Mandala and yantra contemplation

1. Introduction

Version followed: (a) Indo-Tibetan Vajrayana Buddhist mandala practice as the Rubin Museum of Art and the International Kalachakra Network describe it publicly (public outline only); (b) Hindu Tantric yantra worship, centred on the Shri Yantra (Shri Chakra) of the Shri Vidya tradition, as Encyclopaedia Britannica and a University of Pennsylvania study page drawing on the Saundaryalahari and its commentaries describe it (public outline only); (c) secular and clinical mandala work: C. G. Jung's use of spontaneous mandala drawing as summarised by the Jung Society of Utah, and mandala colouring as tested by Curry and Kasser (2005) and later studies. For sand mandalas specifically (construction, public display and ritual dismantling), see guide 102 (sand mandala).

What it is. "Mandala" means "a circle with a center"; in Buddhist art it is often a square set within a circle, representing the cosmos and the palace-home of a deity enthroned among attendants, each quadrant linked to an element, a direction and a buddha embodying an enlightened quality [source: Rubin Museum, Mandala]. A yantra (Sanskrit "instrument") is, in Tantric Hinduism and Vajrayana, "a linear diagram used as a support for ritual"; Britannica describes the yantra as the basic linear form and the mandala as its more elaborate, pictorial form [source: Britannica, Yantra]. The Shri Yantra, used in ritual worship of the goddess (Shakti, Shri), is built of interlocking triangles, four pointing up and five down, around a central point (bindu) where the tradition locates their union [source: Britannica, Yantra; Patrick A. George, Yantra page].

How change happens, as each tradition holds it.

Vajrayana: mandalas are "symbolic aids for meditation and visualization" in deity yoga; the practitioner mentally enters the mandala with the deity at its centre, as one of the meditative and ritual tools by which the practitioner seeks "enlightenment or awakening" [source: Rubin Museum, Mandala; Rubin Museum, Mandala of Chakrasamvara]. In the Kalachakra cycle the mandala is visualised in fine detail in the generation stage, building concentration; in the completion stage the practitioner works to transform body and mind into those of a buddha [source: International Kalachakra Network]. These are the tradition's own claims, not claims this guide makes.
Hindu Tantra: the yantra is the ritual seat or form of the deity and a support for worship; designs range from temporary diagrams traced on the ground and disposed of after the rite to permanent ones in metal or stone in temples [source: Britannica, Yantra].
Jungian and clinical: Jung treated the mandala as an image of the Self, an "archetype of wholeness", and held that the circular form "compensates the disorder of the psychic state" by building a centre to which everything relates [source: Jung Society of Utah, quoting Jung]. Colouring studies frame the mechanism more modestly: a structured, absorbing visual task reduces self-reported anxiety in the short term [source: Knox College; Holt 2023].

Restricted content. Full deity-visualisation practice (sadhana) and yantra worship with mantra are initiatory. In Tibetan Buddhism, initiation (empowerment) is given on the basis of a mandala by a qualified Vajra master and is understood as "granting the authority to practice" the tantra; students take pledges, including keeping the teachings confidential [source: BuddhaNet, The Kalachakra Initiation Explained; International Kalachakra Network]. This guide therefore gives only a public outline of those practices, with no visualisation sequences, mantras, seed syllables, empowerment content or worship procedure. Health claims made for yantras or mandalas (for example, that a yantra heals illness) are the tradition's or seller's claims; no practice here is presented as treating physical disease, and the clinical evidence concerns short-term self-reported anxiety only [source: Holt 2023].

2. Framework

This is a contemplative practice with two very different registers, and the therapist should be clear which one is in play.

Register A: the client's own religious practice (initiatory).

Tradition's path, Vajrayana (public outline): receiving initiation from a qualified teacher → generation stage (visualising the mandala and deities, building concentration) → completion stage (inner transformation as the tradition describes it) [source: International Kalachakra Network; BuddhaNet]. Some people attend a large public initiation "simply as a blessing" without taking on full practice commitments; others take pledges and keep a regular practice [source: BuddhaNet].
Tradition's path, Shri Vidya (public outline): worship of the goddess through the Shri Chakra, taught within a lineage by a guru [source: Britannica, Yantra] [uncertain: details of Shri Vidya initiation stages not verified in a primary institutional source].
Therapist's role: not to teach, correct or deepen the practice, but to understand its meaning, support integration, watch for adverse effects and refer to or (with consent) collaborate with the teacher [synthesis].

Register B: secular or clinical mandala work (non-initiatory). Mandala colouring, spontaneous mandala drawing, and non-devotional looking at mandala images. These borrow the form only; they are not the religious practice and should not be presented as such [synthesis]. Art-therapy training is the natural home for drawing work; therapists without it should keep to simple, low-intensity use [synthesis].

Phases of the therapist's work [synthesis; no source gives a session structure or count]:

Assessment and consent: establish whether mandalas/yantras belong to the client's religious life, which tradition and teacher, whether they are initiated, and what the client wants from therapy in relation to it. Move on when the client's goals are clear and consent to any in-session use is explicit.
Stabilisation and resourcing (if needed): screen for trauma, dissociation, psychosis or mania risk and for current meditation-related difficulties. Move on when the client can stay within their window of tolerance during brief attention tasks.
Integration or clinical use: either client-led integration of their own practice (Register A) or offered secular exercises (Register B).
Review and referral: check benefit and adverse effects; refer to a teacher, art therapist or psychiatric care as indicated.

Format and dose. No source gives a session count for this practice in psychotherapy. In the best-known colouring experiment, participants coloured for 20 minutes [source: Knox College]. Keep in-session exercises short and optional [synthesis].

Cross-references. Mindfulness-based programmes (Domain II: MBSR, MBCT, MSC, CFT); contemplative, Buddhist and spiritually integrated psychotherapy (Domain VII); trauma-sensitive yoga (Domain IV); sand mandala (guide 102).

3. Guiding principles

The tradition owns the practice. Deity visualisation and yantra worship are taught by qualified teachers after initiation; in practice: never teach, coach or improvise sadhana, mantra or visualisation sequences in therapy [source: BuddhaNet; International Kalachakra Network].
Client-led integration. Bring the mandala or yantra into therapy only when the client raises it and wants it there; in practice: ask, do not suggest [synthesis].
Respect confidentiality vows. Initiated practitioners may have pledged to keep teachings private; in practice: never ask a client to describe restricted content, and tell them they need not [source: BuddhaNet; synthesis].
Attribute, do not adjudicate. Describe deities, the bindu, enlightenment or blessing as the tradition holds them, neither affirming nor dismissing; in practice: use the client's own terms ("in your practice, the deity...") [synthesis].
Keep registers separate. A colouring sheet is not a sacred object to everyone, and a sacred image is not a colouring sheet to a practitioner; in practice: ask before using any religious image in a secular exercise [synthesis].
Low intensity first. Structured colouring is the gentlest form; free drawing can feel more demanding and in one study did not reduce anxiety [source: Holt 2023; Knox College].
Trauma sensitivity. Expect trauma in any client; recognise and respond to dysregulation; offer choice; prevent retraumatisation [source: BACP, summarising Treleaven].
Adverse effects are real. Meditation-related difficulties occur, including in people with no prior mental-health history [source: Farias et al. 2020, Acta Psychiatrica Scandinavica]; in practice: ask about them routinely.
Stay in role. The therapist is not a lama, guru or priest; in practice: avoid dual relationships, keep self-disclosure about your own practice purposeful, and refer spiritual-instruction questions to the teacher [synthesis].
No health claims. Do not present mandala or yantra work as treatment for physical illness; evidence is limited to short-term self-reported anxiety reduction in mostly student samples [source: Holt 2023].

4. Intervention inventory

Items 4.1–4.2 are public outlines of the traditions' own practices, for the therapist's understanding; they are not instructions. Items 4.3–4.12 are the therapist's own work.

4.1 Tibetan Buddhist mandala and deity visualisation (public outline only)

Purpose and when to use: For the therapist's orientation when a client practises Vajrayana Buddhism. Not delivered by the therapist.
What the tradition publicly describes: The mandala is the residence of a deity, often shown as a multi-level palace; in the Kalachakra system it is understood at outer (cosmos and time), inner (body and mind) and "other" (practice) levels [source: International Kalachakra Network]. Practice begins with initiation given on the basis of a mandala by a Vajra master [source: BuddhaNet; International Kalachakra Network]. In the generation stage the initiated practitioner visualises the mandala and its deities in detail; in the completion stage the practitioner works on inner transformation as the tradition describes it [source: International Kalachakra Network]. Viewing mandala images is itself believed by the tradition to support progress toward awakening [source: Rubin Museum, Mandala of Chakrasamvara]. Sand mandalas are built for initiations and then dismantled, the sand carried to water (see guide 102) [source: BuddhaNet].
Who teaches it: Qualified lamas within Tibetan Buddhist lineages; large public Kalachakra initiations have been given by the Dalai Lama [source: International Kalachakra Network; BuddhaNet].
Steps: None given here. Sadhana texts, visualisation sequences, mantras and empowerment content are restricted; refer questions about method to the client's teacher.
Example language (illustrative): "I won't ask you about the content of your practice, and you don't need to tell me anything you've promised to keep private. I'm interested in what it means to you and how it's going."
Watch for: Clients practising from books or online material without a teacher who report distressing imagery, energy-like sensations or changes in sense of self (see 4.10); pressure from a group or teacher (see 5.8).

4.2 Hindu yantra worship and contemplation, Shri Yantra (public outline only)

Purpose and when to use: Orientation when a client worships with a yantra or keeps one at home or in a temple context.
What the tradition publicly describes: Yantras are ritual diagrams that range from temporary ones traced on the ground to permanent ones in stone or metal in temples [source: Britannica, Yantra]. They share a common enclosing scheme (gated outer walls, lotus petals, circles) while the inner content changes with the deity and purpose; the Shri Yantra's interlocking triangles are described in verses of the Saundaryalahari and its commentaries [source: Patrick A. George, Yantra page]. The Shri Chakra is used in ritual worship of the goddess, with the central bindu as the point of union [source: Britannica, Yantra]. Yantras are also used in Tantric initiation and empowerment [source: Patrick A. George, Yantra page].
Who teaches it: Gurus and priests within Shri Vidya and other Tantric lineages, and temple priests for temple yantras [source: Britannica, Yantra] [uncertain: named contemporary institutions not verified].
Steps: None given here. Mantra, installation of the deity and worship procedure are taught within the lineage.
Example language (illustrative): "Your Shri Chakra sounds central to your devotion. What does sitting with it do for you, and has anything about it changed lately?"
Watch for: Mass-marketed yantras sold with promises of wealth or cures (attribute such claims to the seller; no evidence supports them); anxiety about having done worship "wrongly" (see 4.11).

4.3 Spiritual and cultural assessment of the practice

Purpose and when to use: At intake or whenever the client mentions a mandala, yantra, deity practice or retreat.
Steps: (1) Ask open questions about the client's religious life in their own terms; the DSM-5-TR Cultural Formulation Interview and its supplementary module on spirituality, religion and moral traditions can structure this [uncertain: not verified]. (2) Establish tradition, lineage, teacher and whether the client is initiated or practising informally. (3) Ask what the practice gives them (meaning, calm, devotion, community) and any difficulties. (4) Ask how much they practise and whether they plan an intensive retreat. (5) Ask what role, if any, they want the practice to have in therapy. (6) Record consent for any in-session use [synthesis].
Example language (illustrative): "Some people want their practice to be part of therapy; others prefer to keep it separate. What would feel right for you?"
Watch for: Reluctance that reflects confidentiality vows (respect it); signs of current meditation-related difficulty; a gap between the client's practice and community support. Working when: the client can describe the practice's place in their life and their goals for therapy.

4.4 Client-led integration of the client's own practice

Purpose and when to use: Spiritually integrated psychotherapy with an initiated or devotional client who wants their practice to inform therapy (cross-refer Domain VII).
Steps: (1) Invite the client to name what the mandala or deity means to them (protection, wholeness, compassion, the goddess's presence). (2) Explore how they draw on that meaning outside formal practice, for example during stress. (3) Link it to therapy goals in the client's words. (4) Encourage them to take method questions to their teacher. (5) Review whether the integration helps [synthesis].
Example language (illustrative): "When you said the palace in your practice feels like a place of refuge, what is it like to remember that when you're at work and things get tense?"
Watch for: The therapist drifting into teaching or interpreting doctrine; spiritual bypassing (using practice to avoid grief or conflict); the client feeling judged for "needing" therapy alongside practice. Working when: the client reports more access to steadiness or meaning without increased strain.

4.5 Structured mandala colouring

Purpose and when to use: A low-intensity, non-religious calming task for short-term anxiety, waiting-room or pre-procedure distress, or as a gentle start to sessions. Evidence: a randomised experiment found colouring a mandala reduced self-reported anxiety more than colouring a plaid design or free drawing, which did not reduce it [source: Knox College; Curry & Kasser 2005 as cited in Holt 2023]; a replication supported the finding, but comparisons with other designs are mixed [source: Holt 2023].
Steps: (1) Offer it as optional and secular; ask whether religious images would be welcome or not. (2) Provide a printed geometric mandala outline and colours. (3) Invite the client to colour at their own pace, choosing colours freely; avoid prescribing colour schemes, since overly prescriptive colouring was ineffective in one study [source: Holt 2023]. (4) Keep time short (the Curry and Kasser study used 20 minutes) [source: Knox College]. (5) Briefly check in afterwards about state and anything noticed [synthesis].
Example language (illustrative): "This is just colouring, not a spiritual exercise. Pick any colours you like and stop whenever you want."
Watch for: Self-criticism about doing it "well"; boredom; use as avoidance of the session's work. Evidence is mostly from students and self-report, effects are short-term, and benefits for severe anxiety are unclear [source: Holt 2023]. Working when: the client reports feeling calmer and can then engage with the session.

4.6 Spontaneous mandala drawing (Jungian use)

Purpose and when to use: For clients drawn to symbolic or art-based work, especially in periods of inner disorder; best within art-therapy or Jungian training.
Steps: (1) Offer a blank sheet with a drawn or traced circle, or simply invite a circular drawing. (2) Ask the client to fill it however they wish, without a theme. (3) Afterwards, invite the client to describe what they see and what it evokes, exploring recurring shapes and numbers in their meaning, not the therapist's. (4) Keep the drawings, with consent, to review later (see 4.7) [source: Jung Society of Utah, describing Jung's practice; steps 1–3 are a synthesis of that description].
Example language (illustrative): "There's no right way to fill this. When you're done, tell me what you notice."
Watch for: Free drawing can feel more demanding than structured colouring and did not reduce anxiety in one study [source: Holt 2023]; images may bring up trauma material (pause, ground, see 4.9). Do not interpret drawings for the client or treat them as diagnostic proof [synthesis]. Working when: the client finds the process absorbing and uses the image to name experience.

4.7 Tracking a mandala series over time

Purpose and when to use: In longer-term work using 4.6, to notice change.
Steps: (1) Date and store each drawing. (2) At review points, lay out the series with the client. (3) Ask what has changed in structure, colour, centre and boundaries, and what the client makes of it [source: Jung Society of Utah, describing Jung tracking patients' recovery through mandalas; synthesis for steps].
Example language (illustrative): "Looking at these side by side, what stands out to you?"
Watch for: Over-reading the images as markers of progress; client feeling evaluated. Working when: the client links changes in the images to changes in their life.

4.8 Reflection on impermanence and the dissolved mandala

Purpose and when to use: For Buddhist clients, or clients who have watched a sand mandala being dismantled, who wish to explore loss, change or letting go (see guide 102).
Steps: (1) Ask what the client saw or knows of the dismantling and its meaning in the tradition (the sand taken to water to release its positive energy into the world, as BuddhaNet describes) [source: BuddhaNet]. (2) Explore what it touches in their own life. (3) Keep the reflection in their framework; do not offer doctrinal teaching [synthesis].
Example language (illustrative): "You said watching the sand being swept away moved you. What in your life right now feels like that?"
Watch for: Premature "letting go" of grief that still needs space. Working when: the reflection deepens rather than closes down feeling.

4.9 Trauma-sensitive adaptation

Purpose and when to use: With any client using mandala or visualisation practice who has trauma history or shows dysregulation; as a published adaptation, Treleaven's trauma-sensitive mindfulness (2018) frames this as trauma sensitivity, not trauma treatment [source: BACP, summarising Treleaven].
Steps: Follow the four "R"s as summarised: (1) Realise trauma is common and may be present in any client. (2) Recognise dysregulation: hyperarousal (agitation, fidgeting) and hypoarousal or freeze (flattening, collapse). (3) Respond by grounding and offering choice so the client returns to the window of tolerance: eyes open, upright posture or back to a wall, moving instead of sitting, pressing the feet into the floor, anchoring attention on stable areas such as the soles of the feet or hands, shortening practice. (4) Prevent retraumatisation by building adaptations in from the start, considering social and cultural context, knowing when to stop, and referring on to trauma specialists when dysregulation persists [source: BACP, summarising Treleaven]. For visual work specifically: favour external, eyes-open looking at a printed image or colouring over internal imagery, and let the client choose the image [synthesis]. Cross-refer trauma-sensitive yoga (Domain IV).
Example language (illustrative): "Let's keep your eyes open and on the page. If anything gets too much, you can stop, look around the room, or feel your feet on the floor."
Watch for: Intrusive images, freezing, spacing out, sudden emotion. Working when: the client stays present and can shift attention voluntarily.

4.10 Screening for and responding to adverse effects

Purpose and when to use: Before intensive retreats or when a client reports difficulties linked to practice.
Evidence base: The Varieties of Contemplative Experience study (Lindahl, Fisher, Cooper, Rosen & Britton 2017, PLOS ONE) interviewed Western Buddhist meditators and teachers from Theravada, Zen and Tibetan traditions and described challenges across seven domains (cognitive, perceptual, affective, somatic, conative, sense of self, social); distress ranged from minimal and transient to severe and lasting; influencing factors included practitioner factors (psychiatric and trauma history, worldview, intentions), practice factors (amount, intensity, type), relationships (teacher and community) and health behaviours (sleep, diet, exercise) [source: Cheetah House VCE page; Britton/SciPod summary]. A related paper focuses on Vajrayana practitioners [source: Cheetah House VCE page]. Farias et al. 2020, Acta Psychiatrica Scandinavica, found an overall adverse-event rate of 8.3% across 83 studies, most often anxiety, depression and cognitive anomalies, including in people with no prior mental-health history [source: Coventry University Pure portal]. Visualisation-specific risks are not reported separately in these sources [uncertain].
Steps: (1) Ask about psychiatric and trauma history, current sleep, and planned practice intensity before retreats [source: SciPod summary for risk factors; synthesis for screening]. (2) Ask directly about unusual perceptions, intense fear, energy-like body sensations or changes in sense of self. (3) If difficulties arise: reduce practice dose or pause, favour grounding and eyes-open activity, improve sleep, diet and support, which interviewees reported as helpful [source: SciPod summary]. (4) Offer coordination with the teacher if the client wishes, since the tradition may have its own interpretation and remedies, which differ between lineages and teachers [source: SciPod summary]. (5) Point the client to Cheetah House, a resource for meditators in difficulty [source: Cheetah House VCE page] [uncertain: scope of current services not verified].
Example language (illustrative): "Sometimes practices like this bring up experiences that are unsettling. Has anything like that happened for you, even if it seemed strange to mention?"
Watch for: Remedies are individual and some are unhelpful [source: SciPod summary]; do not impose a single interpretation. Working when: distress and impairment reduce and the client feels less alone with the experience.

4.11 Scrupulosity around precise practice and commitments

Purpose and when to use: When a client is distressed by fear of having visualised, recited or worshipped incorrectly, broken a pledge, or disrespected a sacred image.
Steps: (1) Distinguish ordinary religious conscientiousness from obsessive doubt and compulsive repetition (redoing practice, seeking reassurance, excessive confession). (2) If OCD is likely, offer exposure and response prevention adapted to religious clients, designing exposures that do not ask the client to violate genuine religious obligations, and, with consent, consult the client's teacher about what the tradition actually requires [synthesis; IOCDF guidance on scrupulosity uncertain: not verified]. (3) Let the religious authority, not the therapist, rule on doctrine.
Example language (illustrative): "Would it help to ask your teacher what is actually required here, so we know which part is the tradition and which part is the worry?"
Watch for: Reassurance-seeking from the therapist; the therapist being drawn into doctrinal rulings. Working when: practice becomes less driven by fear and repetition.

4.12 Referral and collaboration with teachers, clergy and art therapists

Purpose and when to use: When questions concern method, doctrine, initiation or vows; when art work goes beyond the therapist's training; when symptoms suggest psychiatric illness.
Steps: (1) Refer method and initiation questions to a qualified lama, guru or priest in the client's tradition, not to unaccredited online sources [source: BuddhaNet on transmission by a Vajra master; synthesis]. (2) With written consent, agree what may be shared with the teacher. (3) Refer to an art therapist for in-depth image-making work. (4) Refer to psychiatric or medical care for psychosis, mania, severe depression, suicidality or physical symptoms [synthesis].
Example language (illustrative): "That sounds like a question for your teacher. If you'd like, we can think together about how to raise it with them."
Watch for: Clients being discouraged by any teacher from seeking health care (see 5.8). Working when: the client has the right helper for each need.

5. Handling problems

Most guidance in this section is [synthesis] unless a source is tagged.

5.1 Client asks the therapist to teach deity visualisation or yantra worship. Decline warmly; explain that these are taught within the tradition after initiation [source: BuddhaNet; International Kalachakra Network]; help the client find a legitimate teacher or centre. Illustrative: "That's outside what I can offer, and your tradition has its own way of passing it on. Let's think about who could teach you properly." Do not encourage practising initiatory material from books or videos instead.
5.2 Unusual perceptions, visions or energy experiences after intensive practice. Assess without pathologising or dismissing: onset, distress, function, sleep, insight, family and personal history, substance use. The VCE study found that whether an experience counts as progress or pathology varies between traditions, lineages and teachers [source: SciPod summary]. Features that call for urgent psychiatric assessment: loss of insight, persistent hallucinations outside practice, grandiosity or reduced need for sleep suggesting mania, suicidal thinking, inability to care for self. Where the main issue is religious or spiritual distress without a mental disorder, DSM-5-TR lists "Religious or spiritual problem" among other conditions that may be a focus of clinical attention, code Z65.8. Reduce or pause practice, ground, protect sleep, and coordinate with the teacher if the client wishes (see 4.10).
5.3 Overwhelm or dissociation during an in-session exercise. Stop; eyes open; orient to the room; feet on the floor; name a few objects; return to conversation [source: BACP, summarising Treleaven, for grounding methods]. Afterwards, review together whether to continue, adapt (colouring instead of drawing, shorter time) or drop the exercise.
5.4 Stuck or flat response to colouring or drawing. Effects in research are modest and mainly short-term [source: Holt 2023]. Check whether the task suits the client; offer choice (different design, different medium, no art at all); do not push art work on clients who find it childish or exposing.
5.5 Client feels the secular use of a sacred image is disrespectful. Apologise if offence was caused, remove religious imagery, and use plain geometric designs; ask what would be respectful in their tradition. Conversely, a devotional client may not want a sacred image coloured or discarded; let them decide how the image is handled.
5.6 Non-adherence to between-session colouring or drawing. Treat as information: explore meaning and obstacles, shrink the task or drop it. No source recommends homework frequency.
5.7 Rupture over religious difference or perceived judgement. Name it, invite the client's view, own any misstep. Reflect on your own religious or secular commitments and keep self-disclosure purposeful. Professional statements of spiritual and religious competencies (Vieten et al. 2013) are relevant here [uncertain: not verified]. The APA Ethics Code's standards on competence, multiple relationships and respect for cultural and religious difference apply [synthesis]. Avoid dual roles such as attending the client's initiations or practising in the same sangha without careful consideration and consultation.
5.8 Power, misconduct or high-control dynamics around a teacher. Tantric traditions place strong emphasis on the teacher who gives initiation and on pledges [source: BuddhaNet], which can be a source of meaning and also of vulnerability. VCE interviews found the relationship to the teacher could be a risk factor when inadequate and a remedy when supportive [source: SciPod summary]. Listen for coercive control: isolation from family, pressure for money or labour, secrecy used to hide harm, punishment for questions, discouragement from medical or psychological care, sexual contact presented as teaching. Do not label a group; support the client's own appraisal, safety planning and, if they decide to leave, grief for lost community and practice and help with religious trauma. Report safeguarding concerns about children or vulnerable adults under local law. Documented teacher misconduct relating to the traditions described here: none found in the sources consulted. Name individuals as wrongdoers only where courts, regulators, independent investigations or major news organisations have done so.
5.9 Client distressed at having "broken" a pledge or done practice wrongly. Assess for scrupulosity (4.11); invite consultation with the teacher about the tradition's own means of repair; do not supply doctrinal answers.
5.10 Client buys yantras or mandala products for health or wealth. Explore what the purchase means and hopes for; respect devotion; state plainly that no evidence supports health cures from such objects and that physical symptoms need their doctor; watch for financial exploitation.
5.11 Client with psychosis, mania or severe dissociation who wants to practise. Prioritise stabilisation and psychiatric care; prefer brief, external, eyes-open activities (colouring) over internal visualisation; involve the teacher with consent so practice can be adjusted within the tradition [synthesis informed by VCE risk factors, source: SciPod summary].

Sources

Web pages:

Publications cited:

Curry, N. A., & Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy, 22(2), 81–85.
van der Vennet, R., & Serice, S. (2012). Can coloring mandalas reduce anxiety? A replication study. Art Therapy, 29(2), 87–92.
Lindahl, J., Fisher, N., Cooper, D., Rosen, R., & Britton, W. (2017). The varieties of contemplative experience: A mixed-methods study of meditation-related challenges in Western Buddhists. PLOS ONE, 12(5), e0176239.
Farias, M., Maraldi, E., Wallenkampf, K. C., & Lucchetti, G. (2020). Adverse events in meditation practices and meditation-based therapies: A systematic review. Acta Psychiatrica Scandinavica, 142(5), 374–393.
Treleaven, D. A. (2018). Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing.
Vieten, C., et al. (2013). Spiritual and religious competencies for psychologists [uncertain: not verified].
American Psychiatric Association. DSM-5-TR, the code for a religious or spiritual problem.
ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances

Cross-references: guide 102 (sand mandala); Domain II (MBSR, MBCT, MSC, CFT); Domain IV (trauma-sensitive yoga); Domain VII (contemplative, Buddhist and spiritually integrated psychotherapy).

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