Practice Innovations © 2018 American Psychological Association 2018, Vol. 3, No. 1, 18–31 2377-889X/18/$12.00 http://dx.doi.org/10.1037/pri0000059 The Zentensive: A Psychodynamically Oriented Meditation Retreat for Psychotherapists

Simon B. Goldberg Lawson D. Sachter Veterans Affairs Puget Sound—Seattle Division, Windhorse Zen Community, Alexander, Seattle, Washington, and University of North Carolina Wisconsin—Madison

There is a substantial body of evidence suggesting that therapists vary in their ability to positively impact patient outcomes, but less is known about ways therapists can improve their outcomes. While several promising methods exist for training therapists in interpersonal skills linked to patient outcomes, fewer methods have been outlined for training intrapersonal skills. The current study reports the rationale and theoretical framework for a psychodynamically oriented meditation retreat: the Zentensive. This retreat combines Zen Buddhist teachings and meditation practice with an understanding of unconscious dynamics drawn from Habib Davanloo’s Intensive Short-Term Psy- chodynamic Psychotherapy. We argue that intensive meditation practice offers a unique opportunity for mental health providers to gain insight into their own unconscious dynamics, leading to the development of intrapsychic skills, in ways that can improve their ability to work with others. The structure of the Zentensive, theoretical contribu- tions from both Buddhist and psychodynamic traditions, and the unique need addressed by this integration are discussed. In addition, preliminary qualitative feedback from past retreat participants is presented.

Clinical Impact Statement This study outlines a meditation retreat designed for psychotherapists and based on Zen Buddhist and psychodynamic psychology that may help develop skills that are relevant for professional practice in psychotherapy.

Keywords: therapist training, intrapersonal skills, Zen Buddhism, meditation, intensive short-term dynamic psychotherapy Supplemental materials: http://dx.doi.org/10.1037/pri0000059.supp

Knowing your own darkness is the best method for There is now compelling evidence that psy- dealing with the darkness in other people. chotherapists exert a significant influence on —Carl Jung (Coward, 1985,p.47) their patients’ treatment outcomes. While many practicing psychotherapists have long been con-

This document is copyrighted by the American Psychological Association or one of its allied publishers. vinced this is the case (Walfish, McAlister, This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. O’Donnell, & Lambert, 2012), only recently has This article was published Online First January 18, 2018. this been demonstrated meta-analytically. In a Simon B. Goldberg, Veterans Affairs Puget Sound— recent review of 46 studies, Baldwin and Imel Seattle Division, Seattle, Washington, and Department of Counseling Psychology, University of Wisconsin— (2013) reported that approximately 5% of the Madison; Lawson D. Sachter, Windhorse Zen Community, variance in patient outcomes is explained at the Alexander, North Carolina. therapist level, with an even larger proportion Correspondence concerning this article should be ad- attributable to therapists in naturalistic settings dressed to Simon B. Goldberg, Veteran Affairs Puget Sound Health Care System—Seattle Division, 1660 (7%). Of note, this proportion of variance is South Columbian Way, Seattle, WA 98108. E-mail: considerably larger than that due to differences [email protected] between treatments (i.e., 1%; Wampold & Imel,

18 ZENTENSIVE RETREAT FOR PSYCHOTHERAPISTS 19

2015), and similar to that associated with fac- 2016) and improving therapists’ detection of tors common across treatments (e.g., 7.6% at- cases that are deteriorating. tributable to therapeutic alliance; Horvath, Del Deliberate practice is another avenue through Re, Fluckiger, & Symonds, 2011). A growing which therapists may improve (Rousmaniere, body of literature has begun to demonstrate the 2017). Deliberate practice has been defined as various specific ways in which therapists may observing one’s own work, getting expert feed- impact their patients’ outcomes over the course back, setting learning goals just beyond one’s of therapy (e.g., through impacting trajectories ability, repeatedly rehearsing relevant skills, and of symptom change; Goldberg, Hoyt, Nissen- continually assessing performance (Ericsson, Lie, Nielsen, & Wampold, 2016). Krampe, & Tesch-Römer, 1993; Rousmaniere, Although it is clear that therapists impact 2017). Although experimental studies examin- patients’ outcomes, it is less clear what thera- ing the efficacy of deliberate practice are lack- pists can do to improve their outcomes. This is ing, findings from learning sciences (e.g., Eric- not an inconsequential concern, particularly sson et al., 1993), medicine (McGaghie, given it appears that therapists’ outcomes do not Issenberg, Cohen, Barsuk, & Wayne, 2011), improve simply by therapists gaining clinical and correlational evidence in psychotherapists experience (Goldberg, Rousmaniere, et al., supports this practice. For example, the amount 2016). Historically, training in specific treat- of time that therapists spend engaging in delib- ment modalities has been considered to be the erate practice is correlated with their patient most obvious route to improving outcomes, but outcomes (e.g., “mentally running through and evidence suggests that differences between reflecting on what to do in future sessions”; treatments are small (Wampold & Imel, 2015). Chow et al., 2015, p. 341). Because of this, some researchers have begun to While the methods discussed (i.e., interven- focus on other aspects of treatment delivery that tion-specific clinical supervision, ROM, delib- may influence outcomes (e.g., therapeutic alli- erate practice) may be effective for training ance; Horvath et al., 2011). many of the technical aspects of clinical prac- Whether receiving training in a specific treat- tice, none of these methodologies focus on ment modality or in strengthening therapeutic training therapists’ intrapersonal skills.1 By in- factors common across therapies, psychothera- trapersonal, we are referring to events occurring pists often rely on some form of clinical super- within the therapist. In contrast to interpersonal vision for the development of skills that can skills (e.g., the ability to communicate clearly improve patient outcomes. However, it appears and effectively with patients, the ability to ex- that supervisors predict essentially zero vari- press empathy; Schot˘tke, Fluc˘kiger, Goldberg, ance in patient outcomes (i.e., 0.04%; Rous- Eversmann, & Lange, 2017), intrapersonal maniere et al., 2016). A recent systematic re- skills are by nature not directly observable. view failed to find convincing evidence that Nonetheless, several intrapersonal skills are in- supervision significantly impacts patient out- tuitively linked to therapists’ efficacy and are comes (Watkins, 2011). highlighted in competencies that have been There are, however, other therapist practices identified to guide clinical training and practice that have been shown to relate to outcome. One (Fouad et al., 2009). In particular, Fouad et al. such practice, routine outcome monitoring (2009) identified a variety of affective and ex- This document is copyrighted by the American Psychological Association or one of its allied publishers. (ROM), involves having patients complete ques- pressive skills (such as awareness of inner emo- This article is intended solely for the personal use of the individualtionnaires user and is not to be disseminated broadly. (e.g., of psychological symptoms, tional experience, affect tolerance, and the abil- well-being, life functioning) on an ongoing ba- ity to effectively communicate one’s thoughts sis over the course of treatment, providing ther- apists feedback on how treatment is (or is not) 1 It is worth noting that some forms of deliberate practice progressing (Wampold, 2015). These methods and clinical supervision may focus in part on developing have been linked to improved outcomes in sev- intrapersonal skills (e.g., psychodynamic clinical supervi- eral randomized controlled trials (Shimokawa, sion, affect-focused deliberate practice; Rousmaniere, 2017). However, to our knowledge, typical forms of clinical Lambert, & Smart, 2010), perhaps through supervision and deliberate practice are not designed specif- making therapy a context more conducive to ically to provide the intensive intrapsychic training offered learning (Goldberg, Babins-Wagner, et al., in the Zentensive. 20 GOLDBERG AND SACHTER

and feelings) that are theoretically predicated on the degree of improvement in their symptoms intrapersonal skills and potentially linked to key more favorable than the patients of therapists therapy ingredients (e.g., the formation of a who did not receive training. Another study strong therapeutic alliance; Horvath et al., suggests that training in mindfulness may help 2011). The idea that therapists’ ability to effect decrease therapists’ stress and negative affect change in their patients is influenced by the and increase self-compassion (Shapiro, Brown, therapists’ own psychological functioning and & Biegel, 2007). Importantly, Shapiro et al. intrapersonal development has deep roots in the (2007) also reported increases in mindfulness, a history of psychotherapy. This is particularly construct that potentially measures some of the emphasized in psychodynamic traditions, sug- intrapersonal capacities that may be most useful gesting that intrapsychic capacities allow ther- for psychotherapists (e.g., awareness and accep- apists to more effectively manage countertrans- tance of one’s inner experience). A recent sys- ference reactions (Hayes, Gelso, & Hummel, tematic review of 39 studies found evidence that 2011). Assuming therapist intrapersonal skills interventions based on mindfulness are associ- are important for the provision of effective ated with improvements in burnout and nega- treatment, there is a need for methods to de- tive affect as well as increases in empathy in velop these skills. health care providers (Lamothe Rondeau, Mal- boeuf-Hurtubise, Duval, & Sultan, 2016). Cor- Meditation as Intrapersonal Skills Training relational studies have linked therapist trainees’ meditation experience with supervisor ratings Meditation practices offer one possible route of the trainees’ ability to manage countertrans- for the development of intrapersonal skills ference (Fatter & Hayes, 2013) and therapists’ (Goldberg, 2017). Meditation and mindfulness mindfulness skills with patient-rated therapeutic training have become topics of increasing sci- alliance (Ryan, Safran, Doran, & Muran, 2012). entific interest in Western psychology (Gold- Despite a growing body of literature examining berg et al., 2018; Sedlmeier et al., 2012; al- the impact of meditation-based interventions for though prior interest in the interface between psychotherapists, to our knowledge no empirical meditation and psychotherapy dates back sev- studies have explored the impact of an intensive eral decades, e.g., Ajaya, 1983; Walsh, 1977) and are part of a broader effort to integrate meditation retreat for psychotherapists (although elements of spirituality into psychotherapy, par- phenomenological examinations of retreat from a ticularly those perspectives and techniques Western psychological perspective exist; e.g., drawn from Eastern spiritual traditions (Kabat- Walsh, 1977). Of course, the potential transforma- Zinn, 2011). Many of the meditative practices tive power of retreat practice has long been rec- that have received the most scientific attention ognized in Buddhist contemplative traditions (Ra- are those derived from Buddhist traditions (e.g., hula, 1974; Kapleau, 1966) and some theorists mindfulness). These traditions use a variety of have suggested that unconscious material can be techniques, typically with the intention of cul- revealed during meditation (e.g., Ajaya, 1983; Ep- tivating certain qualities of awareness and un- stein, 1995). Several standardized mindfulness in- derstanding (e.g., nonjudgmental acceptance of terventions (e.g., mindfulness-based stress reduc- one’s internal experience, insight into the nature tion; Kabat-Zinn, 2011) include a daylong retreat of self; Dahl, Lutz, & Davidson, 2015; Kapleau, as part of the curriculum, with the explicit inten- This document is copyrighted by the American Psychological Association or one of its allied publishers. 1966). Given that meditation commonly in- tion of deepening participants’ experience of med- This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. volves attending to the content and/or process of itation practice. Compared with the amount of one’s inner experience, this family of practices research studying meditation-based interventions would seem to be highly relevant to the devel- occurring in the community, research on medita- opment of intrapersonal skills. tion retreats is nascent. There is, however, prom- There is some evidence from randomized ising preliminary evidence that meditation retreats controlled trials that meditation training may be may offer benefits similar to longer-term, nonre- useful for psychotherapists. In a landmark study, treat-based interventions. In a meta-analysis of 21 Grepmair et al. (2007) found that the patients of studies, Khoury, Knäuper, Schlosser, Carrière, therapists who received training in Zen medita- and Chiesa (2017) found moderate-to-large effects tion both rated the quality of their treatment and of traditional meditation retreats on measures of ZENTENSIVE RETREAT FOR PSYCHOTHERAPISTS 21

clinical outcomes (e.g., anxiety, depression), emo- tensive meditation practice, Zentensives can offer tion regulation, and mindfulness. participants therapeutic insights similar to those that may occur in psychotherapy. Such insights The Zentensive: A Meditation Retreat can contribute significantly to psychotherapists’ for Psychotherapists intrapersonal skills, and thus their personal and professional functioning. The current study reports on the theoretical framework of “Zentensives,” a specific type of Zentensive Model and Theoretical meditation retreat designed primarily for psycho- Underpinnings therapists. We have also included preliminary qualitative feedback shared by past retreat partic- Structure ipants. The structure and spirit of these retreats is rooted in both Buddhist and psychodynamic tra- Extended meditation retreats have been a ditions. They focus on the unique ways the West- core element of Zen training for well over 1,000 ern unconscious becomes mobilized during peri- years, and retreat-style practices are found in a ods of intensive meditation practice. Although the variety of spiritual traditions (Khoury et al., structure of this style of retreat has been evolving 2017; Wu, 2003). Zentensives strive to replicate since the mid-1990s, the first formal Zentensive the essential spirit of these retreats by cultivat- was held in 2014. ing both inner and outer silence (including Zentensives incorporate the metapsychology avoiding eye contact, i.e., “noble silence”), of the unconscious as formulated by Habib Da- while maintaining an ever-deepening presence vanloo in the form of intensive short-term dy- with each unfolding moment. During a Zenten- namic psychotherapy (ISTDP; Davanloo, 1990, sive, the actual formal sitting practice (i.e., sit- 2001b). These retreats are founded on the prem- ting on meditation cushions or chairs) most ise that intensive meditation practice offers ther- often involves either absorption in the breath, or apists a unique opportunity to work with deeper an inquiry practice (e.g., inquiry into the nature levels of their own unconscious than is typically of mind, e.g., through koan practice; Aitken, available in other settings (e.g., outpatient psy- 1982; Kapleau, 1966). Outside of the formal chotherapy, traditional clinical supervision). sitting periods (approximately 8 hr per day), This is designed to enhance participants’ ability participants are instructed to engage fully with to see into a range of emotional and character- the other activities of daily life (e.g., eating, ological patterns relevant to intrapersonal skills. walking, showering), in other words, to attend Before describing the specific theoretical tenets to the actual immediate experience of these and framework of the Zentensive, a final contex- activities rather than becoming lost in discur- tual comparison is worth making. Zentensives are sive thought. The daily schedule is included in designed to augment intrapersonal skills that ther- the online Supplemental Materials. apists may traditionally seek through personal Because of the emphasis on direct, moment-to- psychotherapy. Research suggests that the major- moment experience, a central ongoing theme ity of practicing psychotherapists receive their throughout the retreat involves distinguishing own therapy at some point in their lives (Ma- thoughts and ruminations from direct experience. honey, 1997). Some theoretical orientations also Thus, the practice calls for a returning of the emphasize receiving personal psychotherapy as a attention again and again to the present moment. This document is copyrighted by the American Psychological Association or one of its allied publishers. vital ingredient for developing both treatment- Some Buddhist retreats focus primarily on bodily This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. specific skills as well as the intrapsychic capacity sensations, or emphasize more affectively oriented for providing therapy. This practice is perhaps themes (e.g., compassion or loving-kindness prac- most common in psychodynamic and psychoana- tice; Khoury et al., 2017). During the Zentensive, lytic traditions (Kernberg, 1986), starting with this moment-to-moment attentiveness includes an Freud (1937): “But where and how is even the ongoing sensitivity to the unconscious dynamics most inadequate of individuals to acquire the ideal that may be arising—in other words, to the ways qualification for his work? The answer is: in his that the mobilized unconscious lets its presence be own analysis” (p. 401). We have found that by known. This process, as discussed below, involves taking advantage of the natural mobilization of the learning to attend to a range of “communications unconscious that occurs within the context of in- from the unconscious” (Davanloo, 2001a, p. 45). 22 GOLDBERG AND SACHTER

These may include elements of conscious anxiety, kind of training for that individual. Those unconscious anxiety (e.g., cognitive disruption, who struggle with certain instabilities (e.g., striated and/or smooth muscle tension), and/or a borderline personality disorder) may be en- variety of defensive structures (see Davanloo, couraged to first get further training before 2001a, for a discussion of these). attempting a Zentensive. The Zen teacher, in In addition to formal sitting and walking consultation with the Zentensive Advisory meditation, the retreat includes opportunities for Board comprised of mental health profession- participants to meet privately with the Zen als, makes the ultimate decision about teacher and to engage in group discussions. The whether to accept a potential participant. To meetings with the teacher, a licensed clinical further ensure participants’ well-being and social worker with nearly three decades of train- postretreat reintegration into their personal ing in ISTDP, offer participants a chance to and professional lives, guidelines are pro- explore, at whatever depths they choose, issues vided, and the Zen teacher is also available that arise related to their ongoing experience. for postretreat consultations. While meetings with the teacher are not in- tended to function as therapy, they are consid- The “Zen” in Zentensives ered confidential and are a place to work with anxiety that may arise in the course of practice The fundamental teaching of Buddhism gen- and to guard against potential iatrogenic effects erally and Zen Buddhism specifically is that of intensive meditation practice (see Lindahl, each of us is intimately, timelessly, and inexo- Fisher, Cooper, Rosen, & Britton, 2017, for a rably connected with all of existence (Kapleau, discussion of such potential effects).2 1966). Contrary to the established “medical The group discussions, which are also ex- model” of mental health, which tends to focus plicitly confidential, focus primarily on the on pathology (American Psychiatric Associa- theory of ISTDP, with additional discussion tion, 2013), Buddhism teaches that all human of relevant topics (e.g., professional ethics, beings are intrinsically whole and complete, and personal experiences of the mobilized uncon- that interconnectedness is fundamental to all scious). Since participants arrive with a range life (Wu, 2003). From this standpoint, it follows of prior experience with ISTDP (and are not that much of the suffering that human beings required to engage in background reading be- experience arises out of a false or deluded sense fore the retreat), the basic principles of of separation. Furthermore, Buddhist teachings ISTDP are presented. This is done in general hold that the wish for understanding and free- terms, however, so as not to overly influence dom is innate in each one of us, and that through someone’s retreat experience. Because of this disciplined and skillful practice, we can taste blending of didactic content with psychody- this freedom and wholeness for ourselves (Ait- namically based experiential learning, ken, 1982). Through a quieting of the mind and Zentensive has been approved for ethics con- a focused inner exploration, we can free our- tinuing education credits through the Wash- selves from the sense of separation that causes ington School of Psychiatry. misery for others and ourselves. It is important to point out that a Zenten- Awakening experiences illuminate, to one sive is considered to be a form of advanced degree of another, the unreality of this alienated professional training, and may not be appro- This document is copyrighted by the American Psychological Association or one of its allied publishers. sense of self (Kapleau, 1966). When these open- priate for all potential participants (see infor- This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. ings occur, the rigid distinctions between self mation provided to potential participants in and other fall away, revealing a kind of flowing the online Supplemental Materials). Ideally, freedom and compassionate awareness that take participants have some background experi- us beyond ordinary levels of consciousness (Ai- ence in meditation and in psychodynamic principles. Potential participants are initially screened via an online application and con- 2 In addition, participants are asked to read a Zentensive sent form (see the online Supplemental Ma- Description document highlighting potential risks (see on- line Supplemental Materials). Of note, participants are free terials). If the teacher does not know the to discontinue the retreat, if they feel it is no longer pro- applicant, he will personally interview her or ductive for them. Over eight Zentensive retreats, only one him to determine the appropriateness of this participant chose to discontinue for this reason. ZENTENSIVE RETREAT FOR PSYCHOTHERAPISTS 23

tken, 1982; Kapleau, 1966). Such experiences and watching it pass by, whereas nondual prac- allow a person to live naturally out of a greater tices call for us to leap right in, trusting and sense of wonder, gratitude, and connection with moving with the current. As this kind of im- all life. Rather than some fanciful escapist mersed engagement continues, concentration dream, genuine awakening experiences mirror naturally deepens, and the sense of self begins an understanding found in the contemplative to open and shift. Nondual approaches lead to a and mystical writings of many spiritual tradi- different kind of “knowing,” and a different tions (Ladinsky, 2002). Throughout history, po- quality of experience. It is this direct merging ets, scientists, and many others have also written with experience that underlies the transforma- accounts of these self-transcending openings. Al- tive power of Zentensives. bert Einstein, for example, noted “the true value of The power of Zentensives rests upon the par- a human being can be found in the degree to adoxical truth that the more we lose ourselves, which he has attained liberation from the self” the more present we can be. By allowing a (Pritscher, 2010, p. 178). quieting of the upper levels of consciousness, The Zentensive model is based largely on the deeper strata of the psyche—those which Lawson D. Sachter’s experience of Zen medi- contain both the creative and compassionate tation intensives and his own training in Zen energies as well as the darker repressed forces— which began in 1971 at the Rochester Zen Cen- become much more accessible. To put it another ter. Zen places great importance on the direct way, we become more sensitive and vulnerable to experience of each moment (Kapleau, 1966; both our caring and compassionate feelings (e.g., a Wu, 2003), and is rooted in the life and teach- natural wish for the well-being of others) as well ings of Siddha៮rtha Gautama, an Indian prince as to all that has been repressed. Within the who lived between approximately 560 B.C. and Zentensive context, this dual dynamic is termed 480 B.C.(Prabhavananda, 1979). Buddhist comergence, and it is, in part, why the inner work teachings later spread to China and Japan, in- that is fostered during a Zentensive may have corporating traditions native to East Asia (e.g., value for mental health professionals. Taoism; Wu, 2003). Zen emphasizes the trans- The inspiration for a psychodynamically ori- formative power of meditation, and the possi- ented Zen meditation retreat came primarily bility of waking up to an understanding that from Sachter’s personal experiences, first as a transcends the limitations inherent in dualistic Zen practitioner and later as a Zen teacher and thought. Zentensives place a strong emphasis on psychotherapist. He noted that intensified forms opening oneself to the intrapsychic realms oc- of nondual Zen meditation were giving medita- curring in the present moment, which naturally tion practitioners access to levels of awareness include the direct and uncensored experience of that were difficult, if not impossible, to reach the full range of our feelings and impulses. outside of the context of retreat, even through It is important to clarify the difference be- conventional therapeutic approaches. Unfortu- tween the kind of meditation practice in a nately, these same meditation practices, though Zentensive and other forms of Buddhist practice helpful up to a point, in and of themselves did now common in the West. The most widely not necessarily resolve the more significant in- studied Buddhist practice, at least in scientific trapsychic conflicts that were arising for West- circles, is mindfulness meditation based in the ern practitioners (for a thorough discussion of Theravada Buddhist tradition (Kabat-Zinn, the psychological differences between Western This document is copyrighted by the American Psychological Association or one of its allied publishers. 2011). Mindfulness practices often include in- and Eastern contexts, see Nisbett, 2003). These This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. structions encouraging practitioners to pay at- observations lead to an exploration of ways to tention to their moment-to-moment experience incorporate Western psychological understand- through the cultivation of the observing ego ings of the mind directly within the meditation (e.g., noticing and noting changing sensations, practice itself. feelings; Kabat-Zinn, 1990). In contrast, Zentensives seek to embody the spirit of non- Psychodynamic Contributions: Intensive duality, emphasizing selfless absorption into the Short-Term Dynamic Psychotherapy moment. An analogy that is sometimes used to compare these two approaches is that mindful- In the midst of intensive forms of meditation, ness is more like sitting on the bank of a river complexities often arise that seem to be unique 24 GOLDBERG AND SACHTER

to Western Buddhist practitioners (outside of Davanloo’s central dynamic sequence (Da- the Asian Buddhist contexts in which these tra- vanloo, 2001a, 2001b) utilizes the Triangle’s ditions originally developed; Aronson, 2004). pathways. Through the use of clarification, Because of his own 25 years of clinical training pressure, and challenge (e.g., pointing out de- and practice as an ISTDP psychotherapy, Sa- fenses, applying pressure for patients to disclose chter was inspired to incorporate frameworks feelings that emerge; see Davanloo, 2001a, rooted in Western psychotherapeutic traditions 2001b, for an extended discussion of these tech- into meditation intensives. Drawing from his niques), the therapist works to strip away the own personal experience and his work with defenses. This naturally leads to increased anx- patients and Zen students, Sachter became con- iety, which in turn brings up deeper levels of vinced that difficulties in meditation practice, resistance. This spiraling process continues, worked with skillfully, could be transformed such that each new layer of anxiety evokes into opportunities. Rather than being merely increased layers of resistance. Then, as that obstructions, they could become doorways to resistance is stripped away, the underlying anx- deeper insight. iety again regains new force. In this way, an The Zentensive is by no means the first at- intrapsychic “pressure cooker” is formed, con- tempt at integrating Buddhism and Western tinually fueled by the intensified repressed ma- psychological traditions (see Fromm, Suzuki, & terial lying beneath the surface. At certain DeMartino, 1960; Watts, 1961; Walsh, 1977; points within the process, the underlying feel- Welwood, 2002). Indeed, eloquent explorations ings break through, each time leading to deeper of the integration of Buddhism and psychody- levels of insight and understanding. Of course, namic traditions have been written (e.g., Ep- if this work is not grounded in a strong con- stein, 1995). To our knowledge, however, a scious and unconscious therapeutic alliance description of this integration within the context (Della Selva, 2004), it quickly falls apart. Again, the primary rationale for incorporat- of intensive retreat practice has not been dis- ing an ISTDP-based understanding into the con- cussed. The Zentensive offers such an integra- text of Zen practice is that unconscious material tion, incorporating theoretical frameworks from will become mobilized during the course of Habib Davanloo’s ISTDP (Davanloo, 1990). intensive meditation practice. Finding ways of As with our discussion of the Zentensive’s working skillfully with this material is vital for Buddhist underpinnings, a thorough discussion allowing the meditation practice to go deeper of ISTDP and related techniques is outside the (i.e., defensive structures are often what inhibits scope of this article (and has appeared else- progress in practice; Epstein, 1995). Perhaps where, e.g., Abbass & Town, 2013; Davanloo, most important for therapists, this work has the 2001a; Davanloo, 2001b; Frederickson, 2013). potential to lead to significant insights that can However, some basic background is important beneficially impact participants’ personal and to illuminate the integration of Zen and ISTDP. professional lives. ISTDP is an evidence-based therapy (with mod- A second rationale, and the one most ger- ϭ erate-to-large effects for short-term, d 0.69 mane to this article, is the unique opportunity relative to control conditions; Driessen et al., for the Zentensive offers to psychotherapists to 2010), one that utilizes the intrapsychic dynam- personally experience this powerful type of ics described by Malan’s (1995) Triangle of practice blending traditional Zen meditation This document is copyrighted by the American Psychological Association or one of its allied publishers. Conflict. In Malan’s formulation, as the uncon- with an ISTDP theoretical framework. In keep- This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. scious becomes stirred up within the context of ing with the psychodynamic tradition, part of psychotherapy, formerly repressed feelings and this experiential learning involves seeing how impulses are activated and begin moving to- transformative it can be to work on and resolve ward conscious awareness. As the repressive one’s own unconscious dilemmas and repressed barrier between conscious and unconscious material (Freud, 1937), with obvious implica- awareness becomes increasingly permeable, anx- tions for one’s clinical work (e.g., through more iety rises, and the whole psychic system becomes effective management of countertransference more fluid: the greater the mobilization the reactions; Hayes et al., 2011). Zentensives work greater the anxiety; and the greater the anxiety, to foster an environment in which mental health the greater the resistance. professionals can function, in effect, as their ZENTENSIVE RETREAT FOR PSYCHOTHERAPISTS 25

own therapists. The natural unfolding of the worthwhile to us to collect preliminary qualita- unconscious that appears to occur during ex- tive feedback on the experience of past partici- tended periods of zazen is guided by an ISTDP- pants. This was done through a postretreat based understanding of the process as a whole. e-mail inviting participants to provide open- As in individual therapy, resistance is viewed as ended feedback on their experience, both within a very positive sign, confirming that the inter- and following the retreat (see the online Sup- ventions are on target. During a Zentensive, plemental Materials). Mental health professions one’s own internal resistance directs one to from the five retreats occurring prior to Fall those places that are usually the most heavily 2016 were offered the opportunity to provide defended. As Rainer Maria Rilke wrote, “Our consent for the use of their responses in research deepest fears are like dragons guarding our (this was approved by the institutional review deepest treasures” (Brava, 2011, p. 147). Essen- board at the University of Wisconsin—Madi- tially, this practice involves a participant’s im- son). These responses were intended to illumi- mediate, moment-to-moment engagement with nate the retreat process as well as to gain some whatever cognitive and affective material arises understanding of the ways in which the experi- in the course of the meditation practice and ence may have impacted participants’ profes- throughout the retreat. As the retreat continues, sional and personal lives. A total of 14 accounts and the borders between conscious and uncon- were provided, and consent was given by seven scious become more permeable, an intrapsychic participants to have their responses used. We sensitivity arises. This increased sensitivity cou- present aspects of these accounts organized pled with firm grounding in the meditation prac- around five themes that appeared repeatedly in tice can foster an empowered and resilient will- responses and that reflect elements of the ingness to engage with whatever comes forth Zentensive model and rationale that have been from the depths. (We have provided quotations described above. As this feedback is merely from past participants below in order to more preliminary, is very likely impacted by known fully characterize how individuals have imple- response set biases (e.g., social desirability, se- mented these instructions.) Of course, this is often not a comfortable lection bias; Heppner, Wampold, & Kivlighan, process to go through, either in the therapy 2008), and is not intended to characterize the room or in the meditation hall, and it can pro- modal Zentensive experience or “describe and ceed effectively only when a strong conscious explain social phenomena” (Pope, Ziebland, & and unconscious therapeutic alliance is in oper- Mays, 2000, p. 114), formal qualitative data ation (Della Selva, 2004; Horvath et al., 2011). analysis was not performed (see Madill & In therapy, nurturing and sustaining this alliance Gough, 2008, and Pope, Ziebland, & Mays, is one of the central tasks of the therapist (Hor- 2000, for a discussion of various potential ana- vath et al., 2011). Perhaps unexpectedly, the lytic methods and the care necessary for high- collective alliance is also one of the most pow- quality qualitative research). However, we felt erful forces to arise during the course of a that highlighting themes through quotations Zentensive. Though much of the retreat is held from past participants would enrich this intro- in silence, the bond that forms between partic- duction of the integration of Zen and ISTDP. ipants is a core element of the work. Motivation for Integrating Zen and ISTDP This document is copyrighted by the American Psychological Association or one of its allied publishers. Preliminary Qualitative Feedback This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. From Participants The first theme was participants echoing the potential (and perhaps need) for integrating Zen Since the first Zentensive in 2014, a total of and psychodynamic traditions. One participant eight retreats have been conducted to date, in- noted limitations associated with relying solely cluding 65 participants, 23 of whom have been on Buddhist contemplative practices, noting that mental health professionals (e.g., social work- “the rest of the self is still there: old wounds, ers, counselors, psychologists, psychiatrists). shadow selves, abandoned repositories of what Given the unique (and somewhat experimental) we may fear, despise or avoid.” From the other pairing of Zen practice and ISTDP within the side, another participant noted the possibility of context of intensive retreat practice, it seemed getting stuck in one’s clinical work: 26 GOLDBERG AND SACHTER

Preceding the Zentensive, I had been becoming more came up, giving me the opportunity to work through frustrated and demotivated with my clinical work. yet another layer. This process would repeat itself a What seemed a repetitive slog uphill toward processing number of times, with feeling, anxiety, and defense broken attachments and trauma memories in a some- constellations being activated at different times asso- what mechanical and technique-driven way was leav- ciated with different genetic figures. Each time I got ing me numb and disillusioned. through an inner wall I felt more energized and fluid, my heart more open. Similarly, another participant discussed the potential for experiential learning of ISTDP: Another participant described a healing pro- “The Zentensive is a type of hybrid between cess associated with relating to defensive mate- Zen and ISTDP that for me personally allowed rial in a more open way during the course of the me to deeply anchor my understanding of Dr. retreat: Davanloo’s thinking in an experiential dimen- I was amazed and horrified in my experience of how sion.” my brain just serves all those delicious defenses (i.e., Beyond addressing the potential limitations thoughts, analyzing everything, trying to understand of engaging with either Zen or ISTDP without the past, predict the future) often in negative ways. Or just creating ideas (i.e., how can I turn this teaching their integration, one participant remarked on into money or recognition/fame). When I accepted this their potential synergy when combined: part of me, “its [sic] just my dear brain doing what it’s good at” and not getting into a fight with myself, I Combining Buddhist meditation and practice with discovered a depth underneath. My unconscious. Lots ISTDP was brilliant. They are beyond complementary; of feelings, mostly grief in the first two to three days. they are synergistic. The meditation prepares and tills Grief over lost connections since I was born, lost and deepens the mind for the ISTDP. . .and the [indi- opportunities, grief and existential guilt about relation- vidual interviews with the teacher] remove the barriers ships and people I haven’t treated well and so forth. I to the practice, so that the practice deepens. The effect went through most of the important relationships in my felt to me like doing many years of therapy condensed life—did a huge amount of healing—and encountered into 5 days and many years of practice accelerating several versions of my basic conflicts. I experienced it into 5 days. as healing the splits. Some small, some huge. And in the end, I was filled with love and gratitude. And the Process of Working Through Unconscious most amazing is that I did most of it all by myself. Material The Importance of the Group Obviously, experiences of working through unconscious material, be it in traditional psycho- Unlike individual therapy, Zentensives are therapy or within the context of a Zentensive, is intentionally a group-based experience. Al- highly idiographic. Nonetheless, we have tried though conducted in silence, several partici- to describe the basic processes and techniques pants remarked on the power of the group for that are intended to support this unfolding. One supporting their own practice. One noted, participant described the practice of mobilizing The other attendees really factored into the experience the unconscious through attending to anxiety as well. Through shared effort, true shoulder-to- and underlying feelings that came up during the shoulder kind of working together with the others, I course of the retreat: came to feel a strong bond with rest of the group. . .where I felt supported and really bonded in a I became aware of pockets of anxiety that I had pre- deep way. On the last day of the Zentensive, partici- viously not been aware of. During private meetings pants are invited to communicate verbally again. with [the teacher] I was encouraged to examine what

This document is copyrighted by the American Psychological Association or one of its allied publishers. was driving the anxiety and work through the under- This offers a chance for beginning to practice

This article is intended solely for the personal use of the individual user and is not to belying disseminated broadly. feelings, and then to see where that would take integrating the Zentensive experience into inter- me, always looking deeper to see what lies below each personal interactions. One participant remarked layer of the mind. During the many hours of meditation on the ways in which the group was experienced I would notice how by staying with the practice, my own defenses of rumination and diversification would differently: “Never had I felt so open, so in- rear their heads. Staying with the practice, defenses cluded and so alive with a group of people. I eventually crystallized in the form of a wall between laughed easily and joyously and constantly.” my feelings and me, leaving me with a sense of dis- connection. When this happened I would feel into the Impact on Clinical Work felt sense of this experience, stay with the experience, and eventually the wall would cave and intense, often very painful feelings and impulses surfaced as a result. A primary intention of the Zentensive is to I would go deeper and then new areas of blockage support the development of intrapsychic skills ZENTENSIVE RETREAT FOR PSYCHOTHERAPISTS 27

that will support clinical practice. Several par- Two others remarked on an increased trust in ticipants shared comments reflecting ways in elements of the psychotherapeutic process, most which they felt their clinical practice was im- notably the power of unconscious to move to- pacted following the retreat. One participant ward healing. One participant shared, “In re- shared shifts in sessions with patients: turning to my work, I noticed an enhanced perseverance and belief in the unconscious; a The week following the retreat, almost without excep- sense of self-authorized relentlessness and se- tion, all of my psychotherapy sessions were deep and powerful, even sessions with patients I’ve seen for curity that feels wonderful.” A second shared, years, who have felt stuck or coasting. I know that the That sense of mystery relating to the unconscious, and shift in me, the focus, the expansion, opened up some- its capacity for healing and growth when trusted, was thing in the room for them as well. also valuable. On returning to work I found this helpful for me to a) maintain a curious interested stance, b) Others noted changes in the experience of trust and have confidence in the patient’s ability to heal doing therapy, including increased awareness of themselves, c) more confident in my own practice of intrapsychic dynamics. One shared, ISTDP, and that by holding to that process the outcome takes care of itself. I was more present, more patient, and quite frankly I think it freaked one of my patients out, in a good way. Impact on Personal Life It is incredible to see, to really witness how much is missed when my anxiety, imperceptibly, would sweep away an important moment, taking away a client’s Lastly, several participants remarked on the experience. ways that the Zentensive had impacted their per- sonal lives and experience in the world more gen- A second noted, “Having become more con- erally. This is in line with the Zentensive’s shared scious and aware of previously unconscious focus on professional and personal development psychic material, the chances that this material (based on the notion that these two are interre- will come out in left-handed, non-therapeutic lated; Rønnestad & Skovholt, 2003). Several par- ways are far reduced.” ticipants highlighted an increased sense of con- Two participants remarked on the way that nection with others and the world generally having an “agenda” in session with patients had following retreat, with one sharing the following: loosened following the retreat allowing a As I walked through the airport. . .I continued to greater degree of connection during therapy. marvel at the perceptual changes in “reality.” Nor- The first stated, “When I came home I noticed mally, an airport is a place to wait, maybe with mild quickly how my work has changed, my pace, irritation at the chronic overstimulation, crowds, fast food and lack of control over time and schedule. Some- focus, depth, paying notice to the patients anx- thing to get through on the way to somewhere else. Not iety, not having any agenda other than creating so on that morning. For me, it was destination I had a healthy relationship with the patient.” And a never before had the privilege to experience. I felt so second noted, wide open, so moved by everyone I saw. I felt I was in love with every stranger I passed. Streams of compas- I am better able to use my own relationship with clients sion flowed out and into my heart. I watched people experientially, as it unfolds in the room, which requires with an incredible sensation of tenderness, not unlike a degree of sustained presence and emotional intimacy. those first moments of holding my newborn babies. I encourage clients to experience the emotions that arise from these in-the-moment exchanges, which usu- Others shared comments on a shifted experi- ally leads them to identifying a familiarity, a memory, ence of human potential. One noted, “I left the This document is copyrighted by the American Psychological Association or one of its allied publishers. a pattern. And I am better able to be with them as they Zentensive feeling more deeply connected and This article is intended solely for the personal use of the individual user and is not to beexperience disseminated broadly. their feeling, and to encourage them to stay with a sense of exhilaration, awe and certainty of with the feeling themselves. Furthermore, I now ac- the” Buddha nature’ within and all around me.” knowledge the immense mystery and complexity of the world and the self, and at the same time how limited Another stated, our ways of knowing are, especially intellectually. I am The first outcome was a marked difference in my state able to sit with a client at the space before the un- of being—physically lighter, more at peace, energized, known, without jumping to a theory as to why a interested, less preoccupied. It seemed that something symptom or phenomena is occurring. Instead, I am had shifted on a core level that was hard to articulate able to simply be present with the client and say, “We verbally, but certainly known experientially. Emanat- do not know yet,” and turn to the pieces that we do ing from such a shift in experience was a different know: the physical sensations and emotions that show attitude to life: more open to the possibilities that it has up in the body, in the room. to offer, and seeing more distinctly what I want from it. 28 GOLDBERG AND SACHTER

This was such a relief, as if a fog had cleared which seen as supporting a goal shared by both psy- had obscured my view of what I sensed was there. chotherapy and contemplative practice: sup- porting human growth and the development of Conclusion human potential (Kapleau, 1966; Rogers, 1961). Clearly, future work will need to examine Although psychotherapy has become a form these possibilities empirically, for example by of health care with recognized efficacy for treat- examining the impact of intensive meditation ing a variety of mental illnesses and improving training on therapists’ clinical skills and per- quality of life, it is a relatively recent addition to sonal growth, as well as on patient outcomes. human society. Of course, while modern forms Our study is limited by not including such data. of psychotherapy arguably have relatives in ear- Future studies could involve the collection of lier nonmedical (and certainly nonpsychologi- more robust qualitative data, either through cal) traditions (e.g., shamanism; Rieken, 2015) structured or semistructured interviews or a for- and share therapeutic factors common across mal written feedback protocol. Subjecting feed- various forms of healing (Frank & Frank, 1991), back data to qualitative data analysis could re- psychotherapy as it has come to be practiced in veal complementary or contrasting themes to industrialized societies has only been in devel- those elements of the Zentensive model and opment for a little over a century. Buddhist rationale emphasized here (Madill & Gough, traditions have had a far longer period of devel- 2008). The ideal quantitative study would ran- opment (i.e., over 2,500 years), yet it is only domize interested clinicians to Zentensive and within the last several decades that traditional waitlist conditions and assess a potential causal Asian contemplative practices have been avail- effect of the experience on therapist and patient able in the West (Aronson, 2004). Certainly, outcomes. Objective measures of therapist skills attempts at integrating these historically dispa- (e.g., through automated assessment of psycho- rate traditions are only just beginning. therapy process variables such as empathy; Imel In this article we sought to describe one such et al., 2014) as well as purported mechanisms of attempted integration—that between Zen Bud- action (e.g., unconscious mobilization during dhist retreat practice and a psychodynamic un- retreat, the development of meditative capaci- derstanding of the unconscious, as articulated ties) could clarify aspects of Zentensive training within ISTDP (Davanloo, 2001a). This was mo- not subject to response set biases. It could also tivated by the hypothesis that the synergy of be interesting to assess whether participating in Zen and ISTDP can accomplish more than ei- a Zentensive has led some participants to en- ther tradition alone. From the standpoint of gage in further (perhaps even longer duration) modern psychotherapy, we contend that the in- intensive retreat practice. Based on the central- tegration of contemplative practices such as ity of intensive retreat practice within Bud- those derived from Zen Buddhism, particularly dhism (Kapleau, 1966; Rahula, 1974), we feel it within the context of intensive retreat practice, is worthwhile continuing to explore ways this has the potential to develop therapists’ intrapsy- contemplative tradition may be useful for men- chic skills. We provide the theoretical backdrop tal health professionals, and ultimately for their of this conjecture, along with initial feedback patients. from participants highlighting some of the ways this may occur, both in the process of working This document is copyrighted by the American Psychological Association or one of its allied publishers. References through unconscious material during the retreat This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. as well as in sessions with patients following the Abbass, A. A., & Town, J. M. (2013). Key clinical retreat. More broadly, we contend that the inte- processes in intensive short-term dynamic psycho- gration offered in the Zentensive can also sup- therapy. Psychotherapy: Theory, Research, & port therapists’ (and nontherapists’) personal Practice, 50, 433–437. http://dx.doi.org/10.1037/ development. Within the psychodynamic tradi- a0032166 Aitken, R. (1982). Taking the path of Zen. New York, tion, personal development (e.g., resolving NY: North Point Press. one’s internal unconscious conflicts) is not Ajaya, S. (1983). Psychotherapy East and West: A strictly separate from the development of the unifying paradigm. Honesdale, PA: Himalayan In- therapists’ technical skills (Freud, 1937; Kern- ternational Institute of Yoga Science and Philoso- berg, 1986). In this light, the Zentensive can be phy of the USA. ZENTENSIVE RETREAT FOR PSYCHOTHERAPISTS 29

American Psychiatric Association. (2013). Diagnos- man, R. E. (2009). Competency benchmarks: A tic and statistical manual of mental disorders (5th model for understanding and measuring compe- ed.). Washington, DC: Author. tence in professional psychology across training Aronson, H. B. (2004). Buddhist practice on Western levels. Training and Education in Professional ground: Reconciling Eastern ideals and Western Psychology, 3 (4), S5–S26. http://dx.doi.org/10 psychology. Boston, MA: Shambhala. .1037/a0015832 Baldwin, S. A., & Imel, Z. E. (2013). Therapist Frank, J. D., & Frank, J. B. (1991). Persuasion and effects: Findings and methods. In M. J. Lambert healing: A comparative study of psychotherapy (Ed.), Bergin and Garfield’s handbook of psycho- (3rd ed.). Baltimore, MD: Johns Hopkins Univer- therapy and behavior change (6th ed., pp. 258– sity Press. 297). Hoboken, NJ: Wiley. Frederickson, J. (2013). Co-creating change: Effec- Brava, J. (2011). The seeds of love: Growing mindful tive dynamic therapy techniques. Kansas City, relationships. North Clarendon, VT: Tuttle. MO: Seven Leaves Press. Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Freud, S. (1937). Analysis terminable and intermina- Thornton, J. A., & Andrews, W. P. (2015). The ble. International Journal of Psychoanalysis, 18, role of deliberate practice in the development of 373–405. highly effective psychotherapists. Psychotherapy: Fromm, E., Suzuki, D. T., & DeMartino, R. (1960). Theory, Research, & Practice, 52, 337–345. http:// Zen Buddhism and psychoanalysis. Oxford, UK: dx.doi.org/10.1037/pst0000015 Harper. Coward, H. (1985). Jung and Eastern thought. Al- Goldberg, S. B. (2017). Why mindfulness belongs in bany, NY: SUNY Press. counseling psychology: A synergistic clinical and Dahl, C. J., Lutz, A., & Davidson, R. J. (2015). research agenda. Counselling Psychology Quar- Reconstructing and deconstructing the self: Cog- terly. Advance online publication. nitive mechanisms in meditation practice. Trends Goldberg, S. B., Babins-Wagner, R., Rousmaniere, in Cognitive Sciences, 19, 515–523. http://dx.doi T., Berzins, S., Hoyt, W. T., Whipple, J. L.,... .org/10.1016/j.tics.2015.07.001 Wampold, B. E. (2016). Creating a climate for Davanloo, H. (1990). Unlocking the unconscious: therapist improvement: A case study of an agency Selected papers of Habib Davanloo, MD. Hobo- focused on outcomes and deliberate practice. Psy- ken, NJ: Wiley. chotherapy: Theory, Research, & Practice, 53, Davanloo, H. (2001a). Intensive short-term dynamic 367–375. http://dx.doi.org/10.1037/pst0000060 psychotherapy: Selected papers of Habib Davan- Goldberg, S. B., Hoyt, W. T., Nissen-Lie, H. A., loo. Hoboken, NJ: Wiley. Nielsen, S. L., & Wampold, B. E. (2016). Unpack- Davanloo, H. (2001b). Intensive short-term dynamic ing the therapist effect: Impact of treatment length psychotherapy extended major direct access to the differs for high- and low-performing therapists. unconscious. European Psychotherapy, 2, 25–70. Psychotherapy Research. Advance online publica- Della Selva, P. C. (2004). Intensive short-term dy- tion. http://dx.doi.org/10.1080/10503307.20161 namic psychotherapy. London, UK: Karnac. 216625 Driessen, E., Cuijpers, P., de Maat, S. C., Abbass, Goldberg, S. B., Rousmaniere, T., Miller, S. D., A. A., de Jonghe, F., & Dekker, J. J. (2010). The Whipple, J., Nielsen, S. L., Hoyt, W. T., & efficacy of short-term psychodynamic psychother- Wampold, B. E. (2016). Do psychotherapists im- apy for depression: A meta-analysis. Clinical Psy- prove with time and experience? A longitudinal chology Review, 30, 25–36. http://dx.doi.org/10 analysis of outcomes in a clinical setting. Journal .1016/j.cpr.2009.08.010 of Counseling Psychology, 63, 1–11. http://dx.doi Ericsson, K. A., Krampe, R. T., & Tesch-Römer, C. .org/10.1037/cou0000131 (1993). The role of deliberate practice in the ac- Goldberg, S. B., Tucker, R. P., Greene, P. A., Da- quisition of expert performance. Psychological Re- vidson, R. J., Wampold, B. E., Kearney, D. J., & This document is copyrighted by the American Psychological Association or one of its allied publishers. view, 100, 363–406. Simpson, T. L. (2018). Mindfulness-based inter- This article is intended solely for the personal use of the individualEpstein, user and is not to be disseminated broadly. M. (1995). Thoughts without a thinker: Psy- ventions for psychiatric disorders: A systematic chotherapy from a Buddhist perspective. New review and meta-analysis. Clinical Psychology Re- York, NY: Basic Books. view, 59, 52–60. http://dx.doi.org/10.1016/j.cpr Fatter, D. M., & Hayes, J. A. (2013). What facilitates .2017.10.011 countertransference management? The roles of Grepmair, L., Mitterlehner, F., Loew, T., Bachler, E., therapist meditation, mindfulness, and self- Rother, W., & Nickel, M. (2007). Promoting mind- differentiation. Psychotherapy Research, 23, 502– fulness in psychotherapists in training influences 513. http://dx.doi.org/10.1080/10503307.2013 the treatment results of their patients: A random- .797124 ized, double-blind, controlled study. Psychother- Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, apy and Psychosomatics, 76, 332–338. http://dx N. J., Hutchings, P. S., Madson, M. B.,...Cross- .doi.org/10.1159/000107560 30 GOLDBERG AND SACHTER

Hayes, J. A., Gelso, C. J., & Hummel, A. M. (2011). Madill, A., & Gough, B. (2008). Qualitative research Managing countertransference. Psychotherapy: and its place in psychological science. Psycholog- Theory, Research, & Practice, 48, 88–97. http:// ical Methods, 13, 254–271. http://dx.doi.org/10 dx.doi.org/10.1037/a0022182 .1037/a0013220 Heppner, P. P., Wampold, B. E., & Kivlighan, D. M., Mahoney, M. J. (1997). Psychotherapists’ personal Jr. (2008). Research design in counseling (3rd ed.). problems and self-care patterns. Professional Psy- Belmont, CA: Brooks/Cole. chology: Research and Practice, 28, 14–16. http:// Horvath, A. O., Del Re, A. C., Flückiger, C., & dx.doi.org/10.1037/0735-7028.28.1.14 Symonds, D. (2011). Alliance in individual psy- Malan, D. H. (1995). Individual psychotherapy and chotherapy. Psychotherapy: Theory, Research, & the science of psychodynamics (2nd ed.). London, Practice, 48, 9–16. http://dx.doi.org/10.1037/ UK: Hodder Education. a0022186 McGaghie, W. C., Issenberg, S. B., Cohen, E. R., Imel, Z. E., Barco, J. S., Brown, H. J., Baucom, B. R., Barsuk, J. H., & Wayne, D. B. (2011). Does sim- Baer, J. S., Kircher, J. C., & Atkins, D. C. (2014). ulation-based medical education with deliberate The association of therapist empathy and syn- practice yield better results than traditional clinical chrony in vocally encoded arousal. Journal of education? A meta-analytic comparative review of Counseling Psychology, 61, 146–153. http://dx.doi the evidence. Academic Medicine, 86, 706–711. .org/10.1037/a0034943 Nisbett, R. E. (2003). The geography of thought: Kabat-Zinn, J. (1990). Full catastrophe living: Using How Asians and Westerns think differently...and the wisdom of your body and mind to face stress, why. New York, NY: Free Press. pain, and illness. New York, NY: Delta. Pope, C., Ziebland, S., & Mays, N. (2000). Qualita- Kabat-Zinn, J. (2011). Some reflections on the ori- tive research in health care. Analysing qualitative gins of MBSR, skillful means, and the trouble with data. British Medical Journal (Clinical Research maps. Contemporary Buddhism, 12, 281–306. Ed.), 320, 114–116. http://dx.doi.org/10.1136/bmj http://dx.doi.org/10.1080/14639947.2011.564844 .320.7227.114 Kapleau, P. (1966). The three pillars of Zen: Teach- Prabhavananda, S. (1979). The spiritual heritage of ing, practice, and enlightenment. New York, NY: India. Hollywood, CA: Vedanta Press. Anchor Books. Pritscher, C. P. (2010). Einstein and Zen: Learning to Kernberg, O. F. (1986). Institutional problems of learn. New York, NY: Peter Lang. psychoanalytic education. Journal of the American Rahula, W. (1974). What the Buddha taught (2nd Psychoanalytic Association, 34, 799–834. http:// ed.). New York, NY: Grove Press. dx.doi.org/10.1177/000306518603400403 Rieken, B. (2015). The prehistory of psychotherapy Khoury, B., Knäuper, B., Schlosser, M., Carrière, K., and its implications for psychotherapy science: & Chiesa, A. (2017). Effectiveness of traditional Shamanism, folk medicine, philosophy, and reli- meditation retreats: A systematic review and meta- gion. In O. C. G. Gelo, A. Pritz, & B. Rieken analysis. Journal of Psychosomatic Research, 92, (Eds.), Psychotherapy research (pp. 9–37). Vi- 16–25. http://dx.doi.org/10.1016/j.jpsychores enna, Austria: Springer. http://dx.doi.org/10.1007/ .2016.11.006 978-3-7091-1382-0_2 Ladinsky, D. (2002). Love poems from God: Twelve Rogers, C. (1961). On becoming a person: A thera- sacred voices from the East and West. London, pist’s view of psychotherapy. New York, NY: UK: Penguin Books. Houghton Mifflin. Lambert, M. J. (2015). Progress feedback and the Rousmaniere, T. (2017). Deliberate practice for psy- OQ-system: The past and the future. Psychother- chotherapists: A guide to improving clinical effec- apy: Theory, Research, & Practice, 52, 381–390. tiveness. New York, NY: Routledge. http://dx.doi.org/10.1037/pst0000027 Rousmaniere, T. G., Swift, J. K., Babins-Wagner, R., Lamothe, M., Rondeau, É., Malboeuf-Hurtubise, C., Whipple, J. L., & Berzins, S. (2016). Supervisor This document is copyrighted by the American Psychological Association or one of its allied publishers. Duval, M., & Sultan, S. (2016). Outcomes of variance in psychotherapy outcome in routine This article is intended solely for the personal use of the individual user and is notMBSR to be disseminated broadly. or MBSR-based interventions in health practice. Psychotherapy Research, 26, 196–205. care providers: A systematic review with a focus http://dx.doi.org/10.1080/10503307.2014.963730 on empathy and emotional competencies. Comple- Rønnestad, M. H., & Skovholt, T. M. (2003). The mentary Therapies in Medicine, 24, 19–28. http:// journey of the counselor and therapist: Research dx.doi.org/10.1016/j.ctim.2015.11.001 findings and perspectives on professional develop- Lindahl, J. R., Fisher, N. E., Cooper, D. J., Rosen, ment. Journal of Career Development, 30, 5–44. R. K., & Britton, W. B. (2017). The varieties of Ryan, A., Safran, J. D., Doran, J. M., & Muran, J. C. contemplative experience: A mixed-methods study (2012). Therapist mindfulness, alliance and treat- of meditation-related challenges in Western Bud- ment outcome. Psychotherapy Research, 22, 289– dhists. PLoS ONE, 12(5), e0176239. http://dx.doi 297. http://dx.doi.org/10.1080/10503307.2011 .org/10.1371/journal.pone.0176239 .650653 ZENTENSIVE RETREAT FOR PSYCHOTHERAPISTS 31

Schöttke, H., Flückiger, C., Goldberg, S. B., Evers- Walsh, R. (1977). Initial meditative experiences: Part mann, J., & Lange, J. (2017). Predicting psycho- I. Journal of Transpersonal Psychology, 9, 151– therapy outcome based on therapist interpersonal 192. skills: A five-year longitudinal study of a therapist Wampold, B. E. (2015). Routine outcome monitor- assessment protocol. Psychotherapy Research, 27, ing: Coming of age—With the usual developmen- 642–652. http://dx.doi.org/10.1080/10503307 tal challenges. Psychotherapy: Theory, Research, .2015.1125546 & Practice, 52, 458–462. http://dx.doi.org/10 Sedlmeier, P., Eberth, J., Schwarz, M., Zimmermann, .1037/pst0000037 D., Haarig, F., Jaeger, S., & Kunze, S. (2012). The Wampold, B., & Imel, Z. E. (2015). The great psy- psychological effects of meditation: A meta- chotherapy debate: The evidence for what makes analysis. Psychological Bulletin, 138, 1139–1171. psychotherapy work (2nd ed.). New York, NY: http://dx.doi.org/10.1037/a0028168 Routledge. Shapiro, S. L., Brown, K. W., & Biegel, G. M. Watkins, C. E., Jr. (2011). Does psychotherapy su- (2007). Teaching self-care to caregivers: The ef- pervision contribute to patient outcomes? Consid- fects of mindfulness-based stress reduction on the ering thirty years of research. Clinical Supervisor, mental health of therapists in training. Training 30, 235–256. http://dx.doi.org/10.1080/07325223 and Education in Professional Psychology, 1, .2011.619417 105–115. http://dx.doi.org/10.1037/1931-3918.1.2 Watts, A. (1961). Psychotherapy east and west. New .105 York, NY: Ballantine Books. Shimokawa, K., Lambert, M. J., & Smart, D. W. Welwood, J. (2002). Toward a psychology of awak- (2010). Enhancing treatment outcome of patients ening: Buddhism, psychotherapy, and the path of at risk of treatment failure: Meta-analytic and personal and spiritual transformation. Boston, mega-analytic review of a psychotherapy quality MA: Shambhala. assurance system. Journal of Consulting and Clin- Wu, J. C. H. (2003). The golden age of Zen: Zen ical Psychology, 78, 298–311. http://dx.doi.org/10 masters of the Tang dynasty. Bloomington, IN: .1037/a0019247 World Wisdom. Walfish, S., McAlister, B., O’Donnell, P., & Lam- bert, M. J. (2012). An investigation of self- assessment bias in mental health providers. Psy- Received October 5, 2017 chological Reports, 110, 639–644. http://dx.doi Revision received December 12, 2017 .org/10.2466/02.07.17.PR0.110.2.639-644 Accepted December 14, 2017 Ⅲ

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