Sacred Patients, Secular Therapy

This issue of Theology News & Notes focuses on how religious and spiritual themes are addressed in psychotherapy and other disciplines concerned with human development and functioning. Contributors explore the place of religion and spirituality in therapy, the place of spirituality or spiritual resources in youth development, what spiritual direction can teach psychotherapy, and the relevance of the secular/sacred dichotomy for end-of-life care and grief work.

The idea for the issue grew out of my installation address for the Evelyn and Frank Freed Chair for Psychotherapy and Religion, identifying therapeutic approaches to spirituality with patients who are not religious. The subject of this issue—“Sacred Patients, Secular Therapy”—introduces an even broader conversation including voices from spiritual direction, developmental psychology, and therapists.

While we have an emerging and helpful literature on ways of addressing religious and spiritual issues in therapy with religious clients—even on how to creatively use religious practices in therapy with specific clients—there are few formulations about spiritual issues for nonconfessing clients. In that same address, I argued that spirituality is multidimensional and that persons who have no religious affiliation still bring issues to therapy that could be called spiritual.

There are many definitions of spirituality, indicating that it is viewed from various angles depending on the interest of the observer. For therapists who work with the inner life, spirituality is often associated with transformation, growth, and change that results from the work patients do in therapy. For psychologists concerned with development, the angle of vision may be how character develops over time in concert with religious values and traditions. For pastoral counselors and spiritual directors, the viewpoint may be how a person listens and responds to God at key moments and in everyday life. The shaping of character, personal transformation, and relations to transcendent reality aided by the resources of one’s religious tradition can be viewed as inter-related points of view on spirituality. We could add to these the search for meaning and purpose in life.

Clients seek therapy to end emotional distress related to depression, anxieties, interpersonal conflicts, or other conditions. But practitioners are aware that, in addition to the mistreatment, trauma, and chemical or neurological imbalances which may cause dysfunction, our patients are agents whose suffering is embedded in their view of themselves. These views are linked to behaviors which elicit disconfirming reactions from others and often generate distressing emotions. This cycle of self-perception, self-defeating behavior, reactions from others, and negative emotions is typically hidden from the patient’s conscious awareness. Therapy works to reveal the sources of trouble caused by external forces and patients’ own collusion in their distress and to develop new perceptions, behaviors, and emotional responses.

The desire to be healed from distress cannot be separated from the client’s hope to live a meaningful life, with connections that impart a sense of significance. It cannot be separated from the hope for love, acceptance, and a basic sense that one is a good person; nor can the distress be separated from the quest to overcome the absurdity of death and personal isolation. In other words, emotional difficulties come wrapped in the existential quests and questions native to human life. A client, after suffering years of abuse and developing self-defeating approaches to relationships which frustrate efforts at finding acceptance, may question whether life is meaningful and whether a conspiracy of forces placed him in such a destructive family. To him, God may seem distant, the church hypocritical, and the universe a cold and unloving place. The client’s abusive past and despairing spiritual outlook are present in every session of therapy, and though the therapist may work primarily on one set of these issues, the others are real and relevant to the task.

Existential questions need spiritual answers. When our patients discover that they have hurt someone close to them and need forgiveness, the act of seeking forgiveness and reconciling is embedded in a view of what is right and what types of actions and relations are life-giving. The search for forgiveness also contains the deep hope for a return of the affirming and sustaining nurture lost when the friendship died. The reactive depression that comes with the break-up of a vital friendship, for instance, may be healed when there is forgiveness, reconciliation, and renewal of life together. The transformation of resentment and anger, based on increased capacity to be patient and to accept some suffering as a way of preserving a good relationship, is both consistent with the goals of spirituality and the goals of therapy. The transformation wrought in therapy has an emotional side and a spiritual side. The emotional side can be seen as the healing of the self while the spiritual side can be seen as the vision for a good life and the commitment and will to live in a way consistent with that vision.

As therapists help patients heal from trauma and find adaptive approaches to the emotional challenges of life, we also explicitly or implicitly help them work out a view of what is healthy for them: how they should treat significant others, what to fight for, and what to ignore. Their worldview—or the system that guides basic decisions and informs the vision of who they ought to be—changes as basic assumptions are examined and as they come to terms with unexamined feelings and emotions. Standards of emotional health, fair treatment of others, and life values are spiritual questions not always answered by psychological theories.

Therapists must be sensitive to the spiritual domains of our work, with an explicit framework that can guide this dimension of our practice. Just as we have a listening framework that helps us understand patients by their communication patterns, levels of development, and ego strength, for example, our listening frameworks must help us be responsive to patients’ hunger for meaning, hopes to give themselves to something of lasting value, and the search for a guidance system to inform decisions in these and other areas.

The articles herein address these concerns from a variety of angles. It is my hope that the reader will be stimulated by this modest collection to continue developing these ideas and to contribute new angles of vision so that we may all see more clearly what is at stake along this vital path.

I am grateful that the board of directors of Theology, News & Notes invited me to be the integrator for this issue, and I am very pleased that each author accepted my invitation to contribute to the project despite a severely limited timeline. Without the dedicated efforts of Kirsty Bortnik, a doctoral student in the School of Psychology, this issue would never have met its goals. I am indebted to her for her dedicated work.

This article was published in Theology, News & Notes, Winter 2006, “Psychology and Spirituality.”