Cliff Hamrick was meditating long before he became a counselor, having found the practice useful for treating the depression he had experienced some years before. Now a private practitioner in Austin, Texas, Hamrick integrates Eastern and Western approaches to counseling because he believes it benefits his clients.
Partway across the country in Connecticut, counselor Deb Del Vecchio-Scully also combines Eastern and Western approaches when working with clients. She discovered guided imagery and meditation almost three decades ago while seeking ways to manage her pain after multiple back surgeries.
As technology continues to “shrink” the world and as the counseling profession steadily expands its global presence, it is not hard to predict that an increasing number of counselors will join Hamrick and Del Vecchio-Scully in further breaking down barriers and intermingling Eastern and Western approaches to counseling.
Isabel Thompson, an assistant professor with the Center for Psychological Studies at Nova Southeastern University, has researched and presented on this topic. She has also integrated Eastern contemplative approaches into her work with clients and says Eastern and Western counseling approaches have similarities in that they both focus on relieving human suffering and helping people feel better. But they also differ, she points out. Generally, Western approaches place more focus on psychopathology and rely on a medical model of alleviating symptoms, Thompson says. Although Eastern approaches can also be applied to psychopathology and the alleviation of symptoms, their primary focus tends to be on flourishing and achieving optimal human development through leading an ethical life, says Thompson, a member of the American Counseling Association.
Fred Hanna, a professor in the Department of Counselor Education at the University of Northern Colorado, says Western approaches place more emphasis on correction and on mitigating feelings and symptoms. Eastern approaches, on the other hand, are more aimed at liberation and “setting [people] truly free so they can be in charge of their feeling states and so they can control their thoughts,” Hanna says. “This can be done through Eastern meditation techniques as well as direct Eastern-derived psychological techniques.”
In traditional Western thought, emotional problems aren’t viewed as affecting the body, Del Vecchio-Scully says, whereas in traditional Eastern thought, it is all interactive. “Everything that happens in the body affects the mind and emotions, and vice versa,” says Del Vecchio-Scully, a certified yoga therapist and Reiki master who is also the executive director of the Connecticut Counseling Association, a branch of ACA. Del Vecchio-Scully often sees that mind-body interaction play out among her clients, who are referred to her through the neurology group for which she works, Associated Neurologists of Southern Connecticut.
“I find that Eastern thought is rooted more in the integration of mind-body and energy,” says Serena Wadhwa, an ACA member who works in a hospital outpatient group practice and runs a private practice in Chicago. “Western thought tends to separate body and mind, although there is much progress [being made] in this area. We see the approaches of yoga, tai chi, Ayurveda and Chinese medicine, to name a few, that also focus on utilizing the body’s natural healing systems and restoring balance. Western thought usually involves a ‘quick fix’ medicinal approach.”
In a broad sense, there’s also a difference in the locus of control, says Hamrick, a member of ACA. With many Eastern approaches, it is assumed that people will fix themselves, often by paying close attention to themselves and their surroundings, he says. In the West, that control tends to be externally located, he says, with the expectation being that the “right” technique or intervention will fix the client. Hamrick says those differing ideas likely took root in the respective cultures. Buddhist and Hindu traditions teach that each individual person has a soul or god residing within them, whereas Western European thought suggests that individuals should rely on an external, all-knowing God or someone else to help them and guide them along the way. In the West, that often translates to the counselor being viewed as the “expert” and outcome success hinging on the counselor’s advice and interventions,
Hamrick believes there is room for both views. He likes for his clients to feel that they possess the power within to handle and solve their mental and emotional issues, which is based more in Eastern thought. But on the Western side, he says, an abundance of good scholarly work is being done that he can pass along as knowledge to his clients, such as new research in neuroscience and positive psychology.
Although Eastern and Western counseling techniques traditionally come from different vantage points, Wadhwa says it is important for counselors to recognize that the underlying concepts are often the same. For example, the idea that our thoughts have an impact on us is fairly universal, says Wadhwa, who is originally from India and has presented on Eastern treatment considerations in working with Asian populations. “So I use both cognitive restructuring and mindfulness in my work, and depending on how I introduce these techniques, the individual I am working with may be more open to exploring how it may work for them.”
Wadhwa says she discusses with clients how thoughts may cause suffering and explains the idea behind both approaches. “I explain how cognitive restructuring works by providing strategies to cope with the thoughts and how mindfulness practice works at detaching from the thoughts and focusing back on the present moment. I also explore how coping with the thoughts may be initially more relieving than mindfulness, as mindfulness takes practice. Most clients are open to learning how to cope with their thoughts and then how to detach from them.”
In a counseling session that he supervised, Hanna remembers a client diagnosed with borderline personality disorder who had cut herself habitually and reported that she had attempted suicide 160 times. Hanna and his doctoral student asked the client to bring to mind the feeling she would have just before she started to cut or attempt suicide. “Then what we did was have her go directly into that feeling,” says Hanna, a member of ACA. “It was sort of a therapy-assisted meditation of exploring those feelings.”
Hanna and the counselor-in-training asked the client to imagine she was in an elevator made of thick, clear glass that she could take straight down into her feelings. They told her she couldn’t feel the pain or anxiety inside the elevator but that she could see what was deep down inside those feelings. In her mind, the client took the elevator, little by little, all the way to the bottom. She reported that it was like a lake, and at the bottom of it all, there was really nothing to be afraid of. After reaching the bottom and thoroughly exploring her feelings, the client filled the lake with earth and put a house on top of it in her mind. “After those sessions, the client reported a marked decrease in her borderline symptoms,” Hanna says.
Hanna created the approach that he and his doctoral student used with the client. He calls the approach “internal control therapy,” which he describes as a blend of yoga psychology, Buddhism and a few Taoist ideas. “Using that object-oriented approach, [the client] was literally taking control over those feelings … that were before in control of her,” Hanna says. Internal control therapy makes use of a client’s powers of creativity to generate positive feeling states and unbuild negative ones, he says.
From a yoga psychology perspective, the mind is an object that can be manipulated, akin to an ordinary physical object, Hanna says. His internal control therapy taps into that perspective. “If [clients have] a strong image in their mind of someone who hurt them and they carry that image around — I wouldn’t want their image hanging in my living room, would I? But we carry those images around in our minds. … If you treat [that image] as an object, you take it down and throw it away.”
Although yoga psychology is a traditionally Eastern approach, Hanna thinks its application can benefit Western psychology by offering an alternate view of psychopathology. Whereas the Diagnostic and Statistical Manual of Mental Disorders (DSM) presents classifications for disorders in an attempt to explain and treat mental illness, Hanna says yoga psychology offers the idea that there are five points that lead to suffering and dissatisfaction with life: ego and self-centeredness; cravings beyond what we need; resisting something; ignorance; and fear of death. In this view, when people get overly bogged down with any of the five points, it can result in suffering and psychological problems.
Hamrick gravitates toward a different Eastern-based approach — mindfulness meditation — introducing it to almost every client with whom he works. “Usually in the first session, I will spend about five minutes walking a new client through a sitting meditation just to show them how the technique works and demonstrate its usefulness,” he says. “My clients with anger, depression and anxiety find it particularly helpful [as a technique] to … control their emotions, stop ruminating on the past and prevent worrying about the future. Clients learn that racing thoughts can be stopped or slowed down with practice.”
Mindfulness-based therapy is akin to mental training, Hamrick says. “My clients learn how to train their mind so they can think about what they want to think about, when they want to think about it and how they want to think about it,” he says. “[Clients] wouldn’t tolerate their right arm suddenly going off and flailing around without their control. So why would they tolerate their brain doing the same thing? Mindfulness teaches clients to focus on the here and now rather than on the there and then and on what they can control rather than on what they cannot control.”
Hamrick also uses the Buddhist concept of impermanence, especially with clients dealing with depression, anxiety or substance abuse. “This concept emphasizes that nothing lasts forever,” he says. “It gives hope to the hopeless. There is no reason to believe that the client will always be in the same situation [he or she is] in now. Depression can be treated and overcome. A panic attack never lasts forever. And plenty of people have overcome addictions of all kinds. Once we’ve established that the situation can be overcome, then I find using solution-focused techniques will help clients develop a plan to overcome what’s facing them.”
Counseling and contemplation
Thompson has long nurtured an interest in contemplative practices, a broad term, she says, that includes both formal seated meditation practices and practices such as walking meditation and yoga. She says contemplative practices are “activities that are used to cultivate the mind and the heart.”
According to Thompson, the act of contemplation helps shift us out of a current mode of thinking to a broader, more open mode of thinking that increases our ability to understand issues. “When we are stressed out, or if a family system is under extreme stress, [our] brains are firing for survival,” she says. “Contemplation helps one relax so that the brain reorients to a more reflective and calmer place — a place where problems can be solved more easily because there are more resources available to draw from. The foundation of any contemplative technique is to focus on relaxation first, then gain stability of concentration and then advance to vividness/intensity. The West tends to focus on intensity first without understanding that … intensity is unstable” unless relaxation is also emphasized.
Both Eastern and Western mental health approaches use a form of contemplation, Thompson says, but the East has a longer history of developing those techniques. “This stems from the two different modes of inquiry that the East and West have emphasized,” she says. “The West and its modes of inquiry have generally relied on exploring reality from a ‘God’s-eye view’ or an objective standpoint through science, while the East’s more contemplative approach starts with subjective experience and phenomena, then moves out from there. This approach still asks empirical questions, but the answers are more rooted in subjective experience.”
Both the counseling profession and Eastern philosophy share a respect and appreciation for the client’s subjective, internal experiences, Thompson says, which makes them a good match for the integration of contemplative approaches. Contemplative approaches are typically present-focused, Thompson says, adding that studies have linked a contemplative mind to lower cortisol levels, lower rates of depression, fewer heart attacks and lower rates of cancer.
For clients presenting with a concrete situation that they need assistance changing, a Western approach might work best, Thompson says. For example, a Western-based counseling approach might be a better fit for a family seeking help with a child’s school-related issue, such as bullying or poor academic performance. “A contemplative approach may be more useful for issues related to the long term, more related to lifestyle or a chronic condition — for example, working with habits, chronic anger or chronic pain,” she says.
A benefit often exists to blending Eastern and Western approaches as well, Thompson says, such as when working with a client with severe depression. “I have found that addressing the depression first using a more Western counseling approach is beneficial,” she says. “For example, I might start with a person-centered approach to build a therapeutic relationship with clients and then integrate elements of cognitive behavior therapy (CBT) to help clients see the connection between their thinking patterns, behaviors and moods. I also might include psychoeducational components to help clients understand their symptoms and realize that they are not alone in healing from depression. When someone is suffering from severe depression, many things, even contemplative practices, can become tools of self-recrimination. Therefore, helping a client to break the downward spiral of depression characterized by guilt, regret and self-blame is a starting point. Then, a foundation for a positive spiral, characterized by acceptance, gentleness and self-compassion, can be laid.”
In cases such as these, Thompson says, she would gently integrate Eastern approaches at a pace that is right for each client. This gives her time to ensure she is being sensitive to the needs of the client and allows her to gain a solid understanding of the client’s worldview and beliefs. “For me, Eastern approaches emphasize returning to gentleness and self-compassion as foundations for future change,” she says. “Sometimes clients suffering from depression have a greater sense of compassion for others than they do for themselves. Helping them to see their own worth and recognize that they deserve compassion as much as others begins the process of cultivating self-compassion and acceptance.”
Treating trauma and pain
Many of the clients Del Vecchio-Scully sees are dealing with posttraumatic stress disorder (PTSD) and chronic pain. A blended approach of Eastern and Western techniques tends to yield the best results for these clients, says Del Vecchio-Scully, who is certified in integrative yoga therapy, a specialized form of yoga that can be used with clients with medical conditions.
For chronic and acute pain, Del Vecchio-Scully says relaxation and meditation techniques are key. From the Western side, she says, that can include CBT, guided imagery and dialectical behavior therapy (DBT). From the Eastern side, her chosen approaches include mindfulness, yoga breathing, Buddhist meditation, Tibetan chants and mantra. The aim of these techniques is to reduce clients’ anxiety, which can frequently accompany pain and the human tendency to guard against the pain, Del Vecchio-Scully says. “For example, if I have a sprained ankle, I will avoid putting weight on it for fear of pain,” she says. “This phenomenon actually creates more pain by creating additional tension in the muscles and tissues. When a person in pain can release this tension through relaxation, their pain decreases.”
As it relates to PTSD, Del Vecchio-Scully says counselors must have a toolbox of coping skills to help clients effectively manage and heal their trauma. Clients with PTSD often experience a cluster of arousal symptoms, she says, including insomnia, nightmares, irritability, anger outbursts, hypervigilance and an exaggerated startle reaction. These clients are often experiencing a stress response that is stuck on “on,” she says.
“The most effective approach to arousal is calming and soothing,” Del Vecchio-Scully says. “How this is accomplished is where a blend of East-West skills can be applied. Each of these symptoms taken on its own could have its own treatment approach. Insomnia, with difficulty falling asleep, could be treated with CBT and sleep hygiene as well as sleep meditation [and] self-hypnosis. Many times, trauma survivors have insomnia because they are afraid to go to sleep. In this case, identifying ways to foster safety — guided imagery, visualization, hypnosis, expressive therapies and art therapy, which can be either Eastern or Western in how they are applied — can be helpful. It truly is individualized to address each person’s unique presentation.”
Clients who have experienced trauma might present with hypervigilance and dissociation, which together can form a vicious cycle, Del Vecchio-Scully says. But teaching these clients to be present to their feelings can help them feel less afraid and threatened, she says. A Western approach of psychoeducation can be useful in addressing hypervigilance because it teaches clients about the nature of trauma, she says. Del Vecchio-Scully might then follow that up with Eastern techniques that provide restorative, calming experiences, including yogic practice and breathing, mantra meditation, affirmations and safety totems, such as hope stones that clients can carry with them.
“Another way of blending [Eastern and Western] approaches,” she adds, “is through the use of trauma-informed art therapy, which utilizes expressive arts therapies [including] yoga, art-making [and] mindfulness to stabilize mood and dysregulation often experienced by trauma survivors.”
Del Vecchio-Scully again blends East and West in addressing the dissociative piece of trauma, using Western-based progressive muscle relaxation and Eastern-based basic centering/grounding and additional yogic techniques.
One client who came to see Del Vecchio-Scully was dealing with a history of PTSD and bullying, while also struggling with fibromyalgia and chronic fatigue. Once again, Del Vecchio-Scully found a blended approach worked best. “She benefited from medication to improve her sleep and reduce pain; meditation — guided imagery, visualization and mantra — to calm and soothe herself; and psychoeducation regarding the nature of PTSD and the many ways it can present — for example, anxiety and hypervigilance, chronic pain, insomnia. In this case, medication alone would have helped her sleep without changing the cause of her pain syndrome and anxiety. She has found the meditation particularly useful in reducing her anxiety, improving mental clarity and fatigue.”
Del Vecchio-Scully also uses Reiki, a healing tradition that originated in Japan, with some of her counseling clients. The idea is that every living thing has an energetic vibration, and Reiki is one way of experiencing that life-force energy. “There are many ways to share Reiki with another,” Del Vecchio-Scully says. “It can be given through a light touch or by placing your hands close to a person’s body. It can also be shared through intention. For example, in my counseling session, I activate my Reiki vibration, which can help the client feel calmer and settled. Reiki and other energetic-based techniques help clients to assess their own well-being [and] can reduce anxiety and chronic pain. I use psychoeducation to identify [clients’] own energies and teach them methods to do so [themselves].”
Finding the client’s comfort zone
Although Eastern and Western approaches tend to come from different perspectives, these counselors say there are benefits to be gained in session by blending them according to each client’s needs. “The blending of Eastern and Western healing work is a philosophy of how I, as a therapist, approach counseling,” Del Vecchio-Scully says. “My counseling training taught me how to identify psychopathology, which is invaluable in identifying a client’s symptoms and classifying them. It gives me the starting-off point for therapy. However, the healing process begins with normalizing their behaviors, feelings and experiences as often normal reactions to abnormal situations. This clearly doesn’t include psychosis, delusions, hallucinations, intention for self-harm or harm to others. My philosophy is holistic, incorporating the mind and body, emotions and spirit using the best of the traditional Western approaches and perhaps nontraditional — though I believe this is changing — Eastern approaches. Both have value when
used with clinical skill for the client’s greater good.”
For example, Del Vecchio-Scully says, if she is using basic CBT techniques such as cognitive restructuring, cognitive reframing and challenging limited beliefs with a client, at the same time, she will ask that client to take a moment to stop and breathe. Teaching people how to be in the here and now is a basic Gestalt concept, but yoga and mindfulness practice are also steeped in that philosophy, so a lot of overlap is present, she says. “I weave mindfulness into any intervention I am doing,” she says. “It’s always about, ‘Take a breath. Let’s see if we can slow down the pace of what’s going on inside.’”
Wadhwa, who is also the program coordinator for an addictions counseling concentration at Governors State University in University Park, Ill., often allows the client to choose the best route. “I will usually introduce Eastern approaches [by saying], ‘One approach that exists is …’ This seems to work well for my clients. They ask questions, and we discuss the topic.”
For example, Wadhwa has seen clients who were dealing with transgenerational issues. “When clients recognize some pattern from generation to generation, I’ll offer the transgenerational thought of how things may be passed down,” she says. “I’ll introduce the approach of karma and how one approach believes that one generation works out the karma of the previous generation and that maybe what my client is experiencing is the cumulative effect of that karma. If this is something that resonates with the client, then I’ll offer some options on assignments geared toward this. If not, we’ll explore what elements of these different approaches fit better for the client and what [he or she] thinks may be helpful in resolving or healing this particular issue.”
These counselors acknowledge that some clients are hesitant to try techniques that incorporate elements of a traditionally Eastern approach. If Hamrick encounters a client who is unsure about meditation, he raises the point that meditation is a form of mental training. “I explain how meditation has been shown in scientific research to be beneficial in the treatment of depression and anxiety, and [how] scans of the brains of people who have practiced meditation, even for short periods of time, have shown real changes in the structure of the brain that allow for better emotional control,” he says. “When put in these concrete terms, clients typically want to try meditation.”
Thompson looks for approaches that are relatable to the client. For example, she has worked with individuals who were turned off by the idea of meditation because they thought it ran counter to their closely held religious beliefs. “It [didn’t] connect with their experience of the sacred,” Thompson says. “I want to be helpful to them in the worldview that makes sense to them, so I might ask them instead about what Scriptures provide them a sense of peace [or] what brings them calm.”
Radical acceptance, which also has Eastern themes, is another approach Thompson sometimes uses, particularly with clients struggling with perfectionism and self-judgment. At times, however, these clients resist the idea of acceptance because they have come to counseling with the idea of “fixing” themselves, she says. At that point, Thompson might switch to the technique of motivational interviewing. “Have you achieved your goals with self-criticism?” Thompson asks clients. “What would it be like to accept that this is where you’re at?”
Regardless of where counselors fall on the spectrum of Eastern versus Western approaches, Thompson believes meeting clients where they are and using techniques they are comfortable with is most important. “In order for a transaction to occur, the therapist must meet the client in his or her worldview and understanding of change and contemplation,” she says. “It takes so much courage to come to a counselor, and I want to demonstrate to my clients that I honor their courage. I want to help them alleviate the suffering that spurred them to come into counseling. Therefore, gathering information about clients, their cultural backgrounds, their family backgrounds, their worldviews and spiritual and/or religious beliefs is essential. The question ‘How would you like to try … X?’ is helpful. If the client is not interested, then I do not pursue it.”
“Most clients agree that relaxation in one form or another is helpful, so I like to start from there,” Thompson continues. “It can easily move to progressive relaxation, full body awareness or simply cultivating the wish for happiness and to alleviate suffering. A useful question related to mindfulness is, ‘What do I need to do and what do I need to stop doing in order to be happy?’ What is surprising is that answer can frequently range from mundane tasks such as doing more laundry to completely changing how one engages with reality. Contemplative approaches have something for everyone.”
Although not a common occurrence, Del Vecchio-Scully recalls one client who was concerned that yoga might run counter to her Christian faith. “I talked it through with her and supported her decision,” Del Vecchio-Scully says. “The only path is to honor and respect their feelings toward something and move on in another direction.”
Del Vecchio-Scully says she doesn’t present approaches as being Eastern versus Western with clients. “We discuss what may be helpful to them and then try to identify the right interventions for them based on personality, openness and willingness to try,” she says. “I reinforce that if one thing doesn’t work for them, there are always many options.”
Maintaining counselor identity
As more counselors begin promoting the benefits of Eastern-based approaches such as meditation, mindfulness and yoga, the public may question what counseling has to offer that meditation centers or yoga retreats don’t.
“In a meditation center, the only focus is on meditation,” Hamrick says. “In counseling, the focus is on the client feeling better. In counseling, I might use meditation as a tool to help my client, but I have many more tools in my toolbox. I think the biggest benefit that clients can get from counseling that they can’t get at a meditation center is the opportunity to talk about painful and possibly embarrassing topics with an unbiased and confidential professional.”
Counseling remains more clinically oriented as well, adds Del Vecchio-Scully. “I’ve made a diagnosis and formulated a treatment plan that includes multiple interventions based on the diagnosis,” she says. “There are different types and styles of meditation and yoga that garner different outcomes. This is where the blend of my clinical training and Eastern specialties is a distinct advantage. Within the guided imagery field alone, there are many approaches for clinical issues, and [they] are based on the written script. A nonclinician isn’t going to have this expertise. Also, [counseling clients] are getting one-to-one attention to their issues, and techniques can be modified based on their needs. This isn’t going to happen in a group setting [led] by a nonclinician.”
With the influence of globalization, Del Vecchio-Scully predicts the counseling profession will continue to experience a shift toward eclectic practice, including the incorporation of Eastern-rooted approaches. The complementary nature of Eastern and Western approaches will further facilitate that movement, Thompson adds. “Both Eastern and Western approaches share the common goal of helping people,” she says. “Eastern approaches can provide tools to help clients work with their minds and emotions to build on the changes they have made through Western approaches.”
Thompson, who has pursued trainings focused specifically on integrating contemplative practices into counseling, says many training options are available to counselors who want to blend Eastern approaches into their work. However, she says, there is no one “best” training, just as there is no one best approach to counseling.
Regardless, it is imperative that counselors have personal experience in whatever practice they might ask their clients to engage in, she says. “Do your own yoga, seek out meditation on your own,” Thompson says. “Personal exploration and practice are essential. If you want to share meditation with your clients, pursue contemplative training and practice it first. If you want to integrate mindfulness attitudes and practices into your work with clients, again, find ways to integrate them into your own life through training, retreats and personal practice. In addition, finding a community of counselors who incorporate Eastern/contemplative approaches is extremely helpful. There is a community of counselors in my area who incorporate Eastern approaches — specifically mindfulness — into clinical practice. This has been a wonderful resource and inspiration for me. Also, for clinicians working on licensure, finding a supervisor who incorporates Eastern approaches would be an excellent means of getting support.”
Hamrick agrees that personal experience is the best starting point. “Eastern philosophy is based on the individual experience,” he says. “You can read a pile of books and have a beginning understanding of Buddhism, Hinduism or Taoism. You can learn the steps of meditation and teach them to others. But if you really want to incorporate Eastern approaches into your counseling, you need to start practicing them first. Once you’ve really experienced the changes they can bring to your life, then you’ll really be ready to present them to your clients.”
“The first thing to do is put down this magazine and look around the room,” he says. “Really look without thought and without judgment and without analysis. Simply sit, look and be. That’s a good start.”
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