Psychiatrist Mark Epstein’s Advice Not Given: A Guide to Getting Over Yourself (Penguin Press, Jan. 2018) explores the connection between Buddhism and psychotherapy.

Your last book, The Trauma of Everyday Life, touched on how Buddhism and post-Freudian psychotherapy overlap in how they treat trauma. What makes this book different from the last?

The two books differ mostly because I’m still trying to figure out what I understand and what I don’t understand. All my books are attempts to bring together what I’ve learned—on the one hand, from a study of Buddhism that predates my study as a psychiatrist, and, on the other hand, from my ever-increasing number of years of working as a therapist. In this book, I’m trying to write from a position of maturity as a therapist, and present what I’ve learned from Buddhism and what I’ve expressed as a therapist for a general audience.

What’s the general way in which you see these two philosophies cohering?

They’re both about facing the ego—about turning the ego from a fearful master into more of an ally or a servant, through a process of self-observation. But they’re coming at that from very different places. In Buddhism, there wouldn’t even have been a word for ego. But a lot of my work is trying to translate Buddhist psychology into the psychological language we all speak.

What’s a specific way that you’ve found Buddhism can inform psychotherapy in terms of working on the self?

Buddhism has a very clear and simple and practical message, which is that it’s possible to cultivate the muscles of self-awareness. I think psychotherapy understands that very well, but it came upon it through a more circuitous route and hasn’t quite recognized or defined how powerful that actually is—although its method, of sitting two people together, with no agenda between them, looking to see what emerges, is really similar to meditation.

Do you find that trauma therapy taps into Buddhism without even intending to?

I think with any kind of psychotherapy, no matter the method, a big ingredient in whether it helps or not has to do with the relationship between the therapist and the patient, and that’s particularly true for trauma. What helped me the most in learning about trauma is the idea that it’s not only what happens that defines something as traumatic—it’s the relational environment that it’s contained in. In other words, when trauma happens, the tendency has been for people to keep that very private, and to feel ashamed about it themselves. The Buddhist word for suffering is dukkha, which usually translates as “hard to face.” There are all these aspects to our experience that we keep shut away because they’re hard to face—trauma being the most explicit of them. All the trauma therapies are really about opening up what’s been called a relational home in which it becomes okay to actually process or digest or metabolize what that experience was. And that’s where I think therapy becomes therapeutic.

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