Buddhism & Psychotherapy, Part III: The Treatment of Suffering

Their shared goal of alleviating mental suffering renders Buddhism and psychotherapy undeniably entwined. Last week we started to unpack the first two of Buddhism’s foundational Four Noble Truths, which examine the nature and cause of suffering, or dukkha. The first is simply that suffering exists; the second, that the human tendency to crave is what causes it. Today, we’ll continue by looking at the third and fourth ennobling truths, which address the treatment and specific steps required for the ultimate alleviation of suffering.

The third ennobling truth states that there is a treatment for suffering. To overcome suffering one must undermine craving. So how do we let go of craving? Suppression or repression is not advisable and, psychologically speaking, will not work anyway. One is instructed to become aware of craving as it arises in consciousness. But noticing the arising of craving can be extremely arduous and complicated, because our reflective defensive responses protect us from actual awareness of craving, before it even reaches consciousness.

This is a place where psychoanalytically based treatments can interact most effectively with Buddhist practice. As we know, insight is often difficult to come by, and insight alone is not always sufficient for eliciting change. The Buddha thus also proposed a distinctly behavioral and environmental solution to the problem of craving. In Buddhist practice, one creates the conditions under which craving will not arise. Eventually, seeing suffering clearly means seeing that there is really no pleasure in craving, the effects of which keep us stuck in endless rounds of unhappiness and frustration.

The fourth ennobling truth states that the path or treatment for suffering is the ennobling eight-fold path. This path is comprised of eight interconnected factors and behaviors, which consist of ethical factors, mind cultivation, and the development of wisdom. These eight factors are right understanding, right thought, right speech, right action, right livelihood, right effort, right concentration, and right mindfulness. Western psychologies have typically appropriated only the concept of mindfulness into their treatment approaches. Acceptance and commitment therapy (ACT), however, incorporates therapeutic processes related to speech, action, livelihood, and effort (in what are known as change or commitment processes) in addition to perspectives on concentration and mindfulness (that is, acceptance processes).

The universal, transdiagnostic insight gained from engaging in a psychological perspective based on the four ennobling truths is that suffering can be overcome. To stop the craving that causes it, one must learn to notice it arising, notice its self-defeating nature, impermanence, and insubstantiality. However, we need a special technology for doing this, a perspective from which to examine the nature and contents of the mind and to notice what about our habitual tendencies keeps us melded with our suffering.

In Buddhism, the mind is seen as a process, not a thing, and is thus malleable and amenable to change (Olendzki, 2012). We construct experience moment by moment; since experience is constructed, the causes of suffering can be observed, and the reflexive response of grasping and craving can be caught as it arises in consciousness. This is the essence of mindfulness. Such examination does not happen easily in the course of ordinary human experience, and it requires an atypical approach to slowing down and viewing the nature and workings of our minds. The Buddha delineated a system by which the mind could be comprehended and used as a means of understanding the very nature of reality, a system that can thereby help us transcend not just neurotic or pathological suffering but also the experience of suffering in its entirety. Mindfulness meditation is the primary technology for freeing one from the grip of suffering.

In the formal practice of insight meditation, we gradually come to see our grasping and craving as it arises, and we can come to understand our tendency to reify our thoughts as actual “things.” We learn that we can look at these thoughts and feelings unflinchingly and then unhook from them. Like psychoanalysis and psychodynamic psychotherapies, Buddhism is also concerned with the unconscious. In both traditions, that which lies outside of consciousness is seen as also giving rise to behavior and convictions, which become the source of suffering. The goal of uncovering what is unconscious—sometimes referred to as “latent dispositional tendencies” in Buddhist thought—is to understand their relationship to suffering and to give rise to a new, healthier way of being in the world. According to Olendzki (2012), through mindfulness meditation, we come to “reshape the automatic, unconscious structures of the mind. Aspects of experience to which we were entirely blind come into view, and the ability to choose one course of action over another becomes strengthened.” This method is the ultimate one for the study of thoughts and emotions. But it is done alone, seated on a cushion. And, worth noting, there are potential psychological pitfalls inherent in this practice and solitude, which can impede spiritual as well as psychological progress.

For more on integrating Buddhist principles with traditional psychodynamic approaches to psychotherapy, check out the new volume Mindfulness, Acceptance, and the Psychodynamic Evolution: Bringing Values into Treatment Planning and Enhancing Psychodynamic Work with Buddhist Psychology.


Olendzki, A. (2012b). Wisdom in Buddhist psychology. In C. Germer & R. Siegel (Eds.), Wisdom and compassion in psychotherapy (pp. 121–137). New York, NY: Guilford Press.

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