majority of those who reported using these therapies, do so in a 'complementary' manner that is combining strategies such as mindfulness meditation with traditional counseling to improve health," says Margaret Chesney, PhD, deputy director of NCCAM and a clinical psychologist.
"Mindfulness is opening people's awareness of different [complementary] practices and curiosity about Eastern wisdom," notes Shauna L. Shapiro, PhD, a counseling psychology assistant professor and researcher at Santa Clara University who has published numerous studies, articles and book chapters on meditation and mindfulness.
And although more evidence is needed to uphold the effectiveness of Eastern medicine, some research has shown that practices such as mindfulness, meditation and acupuncture can help relieve both physical and mental pain.
Mindfulness over matter
Eastern traditions--specifically psychology that incorporates Buddhist principles and mindfulness--are at the heart of practice for psychologist Christopher Germer, PhD, a practitioner in Arlington, Mass., who also directs continuing education at the Institute for Meditation and Psychotherapy, a non-profit organization dedicated to helping mental health professionals integrate mindfulness and psychotherapy.
"Mindfulness is being aware of whatever is most salient and dominant in your field of awareness, your thoughts, feelings and sensations in the present moment," says Germer, a longtime student of meditation and Buddhist practice, and a clinical supervisor at Harvard Medical School.
In working with patients, he looks for "what is the patient not accepting?" People come to therapy in emotional pain, and they want it to stop immediately. But not only is this unlikely, it's often counterproductive, maintains Germer.
He remembers a patient with anxiety who told him: "I do all the right things. I expose myself to what I am afraid of, I can talk myself out of a panic attack and do relaxation. Why am I still so anxious?"
Germer worked with the patient to help change his ideas about anxiety. "You think it's something bad and to be avoided, but this only magnifies it," he recounts. So, the treatment shifted from decreasing the anxiety toward increasing acceptance. That made all the difference, Germer said. The patient found that while anxiety, depression and pain can indeed be awful, by tolerating and accepting them, he could defuse and decrease the negative emotions, Germer explains.
Mindfulness is a core perceptual process that can be integrated into any therapeutic method. "As Freud said, 'People die with their neuroses. We need to learn to be in accord with them,'" says Germer. "He was right, we can't stamp them out. We need to learn to be with ourselves in a more amicable way."
Psychologist Tara Brach, PhD, a former private practitioner who now trains psychologists and other mental health professionals to integrate mindfulness and meditation into their practices, was drawn to the practice for its ability to change emotional experiences by cultivating a present-centered awareness.
The focus on the moment that mindfulness brings can be a particularly effective way for people to acknowledge and accept difficult emotions and experiences, says Brach. "Teaching a person to note and name their experience--it can be soft, it can be an internal whisper--helps to ease some of the identification and reaction," she explains.
Brach cautions that not all patients are ready to fully embrace mindfulness. In trauma cases especially, she says, it is often necessary to first help the client connect with whatever makes them feel safe and loved, whether it be religious practices, a relationship with a family member or their dog. In creating this safe "container," as Brach calls it, the therapist gives the patient something to hold on to that provides a sense of a healing refuge. In fact, all clients can benefit from establishing some kind of anchor or home base, she says--a way of quieting the mind by returning to one thing, such as the breath, physical sensations or sounds.
Mindfulness is also useful for combating what Brach calls the "trance of unworthiness," the all too common tendency to be constantly and harshly self-critical. Changing one's internal script is also central to cognitive-based therapy, and a 2000 study in the Journal of Consulting and Clinical Psychology, (Vol. 68, No. 4, pages 615-623) found that mindfulness-based cognitive therapy was particularly effective in preventing a recurrence of depression in patients who had experienced three or more previous episodes.
Although there are many ways mindfulness-based techniques can be integrated into therapy, Brach believes that meditation is essential for maintaining mindfulness.
"What I have found is that there really is no substitute for formal practice," she explains. "The conditioning to be harsh with ourselves and others is so strong...you really need a dedicated practice every way."
In the Eastern tradition, says NCCAM's Chesney, acupuncture and meditation are often combined in a whole-system approach. Her center is interested in learning more about the effects of these Eastern therapies used together, and with other psychological interventions, on both physical health and psychological well-being.
Already immersed in such work is Jim Nourse, PhD, a private practitioner in Brevard, N.C., who decided to augment his practice with acupuncture after reading "Dragon Rises, Red Bird Flies: Psychology & Chinese Medicine" (Eastland Press, 2005), a book about the intersection of Eastern medicine and Western psychology by psychiatrist Leon Hammer, MD.
Although few studies specifically address acupuncture's effects on mental health, a 2004 study in the Journal of Affective Disorders (Vol. 83, No. 1, pages 89-95), found that among pregnant women suffering from depression, acupuncture targeted to points that control depression was more effective than either acupuncture targeted to general points or massage therapy. Another study that appeared in the Journal of Clinical Psychiatry (Vol. 67, No. 11, pages 1665-73), in 2006 found that two groups of patients with major depression who received acupuncture demonstrated significantly more improvement than a group placed on a wait list for the same treatment. Nourse says that he was persuaded that acupuncture could have appreciable effects when he used it to resolve his own migraines and fall allergies. Hammer's words about the sometimes ephemeral nature of therapeutic breakthroughs also resonated with him.
"Hammer made the point that he was able to get good resolution of problems on a mental level, but that he had noticed that patients often had a tendency to regress," he says. Nourse agrees that talk therapy wasn't enough--problems would keep resurfacing if a person's underlying energy remained unchanged.
Nourse says acupuncture has allowed him to make progress with patients more quickly and in some cases has been the one tool that has worked when others haven't. For instance, recently a client experiencing a major depressive episode reached a point where she was no longer motivated or interested in anything--her life, daily activities and certainly not her therapy.
"She was all but suicidal and we had already tried two different antidepressants," says Nourse. The client agreed to try acupuncture, and he focused on the kidney, which practitioners of Chinese medicine say affects willpower, energy and motivation. Within two treatments she felt more able to participate in her therapy and could more readily move forward, he says.
Acupuncture can also be helpful for anxiety, anger management, panic disorders and obsessive-compulsive disorders because, among other things, it reduces autonomic overload, believes Nourse. The treatments can restore the body's energy balance, and everything is connected to the energy system.
"Chinese medicine is the original mind-body medicine," he says. "The Chinese view is that personal energy systems are balanced on both the physical and the mental. When you target one, you can't help but influence the other."
American Psychological Association (Producer). Mindfulness-based cognitive therapy for depression: Part of the APA spirituality video series [DVD or VHS]. (Available from APA, 750 First St., N.E.,Washington, DC 20002-4242).
American Psychological Association (Producer). Mindful therapy: Part of the APA spirituality video series [DVD]. (Available from APA, 750 First St., NE, Washington, DC 20002-4242).
Allen, J.B.J., Schnyer, R.N., Chambers, A.S., Hitt, S.K., Moreno, F.A., & Manber, R. (2006). Acupuncture for depression: A randomized controlled trial. Journal of Clinical Psychiatry, 68, 1665–73.
Brach, T. (2004). Radical acceptance: Embracing your life with the heart of a Buddha. New York, NY: Bantam.
Hammer, L. (2005). Dragon rises, red bird flies: Psychology & Chinese medicine, Rev. ed. Vista, CA: Eastland Press.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness. New York, NY: Delacorte Press.
Manber, R., Schnyer, R.N., Allen, J.B.J., Rush, J.A., & Blasey, C.M. (2004). Acupuncture: A promising treatment for depression during pregnancy. Journal of Affective Disorders, 83, 89–95.
Miller, W.R., Ed. (1999). Integrating spirituality into treatment: Resources for Practitioners. Washington, DC: American Psychological Association.