Kurt Kraus, Ed.D , NCC, ACS, LPC Ford Brooks, Ed.D , NCC, LPC, CADC

1. KARMA: How Teaching and Counseling in the Kingdom of Bhutan can Inform Counselors in Pennsylvania Kurt Kraus, Ed.D, NCC, ACS, LPC Ford Brooks, Ed.D, NCC, LPC, CADC

3. What to know Bhutan – a tiny Kingdom in south-central Asia – is halfway around the world from Pennsylvania. Bhutanese citizens received access to television and cell phones in 1999; the Fourth King abdicates his thrown in favor of a Constitutional Democracy in2005

5. What else. . . Bhutan is about the size of West Virginia and Maryland combined; geography – the Himalayas to the Indian delta; elevation from 100m to 7541m; 77% Buddhist, 20+% Hindu; population of +/- 700,000 people; in 2015 there were roughly 60,000 vehicles – and no traffic signals; one National Referral Hospital, three regional hospitals, and clinics across the 20 Dzongkhags.

7. What do we bring Bhutan offered us lessons in mental health care – opportunities to compare and contrast it with Pennsylvania, USA Careful distinction will be made regarding Buddhism as a socio-cultural approach to living as contrasted to Buddhism as a religion or as a spiritual practice.

9. Working with a partner or in triads - Take a look at this familiar list – it is generic and American (source Google Image). What culturally encapsulated concepts are presented in this list of 12 steps? What do you think is truly universal here – what could translate into any language and make cultural sense? Where might “another culture” get tripped-up on these twelve steps?

13. Bhutan’s Buddhist (sociocultural) CONCEPTS Karma: A system of ever accumulating merits and demerits – the workings of cause and effect Three Jewels: the Buddha (the awakened one), the Dharma (laws of the universe), the Sangha (the community) Samsara: Cyclical Existence – the cycle of death and rebirth

14. Bhutan’s Buddhist (sociocultural) CONCEPTS Four Noble Truths: reality of suffering, the cause of suffering, the cessation of suffering, and the path leading to the cessation of suffering. Eightfold Path: the path leading to the cessation of suffering. Nirvana: “Extinguishing” – liberation from suffering, extinction of craving, eradication of craving

15. Four Noble Truths: reality of suffering, the cause of suffering, the cessation of suffering, and the path leading to the cessation of suffering.

16. A principle from Buddhism to guide our discussion – Four Noble Truths: suffering the cause of suffering the cessation of suffering “the path” (in Buddhism) that leads to the cessation of suffering

17. Eightfold Path: the path leading to the cessation of suffering.

18. A reminder - If we acknowledge that our perceptions as well as the perceptions of the people we work with shape our suffering, please remember that nothing we “do to” someone is as effective as when we work together or “move with” the people we choose to serve. (Buddhists speak about the Sangha – or the community of travelers on the path – as a refuge. Working together, moving with others, is in essence the establishment of a purposeful community. Think secularly here rather than religiously or spiritually.)

19. Eight divisions of “the path” leading to the cessation of suffering

20. What are the eight divisions (tasks)? Remember that these eight task – this eightfold path – is part of Bhutan’s cultural foundation. These are the cultural as well as the spiritual tasks children grow up with, parents attempt to cultivate in their parenting, these are the paths that lead to enlightenment. How do these compare with the cultural foundations – the paths – that you grew up with, that you have witnessed (so far) in life; and how about in the lives of your clients.

21. Right view • The first step on the path (forward toward enlightenment – our goals with clients/ourselves should be no less lofty). • “See for yourself that suffering and dissatisfaction infect the entirety of ordinary, unenlightened existence.” • Aware that I am suffering. (The risk associated with the language we use, “patients suffering from depression, suffering from homelessness, suffering from neglect.”) • Aware that others suffer. (The risk associated with distancing ourselves from others.)

22. Right intention • “right thought” • Relinquishing selfish thoughts that lead to further suffering • Replace the “that lead to further suffering” (to self and others) with “the intention to bring happiness to all.”

23. Right speech • “This cultivation involves speaking words that are true and not hurtful, as well as refraining from ‘idle chatter.’”

24. Right action • To avoid causing harm with what you do. • In place of physically harming others through our actions, we seek to help and protect others • In practice we avoid killing, stealing, and engaging in sexual misconduct.

25. Right livelihood • Earn our living in keeping with all other paths. • Seek a livelihood intent on gaining more than material wealth. • Ensure that your dealings with others are honest and kind.

26. Right effort • This division speaks largely to spiritual practices. • (perhaps more challenging than other divisions) • “Instead of being lazy, exert continuous effort (effortlessly) to be aware of what arises in your mind (not only thoughts). • Notice and release negative thoughts and feelings; notice and release positive thoughts and feelings.

27. Right mindfulness • Mindfulness is the practice of “paying close attention to what is happening right now.” • A constant awareness with reference to the body, the feelings, the mind, and “the psychic factors that lead to bondage or release.

28. Right concentration • Practice to develop deep insight into “the nature of reality.” • The focus your mind becomes “sharp and free of distraction and dullness.”

29. Review of “the path” Eight divisions of the path leading to the cessation of suffering • Right view • Right intention • Right speech • Right action • Right livelihood • Right effort • Right mindfulness • Right concentration (“a do it yourself instruction manual that leads to the cessation of suffering.”)

30. Clients’ (our) means of expressing SA and MI • Somatization • Anxiety • Panic • Depression • Trauma • others

31. Use of medication (few for the many)

32. Use of Electroconvulsive Therapy

34. Complexities of treatment when ghosts are involved

35. What to expect A brief introduction to the practices of mindfulness, awareness, and “mind training.”

36. Relieving Suffering Ultimately, the content of this presentation addresses an alternate way of conceptualizing “despair” through a lens of several of Bhutan’s cultural principles and ends by seeing ways through which suffering is relieved.

37. How might we practice this Eight-fold Path in the work we do? From these eight, which (and how) might you practice (or change your current practice) to aid in the cessation of suffering (yours AND those with whom we work)?

38. Mindfulness – a meditation

40. Mindfulness: “You can’t calm the pool by stirring the water.” The practice of being aware, of becoming aware moment by moment, continuously unfolding awareness. Awareness lacks interpretation, lacks valuing and devaluing – lacks all judgment. Mindfulness meditation – is the practice, the dedication to cultivating your awareness.

41. Mindfulness from within Meditation Attempting to teasing mindfulness out from its broader practice of meditation. What is meditation: “it denotes diverse techniques and methods developed to calm, fashion, understand, and release the mind. Mental tranquility or purification Insight into a religious truth Visualization or construction of a special perception (Landaw, 2011) Therefore, meditation is NOT truly a vehicle to mental health! However, mindfulness is a powerful practice with profound implications for wellbeing and mental health.

42. Mindfulness How can this practice become valuable in our work with the population with whom you work? What might mindful awareness change in your daily work and in the daily lives of the people you work with? Where (how) can mindful awareness be cultivated in my workplace? Your thoughts?

43. Compassion . . . a step in fulfilling our highest potential It is NOT overburdening oneself with the suffering of others. It is: first acknowledging the suffering of others and practicing opening yourself (your heart) to feel the suffering of others (and our own). It is: finding clear perception of the way things are. It is: developing strength and skill to do whatever we can to alleviate suffering.

44. Compassion turned inward is Self-care.

45. Applying “Basic Principles” with the goal of taking care of ourselves

46. Turning the page on your great expectations

47. Accepting change gracefully

48. Breaking up the concrete

49. Watching your car rust

50. Pretending to be the Buddha