Tonglen and lojong

1. Introduction

Version followed: the root text The Seven Points of Mind Training attributed to Geshe Chekhawa Yeshe Dorje (1101–1175), in Adam Pearcey's translation (Lotsawa House, 2012, CC BY-NC); tonglen as Pema Chödrön, a student of Chögyam Trungpa and Dzigar Kongtrul, teaches it publicly; slogan practice as Judy Lief, editor of Trungpa's lojong teachings, presents it. [source: Lotsawa House; Lion's Roar, Chödrön 2021, 2025; Lion's Roar, Lief 2021]

Lojong (Tibetan, "mind training") is a Mahayana Buddhist method for cultivating bodhicitta, the wish to awaken for the benefit of all beings, by reshaping everyday attitudes through short pithy sayings ("slogans") and contemplation. The tradition attributes the teachings to the Indian master Atisha Dipankara and their arrangement into a seven-point text to Geshe Chekawa; the commonly taught English version groups them as 59 slogans. Lief describes three strands: formless meditation, tonglen, and post-meditation practice in daily life. [source: Lion's Roar, Lief 2021; Lotsawa House] Versions differ: the Pearcey translation and the 59-slogan arrangement used in Trungpa's line word and number the lines differently; this guide quotes Pearcey and notes the Trungpa-line numbering where Lief uses it.

Tonglen ("sending and taking") is the central practice of the second point: the practitioner imaginatively takes in others' suffering and sends out relief, linked to ordinary breathing. As Chödrön states it, this reverses the habitual pull to avoid pain and grasp pleasure, loosening self-protective patterns and opening the heart to oneself and others; she also links it to shunyata (emptiness). [source: Lion's Roar, Chödrön 2025] The tradition understands change as the gradual reversal of self-cherishing (ego-clinging) by many small interruptions of habit, so that adversity itself becomes the path. [source: Lion's Roar, Lief 2021; Lotsawa House, Point 3]

Lojong and tonglen are openly taught, not initiatory, and are not treatments for any illness. In psychotherapy the clinician does not teach them as a religious instructor; the clinician supports a client who already practises, or wishes to, in the client's own tradition, and draws on published secular adaptations (see Domain II: MSC, CFT; Domain VII: contemplative and spiritually integrated psychotherapy). [synthesis]

2. Framework

The tradition's structure (the seven points) [source: Lotsawa House, Pearcey trans.]

Preliminaries. "First, train in the preliminaries." Teachers explain these as the four reminders or "four thoughts that turn the mind": precious human birth, impermanence and death, karma (cause and effect), and the suffering of samsara (cyclic existence). [source: Nalandabodhi Colorado course page]
Main practice: the two bodhicittas. Ultimate (absolute) bodhicitta: lines on regarding phenomena as dreamlike, examining unborn awareness, resting in the ground of mind. Relative bodhicitta: giving and taking (tonglen) "mounted on the breath", beginning "the process of taking with yourself", and applying slogans in all activities.
Transforming adversity into the path. "Drive all blames into one"; meditate on the kindness of all; whatever is met, apply the practice.
Applying the practice through life. The five strengths in life, and the same five for the time of death ("transference"). The strengths are explained in commentaries [uncertain: not verified].
Measure of mind training. All teachings share one purpose; of "the two witnesses" rely on the principal one (one's own mind, as commonly explained [uncertain]); maintain a joyful attitude.
Commitments. Ethical pledges such as not pondering others' flaws, not retaliating, not seeking others' misery as a crutch for one's happiness.
Precepts. Guidelines such as doing everything with one intention, being patient whichever of the two (good or bad fortune) occurs, not seeking acknowledgement.

Tonglen formal practice has four stages in Chödrön's published teaching: (1) a brief flash of openness (bodhichitta); (2) working with the texture of what is taken in and sent out; (3) a real, specific situation; (4) widening to all who share that suffering. [source: Lion's Roar, Chödrön 2025]

Format and dose. The tradition presents lojong as lifelong practice in formal sessions plus slogans carried into daily life. The sources consulted give no session count or course length for lojong itself. The secular CBCT programme (Emory), which draws on Tibetan Buddhist compassion practice, is taught weekly over 6, 8 or 10 weeks with guided recordings. [source: CBCT Introduction and Overview] [uncertain: whether CBCT is derived specifically from lojong is not stated in the CBCT overview consulted]

Clinical framework for the psychotherapist [synthesis]

Phase A, assessment and consent: spiritual history, the client's lineage and teacher, what the client wants from integrating the practice, trauma and psychiatric history, current practice intensity, retreat plans. Move on when the client has given informed consent to bringing practice into therapy and risk screening raises no bar.
Phase B, client-led integration: the client's own practice language (slogans, tonglen) is used as a resource for therapy goals; the therapist explores, does not instruct in doctrine. Move on when the client can use a practice element without destabilisation.
Phase C, application: slogans or a gentle, self-first tonglen as between-session reflection, or a secular compassion exercise if the client prefers no religious frame. Move on, or step back, according to arousal, functioning and the client's own report.
Phase D, consolidation and referral: doctrinal or advanced questions go to the client's teacher; intensive retreat is discussed with the teacher and screened clinically.

3. Guiding principles

Client-led, in the client's own tradition. Practical meaning: use lojong only when the client brings it or chooses it after an informed offer; use their words, lineage and teacher's version. [synthesis]
The therapist is not the lama. Practical meaning: explore how the client understands a slogan; send doctrine, empowerment and advanced practice questions to the client's teacher. [synthesis]
Attribute concepts, do not adjudicate them. Practical meaning: speak of karma, emptiness, bodhicitta and rebirth "as your tradition teaches", neither affirming nor dismissing. [synthesis]
Go at your own pace. Practical meaning: begin with what is manageable now; Chödrön repeatedly advises gentleness and patience and not being discouraged. [source: Lion's Roar, Chödrön 2021]
Start where it is real. Practical meaning: work with an immediate, specific situation, not an abstraction. [source: Lion's Roar, Chödrön 2021]
Begin with yourself. Practical meaning: the root text says to begin taking with oneself; Chödrön offers one's own pain as a starting point when stuck. Useful for clients with high self-criticism. [source: Lotsawa House; Lion's Roar, Chödrön 2025]
Use what seems like poison as medicine. Practical meaning: personal stuckness (fear, resistance) becomes the object of practice rather than a failure. [source: Lion's Roar, Chödrön 2025]
Many small interruptions. Practical meaning: a slogan recalled in the moment interrupts habitual reactivity; frequency matters more than intensity. [source: Lion's Roar, Lief 2021]
Responsibility, not self-blame. Practical meaning: Lief reads "drive all blames into one" as tracing problems to ego fixation and moving from blame to problem-solving; watch that clients do not turn it into self-punishment or excuse for abuse by others. [source: Lion's Roar, Lief 2021] [synthesis for the clinical caution]
Joy and patience as measures. Practical meaning: "Always maintain only a joyful attitude" and patience in good or bad fortune are signs of progress; mounting dread, guilt or exhaustion signal the practice is being misapplied. [source: Lotsawa House] [synthesis for the clinical reading]
Window of safety first. Practical meaning: Treleaven's trauma-sensitive principles (attention, arousal, relationship, dissociation, social context) override any wish to deepen practice. [source: Treleaven 2018, publisher description]
Non-harm and monitoring. Practical meaning: ask about adverse experiences routinely; they occur in people with and without prior mental health history. [source: Farias et al. 2020]
Professional boundaries and competence. Practical meaning: avoid dual roles (fellow sangha member, teacher, practice partner); keep self-disclosure about your own practice purposeful; seek consultation when outside competence. [synthesis] [uncertain: Vieten et al. 2013 spiritual competencies not verified]

4. Intervention inventory

Part A gives the practices as the tradition openly teaches them, so the therapist can recognise and support a practising client. The steps are given in outline, in this guide's own words; the client's teacher remains the authority on how they are done. Part B gives the psychotherapist's own work.

Part A. The tradition's practices

A1. The preliminaries: the four reminders

Purpose and when to use: In the tradition, reflection on precious human birth, impermanence and death, karma and the suffering of samsara turns the mind towards practice and is the stated first point of lojong. [source: Lotsawa House; Nalandabodhi course page] In therapy, relevant when a practising client brings questions of meaning, mortality, motivation or values. [synthesis]
Steps (outline): (1) The client chooses one reminder as their teacher presents it. (2) They reflect on it in their own words and connect it to their present life. (3) They note what it changes in their priorities that day. [synthesis, based on the published list]
Example language (illustrative): "You mentioned the reminder about impermanence. When you sit with it this week, what does it ask of you?"
Watch for: Reflection on death or karma amplifying depression, suicidal ideation, health anxiety or guilt; karma read as "I deserved the abuse". Working: the reminder increases purpose and steadiness rather than dread. Not working: rumination, hopelessness, self-condemnation; pause and assess risk. [synthesis]

A2. Ultimate (absolute) bodhicitta: the formless main-practice lines

Purpose and when to use: Lines such as "Consider all things and events as dreamlike" and "Rest in the ālaya, the essence" point to the tradition's view of emptiness and the nature of mind. [source: Lotsawa House] These are taught by qualified teachers within Buddhist study and practice; the therapist does not instruct in them. [synthesis]
Steps: None given here. The therapist explores the client's experience of the practice as their teacher has taught it and refers doctrinal questions to that teacher. [synthesis]
Example language (illustrative): "How has your teacher explained 'dreamlike' to you? And how does it feel in your body when you practise it?"
Watch for: "Dreamlike" or "empty" sliding into depersonalisation, derealisation or emotional numbing, or being used to avoid grief and anger (spiritual bypassing). Changes in sense of self are one of the seven domains of meditation-related experience documented by Lindahl et al. 2017. Working: a lighter, less rigid grip on events with intact feeling and functioning. [source: Lindahl et al. 2017 abstract] [synthesis for the clinical reading]

A3. The brief flash of openness (tonglen stage 1)

Purpose and when to use: Chödrön opens tonglen by resting the mind momentarily in openness or stillness, "a flash on bodhichitta"; picturing open space such as ocean or sky can help. [source: Lion's Roar, Chödrön 2021, 2025] Clinically, a gentle settling start before any compassion work. [synthesis]
Steps (outline): (1) Pause. (2) Let attention open, perhaps with an image of wide space. (3) Move on without straining for a special state.
Example language (illustrative): "Before you start, just pause for a moment, the way your teacher describes. No need to make anything happen."
Watch for: Spaciousness experienced as emptiness or void that frightens a client with dissociation; offer a concrete grounding image instead (feet on the floor, a familiar room). [synthesis]

A4. Formal tonglen (stages 2 to 4)

Purpose and when to use: "Train in the two—giving and taking—alternately" and "These two are to be mounted on the breath." [source: Lotsawa House] In Chödrön's teaching the practitioner takes in the feel of suffering (described as hot, dark, heavy, claustrophobic) and sends out relief (cool, bright, light, fresh), first for a specific real situation and then for all who share it, extending even to people one finds difficult. [source: Lion's Roar, Chödrön 2025] Lief notes its value for people who work with pain and suffering, against defensiveness and burnout. [source: Lion's Roar, Lief 2021] In therapy: for a practising client who wishes to bring it in, around grief, caregiving, estrangement, or shame; not as a first-line exercise for a non-practising client. [synthesis]
Steps (public outline only): (1) After the brief opening, the practitioner lets the imagery of taking in and sending out settle into the rhythm of their ordinary breathing; breathing is not controlled, held or deepened. (2) They bring to mind one real, immediate situation, traditionally someone they care about, or their own present pain. (3) They take in that suffering and send out whatever would help. (4) They widen the circle to others in the same situation, and in time to all beings, including those they regard as enemies. Pace and length are for the client and their teacher; this guide gives no counts or durations. [source: Lion's Roar, Chödrön 2021, 2025, paraphrased]
Example language (illustrative): "When you do tonglen for your father, where does it get stuck? What happens if, as Pema Chödrön suggests, you start with your own pain first?"
Watch for: Empathic overwhelm, flooding with images of a perpetrator, magical fears of literally absorbing illness, breath becoming effortful (drop the breath link entirely), exhaustion, guilt for "not doing it right". Working: the client reports softening, less avoidance of the painful situation, more warmth to self and others, steady functioning. [synthesis]

A5. Starting with oneself

Purpose and when to use: "Begin the process of taking with yourself." [source: Lotsawa House] Chödrön: when stuck, begin with your own pain, at the same time including everyone who feels the same; for example take in inadequacy for oneself and all who feel it, and send confidence and relief. [source: Lion's Roar, Chödrön 2025] Clinically suited to shame, self-criticism and isolation. [synthesis]
Steps (outline): (1) Name the feeling present now. (2) Recognise that many people feel this same thing. (3) Wish relief for oneself and them together. [source: Lion's Roar, paraphrased]
Example language (illustrative): "You feel like a failure right now. How many other people, tonight, might be feeling exactly this? What would you wish for all of you?"
Watch for: Self-directed warmth triggering grief or fear in clients with harsh self-criticism (compare Domain II CFT and MSC, where this reaction is anticipated) [uncertain: not verified]. Working: less isolation, more self-kindness. [synthesis]

A6. On-the-spot tonglen

Purpose and when to use: Tonglen can be done at any time, for example when meeting someone in pain, or with one's own painful feeling as it arises. [source: Lion's Roar, Chödrön 2021, 2025] Clinically useful for carers, health workers and clients who want a brief in-the-moment practice. [synthesis]
Steps (outline): (1) Notice the pain (one's own or another's). (2) Silently wish to take it in and send relief, briefly. (3) Return to the activity.
Example language (illustrative): "When you visit your mother on the ward and feel that knot, could a moment of the practice you already know help you stay present?"
Watch for: Use as a way of not acting (wishing relief instead of setting boundaries or seeking help); compassion fatigue in carers. [synthesis]

A7. Slogan practice in daily life

Purpose and when to use: "In all activities, train by applying slogans." [source: Lotsawa House] Lief: a slogan pops into mind in a moment of habit and one changes course; its effect comes from the accumulation of many small interruptions. Her published exercise takes one slogan (e.g. be grateful to everyone; always maintain only a joyful mind; always meditate on whatever provokes resentment) and works with it on three successive days: spiritual practice, personal relationships, colleagues and work. [source: Lion's Roar, Lief 2021] Clinically a values-based, cue-driven reflection that fits CBT-style between-session practice. [synthesis]
Steps (outline): (1) The client chooses one slogan from their own text. (2) They write it where they will see it. (3) Each day they note one moment the slogan came to mind, what they did, and what followed. (4) Review in session.
Example language (illustrative): "Which slogan feels most alive for you this week? Let's notice together where it showed up."
Watch for: Slogans turned into rules that must be obeyed perfectly, checking or reciting compulsively (possible scrupulosity, see B6); slogans used to override valid anger. Working: more flexible responses in difficult interactions. [synthesis]

A8. Transforming adversity: "Drive all blames into one" and "Meditate on the great kindness of all"

Purpose and when to use: The third point turns obstacles into practice. Lief reads "drive all blames into one" as taking responsibility and tracing problems to ego fixation, helping groups move from blame to problem-solving. [source: Lotsawa House; Lion's Roar, Lief 2021] The kindness line invites seeing how one depends on others. Clinically useful for chronic resentment, blame cycles in couples or teams, and gratitude work. [synthesis]
Steps (outline): (1) Identify the situation and the blame story. (2) Ask, as the client's teacher frames it, where self-clinging feeds the reaction. (3) Separate that from factual responsibility for harm (who did what). (4) Choose a constructive next step. [synthesis]
Example language (illustrative): "Your tradition asks you to look at your own clinging here. That's different from taking the blame for what he did to you. Can we hold both?"
Watch for: Survivors of abuse or coercive control applying the slogan to excuse others' harm or stay in danger; depressive self-blame; moral injury. Safety and protective action come first. [synthesis]

A9. The five strengths and practice at death

Purpose and when to use: The fourth point condenses the instruction into five strengths for life and the same five at the time of death. [source: Lotsawa House] Relevant in palliative care, bereavement, and with older practising clients. [synthesis]
Steps: Not given here; the strengths are explained in the commentaries (for example Kongtrul's The Great Path of Awakening, Trungpa's Training the Mind). Refer the client to their teacher or a chaplain from their tradition for death-related practice. [uncertain: not verified]
Example language (illustrative): "You said you want to prepare for death as your tradition teaches. Would it help to involve your teacher or the hospice chaplain?"
Watch for: Distinguish spiritual preparation from suicidal intent or wish to hasten death; assess risk by current standards. [synthesis]

A10. Commitments, precepts and the measure of practice

Purpose and when to use: Points five to seven give ethical pledges and guidelines (do not ponder others' flaws, do not retaliate, be patient in good or bad fortune, do not seek acknowledgement, "Two tasks: one at the beginning and one at the end"), and the measures of progress: relying on the principal witness and keeping a joyful attitude. [source: Lotsawa House] Lief reads "Don't expect applause" as trusting the action itself rather than recognition. [source: Lion's Roar, Lief 2021] In therapy: a source of values clarification and relapse prevention for practising clients. [synthesis]
Steps (outline): (1) Client selects a precept relevant to a therapy goal. (2) Translate it into one observable behaviour. (3) Review at the start and end of the day if that is how their teacher explains the "two tasks" [uncertain: interpretation not verified]. (4) Review in session with self-compassion for lapses.
Example language (illustrative): "'Don't be irritable' is in your text. What would one less irritable moment with your son look like this week?"
Watch for: Perfectionistic tallying of failures, vows experienced as unbearable obligations, fear of karmic punishment; see B6. [synthesis]

Part B. The psychotherapist's work

B1. Spiritual assessment and consent to integrate

Purpose and when to use: At intake or when a client mentions lojong or tonglen; establishes the client's tradition, teacher, practice intensity and goals so that integration is client-led. [synthesis]
Steps: (1) Ask open questions about tradition (Kagyu, Nyingma, Gelug, Sakya, Shambhala, secular, or other), teacher and community, and which text or teacher's version they follow. (2) Ask how often and how intensely they practise and whether retreat is planned. (3) Ask what role they want practice to play in therapy, including none. (4) Explain your role: you will explore, not teach doctrine. (5) Record explicit consent and revisit it. (6) Ask about past difficult experiences in practice. [synthesis]
Example language (illustrative): "Some people want their practice to be part of our work, some prefer to keep it separate. Both are fine. What would you like?"
Watch for: Deference to the therapist as a spiritual authority; pressure the client feels from their community; the therapist's own enthusiasm or scepticism steering the choice. Working: the client sets the terms and uses their own language. [synthesis]

B2. Screening and monitoring for adverse effects

Purpose and when to use: Before encouraging any formal practice, before intensive retreats, and routinely during therapy. Lindahl et al. 2017 documented 59 kinds of meditation-related experience across seven domains (cognitive, perceptual, affective, somatic, conative, sense of self, social) and 26 categories of influencing factors (practitioner, practice, relationships, health behaviours), with distress and impairment ranging from minimal and transient to severe and enduring. Farias et al. 2020 reviewed 83 studies (6,703 participants) and found a pooled adverse-event prevalence of 8.3% (higher in observational studies), most commonly anxiety, depression and cognitive anomalies, including in people without prior mental health history. [source: Lindahl et al. 2017 abstract; Farias et al. 2020 PubMed abstract] [uncertain: neither study reports tonglen-specific rates]
Steps: (1) Screen for current psychosis or mania, severe depression, suicidality, active PTSD or dissociation, recent trauma, substance misuse, sleep problems. (2) If retreat is planned, discuss with the client (and teacher, if the client wishes) intensity, support available and an exit plan. (3) At each session ask briefly about practice and any unusual or distressing experiences. (4) If adverse effects appear: reduce dose (shorter, less frequent, eyes open, less compassion-for-suffering content), shift to grounding and ordinary activity, restore sleep, and consult. (5) Cheetah House offers consultation, support groups and clinician training for meditation-related difficulties. [source: Cheetah House VCE page; steps synthesis]
Example language (illustrative): "Practices like tonglen can sometimes stir up strong things: fear, numbness, odd perceptions, trouble sleeping. If anything like that happens, I'd want to hear about it, and it's not a sign you're doing it wrong."
Watch for: Insomnia, panic, intrusive imagery, depersonalisation, perceptual changes, loss of interest in ordinary life, social withdrawal. Working: the client discloses early and recovers with reduced dose. [synthesis]

B3. Trauma-sensitive adaptation

Purpose and when to use: For clients with trauma histories who wish to practise. Treleaven (2018) argues that mindfulness taught without trauma awareness can intensify flashbacks, dissociation and retraumatisation, and organises adaptations around five principles: attention, arousal, relationship, dissociation and social context. [source: Treleaven 2018, publisher description] Applying these to tonglen is [synthesis].
Steps: (1) Attention: let the client choose the object; never require focusing on a perpetrator, and allow attention to a neutral or supportive anchor (sounds, feet, a sight in the room). (2) Arousal: track activation and stay within tolerable limits; stop or switch to grounding when it rises. (3) Relationship: begin tonglen with self or with a loved one, not "enemies"; the "enemy" stage is optional and may never be appropriate for a perpetrator. (4) Dissociation: keep eyes open, short practice, concrete images, and return to the room. (5) Social context: acknowledge real injustice and power; tonglen is not a substitute for safety or justice. (6) Decouple from breath if breath focus triggers. [synthesis]
Example language (illustrative): "You never have to bring him into your practice. If you want to, we can decide together when and how much. And you can stop at any point."
Watch for: Flashbacks, freezing, shutdown, the client "pushing through" to be a good practitioner. Working: increased choice, steady arousal, more self-compassion. [synthesis]

B4. Secular and clinical adaptations

Purpose and when to use: For clients who want compassion training without a Buddhist frame, or for group delivery. Cognitively-Based Compassion Training (CBCT), developed by Geshe Lobsang Negi at Emory from Tibetan Buddhist practice, runs six modules in order: attention and stability; insight into mental experience; self-compassion; equanimity and impartiality; appreciation, affection and empathy; engaged compassion; taught weekly over 6, 8 or 10 weeks, using analytical meditation and post-meditation practice. Its overview notes it was not designed specifically to treat trauma. [source: CBCT Introduction and Overview] Related programmes: MSC and CFT (Domain II), contemplative and Buddhist psychotherapy and spiritually integrated psychotherapy (Domain VII). [uncertain: not verified]
Steps: (1) Offer options, explaining the Buddhist origin openly. (2) Refer to a certified CBCT or similar teacher for the full programme. (3) In individual therapy, use only those elements you are trained in. [synthesis]
Example language (illustrative): "There's a secular programme drawn from Tibetan compassion practice. It doesn't ask you to adopt any beliefs. Would you like information on it?"
Watch for: Practising Buddhist clients feeling the secular version strips meaning; non-Buddhist clients feeling covertly proselytised. [synthesis]

B5. Referral and collaboration with the client's teacher

Purpose and when to use: Doctrinal questions, advanced or restricted practice, retreat decisions, death practice, or when practice and therapy seem to pull in different directions. [synthesis]
Steps: (1) Ask if the client has a teacher and whether they want you to communicate. (2) Get written consent and agree what is shared. (3) Keep roles clear: the teacher guides practice; you address mental health. (4) If the client has no teacher, they can find one through their tradition's established centres; check that the teacher works within an accountable community. [synthesis]
Example language (illustrative): "That's a question about the practice itself, and your teacher is the right person for it. Would it help to talk to them, or for me to, with your permission?"
Watch for: A teacher who discourages mental health care, demands secrecy, or exerts control over money, relationships or sexuality; see section 5. [synthesis]

B6. Scrupulosity and moral injury

Purpose and when to use: When moral self-accounting ("drive all blames into one", commitments, precepts, karma) becomes obsessive: compulsive confession, reassurance seeking, repeated recitation of slogans until "right", intense fear of breaking pledges. Exposure and response prevention can be adapted to be acceptable and consistent with religious values, as Huppert, Siev and Kushner (2007) describe for ultra-Orthodox Jewish clients. [source: Huppert et al. 2007 abstract] Collaboration with a religious authority in that work and its application to Buddhist clients are [synthesis].
Steps: (1) Assess for OCD separately from devout practice: is the behaviour driven by anxiety and doubt, beyond what the tradition requires? (2) With consent, consult the client's teacher on what the tradition actually requires (usually less than OCD demands). (3) Build an ERP hierarchy that never asks the client to violate genuine commitments, only OCD-driven rituals. (4) Address moral injury separately where real wrongdoing occurred. [synthesis]
Example language (illustrative): "Your teacher said one sincere review is enough. OCD says do it again until it feels right. Which voice do you want to train?"
Watch for: The therapist arguing theology; ERP that offends the client's values; overlooking depression. [synthesis]

B7. Distinguishing spiritual difficulty from mental disorder

Purpose and when to use: When practice brings unusual experiences (energy, visions, loss of self, "dark night" despair). The DSM provides the code V62.89 (Z65.8) Religious or Spiritual Problem for distress centred on religious or spiritual concerns that is not a disorder; using it can prevent misdiagnosis. [source: Barrett 2020, Current Psychiatry]
Steps: (1) Describe the experience in the client's words and the tradition's frame. (2) Assess functioning, sleep, insight, risk, psychotic, manic, depressive or dissociative features, and duration. (3) If disorder is present, treat it and reduce practice; if not, support, normalise without dismissing, and involve the teacher if the client wishes. (4) Reassess. [synthesis]
Example language (illustrative): "Your tradition has a way of understanding this, and I want to respect that. I also want to make sure your sleep and safety are OK. Can we look at both?"
Watch for: Both errors: pathologising a meaningful experience, and calling emerging psychosis or mania "just spiritual". [synthesis]

B8. Boundaries, self-disclosure and competence

Purpose and when to use: Throughout, especially if the therapist practises in the same or another tradition. [synthesis]
Steps: (1) Avoid dual relationships (shared sangha, being the client's practice instructor). (2) Disclose your own practice only when it serves the client. (3) Seek supervision or consultation on spiritual competence. (4) Follow your profession's ethics code. [synthesis] [uncertain: Vieten et al. 2013 not verified]
Example language (illustrative): "I know a little about lojong, but you are the expert on your own practice, and your teacher on the tradition."
Watch for: Drifting into teaching; shared community contact; proselytising either way. [synthesis]

5. Handling problems

The tradition's own guidance for difficulty is limited to a few points: go gently at your own pace, start with what is manageable and real, do not be discouraged, and use stuckness itself as the object of practice (for example, practising for all who want to be compassionate but feel afraid). [source: Lion's Roar, Chödrön 2021, 2025] Everything else below is [synthesis] unless tagged.

Stuck ("I can't feel anything" / "I can't take anything in"): Use Chödrön's stepping-stone: practise for the stuckness itself, for oneself and all who feel it. [source: Lion's Roar, Chödrön 2025] In session, explore what blocks it (fear, anger, numbness) as clinical material rather than a practice failure. (illustrative) "Maybe the numbness is the thing to be kind to right now."
Resistance to the reversal ("Why would I breathe in pain?"): Validate; the reversal is meant to feel counter-intuitive. Offer self-first or a secular compassion exercise; the client may decline tonglen altogether. [synthesis]
Overwhelm and empathic distress: Stop the practice, ground (eyes open, name objects, feet), reduce dose, narrow the circle back to self or a loved one, and drop the breath link. Assess for trauma activation, panic or depression; consider B2 and B3. Carers and clinicians showing compassion fatigue need workload and rest addressed, not more practice. [synthesis]
Fear of literally absorbing illness or misfortune: Ask how the client's teacher explains this; many clients benefit from hearing it from the teacher. If the fear is persistent, anxious and checking-driven, assess for OCD or health anxiety (B6). [synthesis]
Self-blame and abuse ("drive all blames into one" misapplied): Separate the tradition's teaching on ego fixation from responsibility for harm done by others; prioritise safety planning; involve the teacher if the client wishes. [source: Lion's Roar, Lief 2021 for the teaching; synthesis for the response]
Spiritual bypassing: Practice used to avoid grief, anger, conflict or decisions. Name the pattern gently, with reference to the client's own tradition, which treats adversity as the path rather than something to escape. [synthesis]
Non-adherence: Explore meaning rather than push; practice is the client's, not homework the therapist owns. Shrink to a single slogan noticed once a day (A7). [synthesis]
Perfectionism and scrupulosity: "Always maintain only a joyful attitude" or the commitments turned into a test one fails. Use B6; consult the teacher on what is actually expected. [synthesis]
Unusual or intense experiences, retreat-related crises: Follow B2 and B7; reduce or pause practice; coordinate with the teacher and, where needed, psychiatry; Cheetah House offers specialist consultation and support. [source: Cheetah House VCE page; synthesis]
Rupture over religion: If the client experiences the therapist as dismissive or as over-interested, acknowledge, repair, and re-negotiate the role of practice in therapy (B1). [synthesis]
Therapist from a different tradition, or none: Stay curious and attributive; avoid comparative judgements; consult. [synthesis]
Teacher power and misconduct: The teacher relationship carries considerable power in Tibetan Buddhist communities. Warning signs include demands for secrecy, isolation from family or outside help, financial or sexual exploitation, punishment for questioning, and discouraging mental health care. Support the client's autonomy, help them access independent information and community reports, and treat religious trauma after leaving a group with the same care as other relational trauma. [synthesis] No teacher is named here [uncertain: not verified].
Suicidality or wish to die framed as practice: Assess risk by current standards; spiritual framing does not lower the threshold for safety planning. [synthesis]
Problems the sources do not address: children and adolescents (seek parental consent and the young person's assent; keep practice brief and playful; do not use the "enemy" stage); psychosis or bipolar disorder (generally defer formal tonglen until stable, coordinate with psychiatry); grief (self-first tonglen for one's own sorrow may suit, but do not hurry the widening). [synthesis]

No practice described here treats physical disease; claims of health benefit belong to their sources and remain under study. [synthesis]

Sources

Web sources:

Publications cited:

Lindahl et al. (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLOS ONE, 12(5), e0176239. doi:10.1371/journal.pone.0176239
Farias, M., et al. (2020). Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatrica Scandinavica, 142(5), 374–393. doi:10.1111/acps.13225
Treleaven, D. A. (2018). Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing. W. W. Norton.
Huppert, J. D., Siev, J., & Kushner, E. S. (2007). When religion and obsessive-compulsive disorder collide: Treating scrupulosity in ultra-orthodox Jews. Journal of Clinical Psychology, 63(10), 925–941. doi:10.1002/jclp.20404
Barrett, J. A. (2020). COVID-19's religious strain: Differentiating spirituality from pathology. Current Psychiatry, 19(12), e1–e2. doi:10.12788/cp.0072
Chögyam Trungpa, Training the Mind and Cultivating Loving-Kindness; Jamgön Kongtrül, The Great Path of Awakening (both recommended by Lief) [uncertain: publication details not verified]
Vieten, C., et al. (2013), spiritual and religious competencies for psychologists [uncertain: not verified]
American Psychological Association, Ethical Principles of Psychologists and Code of Conduct, https://www.apa.org/ethics/code
ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem')

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