A monograph composed March 2007
Psychotherapy and Spirituality Introduction: What Sorts of Questions? There are two main ways in which to approach the subject of psychotherapy and spirituality. One is to look at the psychotherapy profession and the other is to look at the psychotherapeutic activity. When we look at the profession, we are concerned to ask such questions as: - what part has spirituality played in the formation of our culture and how does a psychotherapy profession serve that culture and especially those aspects of it? - what is the spirit of our times and how relevant to it are the activities and values of the psychotherapy profession? - how does the psychotherapy profession function as a response to critical spiritual issues of our times, issues emerging from our distinctive cultural history. When we look at the psychotherapeutic activity, then we have again two levels of analysis to consider, that of general values, principles and philosophy and that of skills, interventions and procedures. When we look at the general level, we think about questions like: - is psychotherapy a substitute for religion, an aid to spirituality, a secularisation process? - how do the values of psychotherapy harmonise, if at all, with those of spirituality? - do the models in use in psychotherapy have analogues in the realm of spirituality: are they two different languages for saying much the same thing or not? - does spirituality present a critique of psychotherapy or vice versa and how would such critique be defended against? When we look at the specific level, we are concerned with: - are there methods or techniques that therapists can borrow from those in the domain of spirituality or vice versa: one might think, for instance, of ritual, of induction of catharsis, of confession, of affirmations, of mindfulness techniques and so on as instances where spiritual and therapeutic methodologies have some overlap. - how should a psychotherapist respond to a client presenting a spiritual dilemma or how should a spiritual practitioner respond to a person manifesting signs of mental instability? With this come questions of whether it is actually possible to distinguish one domain of issues clearly from the other of whether these are actually simply different presentations of the same thing. - are all psychological problems fundamentally spiritual issues or vice versa? At all three levels there are significant problems of definition. What is psychotherapy? What is spirituality? Do we know where one stops and the other starts? Is clarity on these questions possible? The Question of Definition: What are we talking about? Psychotherapy
The term psychotherapy comes from 2 Greek words. Psyche refers to the soul. A therap was a squire or attendant. A warrior might have a therap who assisted him. Etymologically, therefore, a psychotherapist is a servant of a soul that goes into battle or sets out on a heroic journey. The therap made sure that there were provisions for the journey, that the weapons were all in good order, carried the warrior’s armour and helped him put it on. The warrior, however, had to fight the actual battle and choose the route. The job of the therap was to ensure that he was in best shape and best equipped whn the test came.
In modern times psychotherapy is understood in two separate ways: as accompaniment or as remedy. (i) The therapist as accompaniment offers to accompany a person as he or she reflects upon a life issue or problem or passes through a crisis or life stage. Generally, if we are talking about therapy rather than counselling, insofar as there is any difference, there is also some expectation that the person will be changed in some enduring way by the therapy experience. (ii) Therapy as remedy aims to repair some malfunction that is occurring at a psychological level. In this sense the psychotherapist is a doctor of the mind.
Therapy aims to change not just the way in which a person addresses the problem in hand but also the way that they live life as a whole. Broadly, there have been four ways of attempting this.
- The psychoanalytic mode assumes that there is some form of pathology in the inner dynamics of the psyche, that this pathology is a product of dysfunction in relationships with significant others, that in the relationship with the therapist these dysfunctional patterns will be reenacted or become transparent to discerning reflection, that they can be corrected either by a remedial relationship or by the insight arising from interpretation, and that, once they are corrected, not only will the pathology disappear, but this will also have a salutary effect upon the whole personality of the client.
- The behavioural mode reasons that pathology is only consequential if it manifests as behaviour and that only behaviour is amenable to direct observation and manipulation. This approach therefore ignores inner dynamics and concentrates on teaching the client new behaviour patterns. A number of techniques have been evolved for doing so.
- The humanistic mode assumes that whatever pathology may be apparent it must be a distortion of the basic nature of the person and be a product of adverse "conditions of worth" experienced by the client currently or in the past. The therapist attempts to either provide or help the client to provide for him or herself more clement conditions of worth. The basic assumption here is that the coe pre-occupation of he person is a search for a sense of self-worth supported by at least a minimum of conducive ambient social conditions.
- The cognitive mode focuses upon the thought pattern of the client reasoning that all pathology involves distorted reasoning or inability to perceive the world realistically. The therapist is skilled in identifying those habits of thought that have dysfunctional consequences and helps to educate the client to cognise more effectively.
Now about all of these four modes we can say:
1. they are not necessarily incompatible: all could be true and effective;
2. they are not unquestionable in their basic assumptions: all or any of them could be falsely based;
3. in all cases the therapist is a more powerful figure than the notion "therap" would imply - rather than a servant, the therapist is a kind of consultant expert - more a coach than a servant.
Spirituality
This is a term with many different nuances of meaning. It can mean all forms of religious or quasi-religious thought, sentiment and behaviour. In modern usage it tends to mean individualised religious thought, sentiment or behaviour considered independently of any particular religious institutional frame. In this sense it is either what makes religion real or the alternative to religion, depending upon one’s perspective. Many modern people like to be considered spiritual but not religious. This is a rather vague sentiment and I would like to unpack what it means by looking just a little at its history in Western thought in due course.
However, spirituality must have some reference to spirit and it does seem that the significance of spirit has become muddled. People do not know what it is any more. There is particularly an inappropriate confusion between spirit and soul, but also with such terms as mind, person, and personality on the one hand and ethos, philosophy and purpose on the other. Generally modern people have a clearer sense of spirituality than of spirit. For spirituality to really be meaningful, however, there needs to be some clarification in this area.
Again, our forebears had strongly developed ideas about spiritual domains. The spiritual referred to a domain other than this mundane one. The topography of the spiritual domain was disputed. were there heavens, hells, purgatories and so forth? Different groups had different maps, but there was a wide concensus that a spiritual realm existed. This has gone. Some continue to believe in spiritual realms but many do not. Where should psychotherapists stand on this? Is it possible to be neutral?
The Cathars, or Albigensian heretics, for instance, believed that spirit was what come into one as a result of faith and it constituted one’s passport to eternal life. Those who did not receive the "consolament" of the spirit were doomed to continual rebirth in the world of sorrows. For the Cathars, therefore, the spiritual domain had only heaven and hell was where we are now. For Catholics, on the other hand, the spiritual domain was divided in to heaven and hell, spirit played no direct part in the life of the ordinary person, and what was at stake was the condition of souls. One might think that this difference of metaphysic is something that today is of purely academic interest and ask what has all that got to do with us? However, I would like to argue here that the same debates go on to this day under ever changing labels.
Spirituality can also be defined in terms of purpose, especially ultimate purpose. Simon King-Spooner simply says: "‘Spirituality’ refers to what matters most; ‘spiritual experience’ is central to our lives." (King-Spooner 2001, p.28) He goes on to relate this to meaning: "By... ‘the spiritual’, I mean... an encompassing ‘significance’ or ‘meaning’ within which our lives are lived, wittingly or unwittingly... and against which all other significances and meanings are of a lower order." (ibid.).
Digression: Rogers’ Definition of Psychotherapy
Rogers (1961, p.103): "psychotherapy is a process whereby man becomes his organism without self-deception, without distortion." This is based upon a belief that: "when man is less than fully man - when he denies to awareness various aspects of his experience - then indeed we have all too often reason to fear him and his behavior.... But when he is most fully man, when he is his complete organism, when awareness of experience... is most fully operating, then he is to be trusted, then his behavior is constructive (ibid. p.105)
This definition is interesting because it represents the way in which the spirit has become internalised in the metaphysics of humanism. What Rogers suggests is that it is awareness of our own organismic process that constitutes the most perfect condition for human development. For Rogers himself the apparent radical solipsism of this definition is tempered in reality by the fact that the kind of experience that he privileges most highly tends to be experience of relationship with others, especially with others who are similarly self-actualising. As it stands, however, this definition suggests an extreme of self-sufficiency.
It also privileges awareness. There has been a strong current in contemporary thought that has sought to bridge the divide between spirituality and therapy by using the concept of awareness. If it could be shown that the essence of therapy and of spirituality lay in here and now awareness then it might seem that a unification had been achieved. However, it is very questionable whether awareness really is the crux of the issue in either spirituality or in therapy. A therapist will be quite happy if a client changes in a constructive way even if the client has no idea how the change came about; awareness does not necessarily result in constructive change; and spirituality may culminate in faith or rapture that does not necessarily involve any enhancement of self-awareness. Indeed, the spiritual practitioner may be much more interested in knowing God and knowing self.
A further interesting sidelight of Rogers definition is its call to naturalness. There is a built in assumption that the natural person is to be trusted. This is a quite Rousseauesque sentiment that most existential thinkers would quickly find fault with, but it illustrates another facet of contemporary thinking in both therapy and spirituality that is widely influential.
The Positioning of the Psychotherapy Profession
Spirit in Relation to Soul
Traditionally, spirit stood in contradistinction to soul. Soul is psyche or anima and is the essence of a person whereas spirit is not from us, but from the divine realm. Spirit comes upon one. To be spiritual in this usage would be to be one upon whom the spirit comes. As we have just seen, there is a longstanding issue within Christianity and between Christians and those they regard as heretics about the role of the Holy Spirit. The reason that this matters at the personal level is that it bears on the issue of conscience and the reason that it matters socially is because spirit confers authority. If the divine has entered into one then one speaks for God.
The Reformation began as a quarrel about Church malpractice, but it soon became a debate about whether ordinary people had direct access to spirit, or, on what authority could Luther question the Holy Mother Church? Once it was established, in some minds at least, that the individual could question in this way, the possibility of complete social revolution openned up. The most radical voice in the debate at that time was that of the Quakers who believed in "that of God in everyman" - in other words, that each person is a vehicle for spirit and so is an authority unto him or herself about what is right and wrong to do. Historically this idea has often been called enthusiasm, from en-theos, meaning God coming into one. Those who supported it were conscious of the iniquities of institutions. Those who opposed it saw it as a recipe for social chaos. Each side could point to some evidence. The failings of the church were already evident. Those of the French Revolutionary Terror, Marxism and the secular state were yet to some. The whole movement for protest and reform was further fuelled by a technological innovation. This was printing. The advent of printing made it possible for ordinary people to have direct access to the Holy Books.
If you go into the Cathedral in Leicester where I live, you will see that the centre piece is the alter area. The congregation is some distance away from the alter. The priest goes into the alter area on behalf of the congregation and returns to give blessings and sermons. The pulpit from which he does so is a little to one side of the entrance to the holy area. We can discern in this form of religion origins long ago in shamanism. The shaman is a person who does the dangerous job of communing with the spirit world on behalf of the tribe. He travels to the spirit world and comes back with messages.
Across the square in the Methodist Church, built in the heyday of Puritan Christianity. When you go into the Methodist Church you see something quite different from the Cathedral. Here, the centre-piece is not an alter, but the pulpit itself. In the Cathedral, the spirit of God is worshipped from afar through the mediation of the priest. In the Chapel, the Word of God is worshipped, and it is delivered more directly, though still by a priest.
Across the green you can find the Quaker Meeting House. Here, pride of place still goes to the word. There is a table in the centre of the meeting room and on it a Bible. However, there is no elevation. Everybody is on the same level and the mode of worship is for all to wait in silence until the Spirit speaks and It may do so through any member of the congregation. How accurate a receptor each individual may be is an open question.
So we have here three degrees of enthusiasm. Arguably, there is a fourth even more radical degree in which the spirit is felt to have no collective relevance at all. Even in a Quaker meeting there is a sense that the Spirit is speaking to the whole congregation. Many people nowadays, however, think that the Spirit only speaks to them and for them alone. Is this liberation or alienation? Is it a pinnacle of social development or a pit of social disintegration? The key to satisfaction or the desert of meaninglessness?
More importantly for our present purpose, where does psychotherapy stand in all this. Is the therapist in the role of priest, mediating between the spirit and the person and imparting a wisdom that will make the client into a better, o more rational or more fully functioning soul; or in that of minister, delivering principles that the client can then take away and use as his own conscience directs; or in that of an equal voice and friend as prone to inspiration or to error as the client himself; or does he or she really have nothing to offer at all other than the observation that the client is on his or her own?
Enthusiasm and Psychotherapy
Over the past three hundred and fifty years, since the English Civil War, we have seen the gradual rise of the Enthusiasm Party. It lies in the back of moves for democracy, consumer choice, secularisation, and post-modernism. It is a mixed blessing. We have supposedly become more individualistic, but we follow fashions and fads like a person in the desert running after a water cart. Censorship is hardly needed in a modern state because we are all manipulated by the mass media. In place of priests we have raised up celebrities. It is difficult to escape the impression that in the extreme of spirituality, as opposed to religion, that we have reached, some basic human need is being neglected.
One of the things that has come out of all this is the psychotherapy profession. If understanding the spirit is to be a private, do-it-yourself matter, then there opens up a market for mentors who can teach people how to do it. Psychotherapy has arisen not so much as a kind of secular priesthood, as is sometimes asserted, as as a form of coaching in private discernment of the spirit. The terminology has been changed in order to make the whole thing seem more scientific, but the educational role is unmistakable. And, we now see, emerging on the edge of psychotherapy, the term life-coach which, for many people, rings true as a term for the role.
Another development I can mention in passing has been the popularity of and goodwill people have toward Buddhism. Buddhism has gained a certain prestige as a religion that is not a religion, as a philosophy that advances the idea of personal enlightenment. It is arguable, however, that the Buddhism that has become popular in the West is not so much the genuine Asian article as another artefact of the on-going debate within our own intellectual history; another disguise or front for a campaign in the war over the soul of Western culture not powered so much by Eastern wisdom as by centuries old Western preoccupations.
It is common for people in Britain to reject religion and praise spirituality. It is pointed out that religion is supposedly responsible for many wars. If we apply the analysis so far, however, this assertion becomes less easy to substantiate. Is Osama bin Laden a priest of an institutional religion or is he an enthusiast? What of George Bush or Tony Blair? Are these not really spiritual people rather than religious ones? Are they not individuals who follow their own sense of what the Spirit has imparted to them personally rather than the teachings of the churches to which they supposedly belong? The case is not as open and shut as many who have not thought very far tend to assume.
We should not overlook the fact that psychotherapy has been a significant social pressure lobby in modern Britain. Many public attitudes have been affected by the psychotherapeutic approach. Freud has had a massive impact upon modern culture, both through the work of his followers and of those who disagreed with him in one way or another. We cannot avoid the fact, however, that this influence has now become open to question. The average person in the street may be as sceptical about psychotherapy as most psychotherapists are about religion.
We should not forget that research in the USA has repeatedly confirmed the following findings:
1. active religious affiliation is associated with mental health (Richards & Bergin 1997)
2. the majority of the population at large, and therefore of patients and clients, has religious affiliation
3. the majority of helping professionals do not have religious faith
4. helping professionals significantly influence the outlook of their clients and patients
5. helping professionals significantly influence client’s and patient’s access to spiritual care.
The obvious conclusions are uncomfortable for the psychotherapy profession. Popular adherence to religion is weaker in UK than in USA, but the general direction of these factors is probably similar. Therapists influence not only their clients but Also public opinion and so it is important to ask whether that influence is socially wholesome or not.
Current Trends
Where is all this taking us? Let’s recap: Religion was once the backbone of society. The dynamic of medieval society was substantially enacted through the changing relations between king and church. In modern times, the church has weakened, the individual has emerged as a significant consideration and the state has grown immensely more powerful. At one stage this seemed to suggest that religion would die out. However, behind these changes, as we have seen, what was really happening was the rise of enthusiasm at the expense of religious institution. This process seems now to have reached its extreme limit and is perhaps in process of changing into something else. We have seen how it has, however, given rise to the phenomenon of the life coach, in an increasing number of forms, the psychotherapist being only one. Coaching as such is another. Very recently we are seeing the growth of something called chaplaincy.
A chaplain is a private priest. The first chaplains were priests within the private household of the monarch. The king had his private chapel and to run it there was the chaplain. Now it is not difficult to see this role as akin to that of a therap. The chaplain was squire to the king’s soul. Chaplaincy then expanded into the departments of the king’s activities. Thus we get chaplains to the armed forces, hospitals, prisons, and other institutions. Currently there is a great deal of interest in the development of chaplaincy. It is seen as a way in which concern for the spirit can come back in. It has also been driven along by the multi-culturalism agenda. The development of chaplaincy is creating situations where clergy of different religions can work in teams together serving clients in a diversity of spiritually related ways. There is here the seed of a new relationship between the individual, the state, and the spirit that cuts across the old religious divisions. It is significant that the psychotherapy profession has made repeated attempts to get established within the these kinds of institutions, but it is chaplaincy that is now advancing there. Has psychotherapy missed out?
Some would argue on the contrary that in fact therapy and counselling is a new religious movement (Wallis 1984) and that they do "have all the characteristics of a religion" (Williams & Irving 2001 p.57) including practitioners having shared systems of belief, ethics and morality, prescriptions for how to live, roots in earlier religious traditions, metaphysical foundations defining the nature of humanity, an impulse to convert others and propagate a zeitgeist. This kind of commentary, however, appears to have a critical edge. A religion would have no qualms about having all of these features, but psychotherapists, I think rightly, will read Williams and Irving’s article as implicitly critical. Although psychotherapy has many characteristics in common with spirituality, by and large it still does not want this to be the case.
We do see at the present time an increasing level of interest in things spiritual on the part of psychotherapists. It may be that we are entering a post-secular era in which there will not be a return to old fashioned religiosity, but the growth of a spiritual service industry that while keeping some anchorage in age old institutions, derives its dynamism from pioneering into the field of individualised pastoral care. Where will psychotherapy position itself in relation to these developments?
Principles and Values
In the introduction I posed the questions:
- is psychotherapy a substitute for religion, an aid to spirituality, a secularisation process?
- how do the values of psychotherapy harmonise, if at all, with those of spirituality?
- do the models in use in psychotherapy have analogues in the realm of spirituality: are they two different languages for saying much the same thing or not?
- does spirituality present a critique of psychotherapy or vice versa and how would such critique be defended against?
In the section on definitions we designated four main modes of psychotherapy:
- Psychoanalytic
- Behavioural
- Humanistic
- Cognitive
One might wonder if these different modes have different answers to these questions. However, it seems clear that no matter the differences between them, all four modes are essentially processes of assisting the client into a more secularised approach to life. Psychotherapists may tell themselves that they practice in a value free way and adhere to the dogma of non-judgementalism, but the effect of this is surely to establish them on the side of rational materialism. Having said this, there are many therapists who find this unsatisfactory and do search for a way to practise that incorporates rather than excluding a spiritual dimension to life.
In the sense that we used the terms earlier, psychotherapy can be seen to be on the side of the soul rather than that of the spirit. Spirit has been subsumed into the soul. The psychotherapist helps the client to achieve a greater degree of self-sufficiency and not to look for salvation from beyond him or herself. Only, perhaps, in marital or family therapy does this principle to some extent break down and even there what is looked for is the self-sufficiency of the small social unit.
Insofar as spirituality has come to mean individualised religiosity, psychotherapy seems to have no difficulty in encompassing it, just as it can encompass any expression of personal choice. The psychotherapist may be as little concerned with the client’s spiritual preferences as with their taste in clothes. On the other hand, even taste in clothes reveal essential features of the person and taste in spiritual matters even more so. The psychotherapist thus faces a dilemma. Secularist thought suggests that the choices a person makes about whether to believe in God, practise prayer or meditation, expect an afterlife and so on are purely private matters of no real concern to anybody but themselves. This attitude, however, substantially constitutes a refutation of the items chosen. If I say that it does not matter whether you believe in God or not, I am saying that God does not matter and so, in effect, saying that there is no meaningful or consequential God. Thus it is not possible to be neutral. Secularism begins as a neutrality intended to give scope for all but ends as a dismissal giving room for none.
An alternative is for psychotherapy to attempt to value all. This implicitly means treating all forms of spirituality as expressions of something that must in principle emanate from a single source. A Christian therapist may be able to work with a Moslem client by making a tacit assumption that there is one God and they are both talking about the same thing using slightly different language. The next client, however, may believe that they do not believe in God at all. Does this mean that the therapist now has to act on the assumption that although the client does not think that he or she believes, really they do believe but are expressing their faith in secularised language? This seems rather difficult. Converse problems arise for the declaredly secularist therapist meeting religious people. Can they really understand each other if they do not share a world view? This is a real issue in multi-cultural Britain.
What seems to be at stake is the generation of a set of meta-values that hold the ring in cross-cultural encounters. Mutual respect, emphasis upon common humanity, acceptance that rationality has real limits, some basic generic ethics such as non-violence, may all play a part in this meta-structure. We are, however, far from having completely solved these dilemmas.
Methodology
At the micro-level, there are three things to concern ourselves with:
1. Technical Borrowing: the transfer of techniques between psychotherapy and spirituality, more commonly from spirituality to psychotherapy but also sometimes in the opposite direction.
2. Spiritual Care: the question of what constitutes a spiritual issue and how therapists are to respond to it and what constitutes a psychological problem in a narrow sense and how spiritual practitioners are to respond to it. This raiss th whole question of whether therapists and spiritual practitioners are doing different things or variants upon the same thing.
3. The Relationship: Is a spiritual relationship and a therapeutic relationship the same or similar? How similar? Are therapy and/or spirituality defined by the relationships that they form or are relationships epiphenomena?
Technical Borrowing
At the level of skills and methods, there is an almost infinite amount that one could say. Psychotherapy in the 1960s, 70s and early 80s was a highly creative arena. Many different schools of thought competed and innovations came thick and fast. Then there was a reaction. There was concern about risk and about respectability. A drive toward professionalisation took place and it still has some momentum. This did many things. One was that it stiffled innovation.
Recently, therefore, psychotherapists have been turning their eye toward spirituality not so much for the cultural and philosophical reasons tha we have reviewed so far in this essay, but rather as a source of know-how. Spiritual practitioners have presided over human change processes for millennia. They must know something and some of those things may be useful to therapists. There has, therefore, been a tendency to regard spiritual practice as a resource to be mined.
Actually this process of borrowing has been going on for a long time. William James was acknowledging it at the turn of the 20th century. In fact, one could ask whether there is anything in the repertoire of psychotherapy that has not been adapted from the spiritual disciplines. The couch surely has its precedent in the confessional. The oh so scientific methods of behaviouralism are surely little more than the type of moral influence that the church has engaged in for centuries made more systematic. The humanistic therapist nurturing the self-actualising tendency of the client does not seem a million miles away from the spiritual director listening for the stirrings of the spirit in the soul of the adherent. Cognitive restructuring may sound scientific, but have not priests been telling us how to think since time immemorial? Drama derives from ritual and drama therapies no less. In our own spiritual community we practice a Japanese meditation that induces contrition called nei quan or naikan and in the 1950 in Japan this method was repackaged in secular dress and is widely practised as a psychotherapy. Currently there is much interest in mindfulness methods derived from Buddhist meditation techniques. Where the first psychotherapists plundered Christianity for their innovations, modern ones look to Buddhism, but it is essentially the same process. A method that has long been used in a spiritual context is repackaged according to the dogmas of secularism for general approved use. The irony is that secularism is every bit as coercive in its dogmas as any of the creeds that it draws its materials from.
Secular professions are only allowed to use techniques after the spiritual element has been removed or suitably disguised. The question arises, of course, whether this matters. Is mindfulness based stress reduction practised in a clinic as effective as mindfulness meditation practised in a hermitage? The answer probably depends upon what you mean be effective. In other words, it is a question of values rather than data. The mindfulness of a Buddhist saint may bring him into a sublime relationship with a transcendent reality whereas that of a hospital patient may bring speedier healing of a wound. Both are effective, but the effects are of rather different scope.
The fact that psychotherapists find techniques drawn from spirituality useful does, however, suggest that they are not engaged in a wholly different kind of operation. It is possible to assert that "psychotherapy is ultimately a spiritual project" (King-Spooner 2001, p. 28).
Spiritual Care
What is a spiritual issue? Fear of dying? Questioning the meaning of life? Knowing right from wrong? Wondering if it matters? Asking who one is? Missing the dead? Feeling guilty? Not feeling guilty? Wondering why one should get up in the morning? Brian Thorne points out that "It is now common for people to present themselves to therapists with concerns that they themselves have categorised as specifically spiritual in nature" (Thorne 1998, p.x)
Is there such a thing as a psychological problem that is not also in some sense spiritual? A client comes presenting a phobia or an obsession. This is a psychological problem. A psychologist or psychotherapist should have some procedure for assisting such a person. If the problem is analysed in depth, however, is it not likely to reveal itself also as a spiritual dilemma? Although it may have crystalised into a symptom that makes it appropriate for the client to go through the door of the clinic rather than the shrine, the great majority of psychological problems have spiritual roots and spiritual problems commonly have psychological manifestations.
At the same time, we must also take into account that there are specifically spiritual manifestations too and it is quite common for psychotherapists to be found ill-equipped to respond to them. Indeed, Allman and his colleagues (Allman et al 1992) found prejudices amongst therapists faced with clients reporting mystical experiences. The ability to untangle a spiritual awakening from a spiritual emergency (Grof & Grof 1989) and also to recognise what is healthy spiritual rapture and what is psychotic symptom are not as widespread as they should be.
The question therefore arises, how far should the therapist go? Is it the therapists job to simply cure the symptom or is it his or her concern to go into the spiritual issues that are more central to th life of the client? There can be little doubt that many therapists do venture into such territory.
At the same time there are those for whom it is the spiritual issue that is on top and that is presented. There is an increasing awareness, for instance, that people who are dying need spiritual as well as physical care and that it is important for both the dying person and the surviving relatives that death be seen in more frames than simply that of medical failure. 70% of US hospitals now have some kind of spiritual care programme. This means the involvement of professionals other than doctors. These hospitals in many cases also have psychological or psychotherapeutic staff but there would be no prima facie assumption that they were relevent to the dying patient other than exceptionally.
Spiritual care of the dying is much easier and more effective when the patient has a background of spiritual practice and faith. The presence of priest or other religious counsellor or professional at the time of death may occasionally effect a deathbed conversion and bring peace to a patient, but more usually will not be felt relevant if the person has no spiritual background.
People who have an established spiritual practice embedded in a consistent framework of religious concepts and world view fare better not only while dying, but in a wide range of testing situations such a critical illness, concentration camps (Lifton), torture, or death row situations. Faith yields resilience.
Are psychotherapists equipped to respond appropriately to these situations too or are they irrelevant or even counter-indicated? Some psychotherapists - one thinks, for instance, of those who are strongly influenced by existentialism - would agree that the spiritual dimension of human problems is the crucial aspect and would see it as the therapist’s role to be a spiritual companion. How well equipped are they to do so?
The Relationship
The Jewish philosopher Martin Buber made a great impression upon both therapeutic and spiritual practitioners with his philosophy of "I and Thou" (Buber 1923). Buber pointed out that there are two modes of relating which he called I-it and I-Thou. I-it is the way in which one relates to things in use whereas I-Thou is the way one relates to another considered to be as real and personal as oneself. He points out that mostly people relate in an I-it mode even when relating to other people. The I-Thou mode is respectful and free from calculation, comparison or manipulation. This I-Thou mode is the mode in which God relates to us. The I-it mode is the mode of utility. Buber’s contention has been something around which both spiritual and therapeutic practitioners have been able to find common cause. King-Spooner says: "it seems to me that the I-Thou mode is also absolutely of the essence of any real therapy." (King-Spooner 2001, p.34).
Carl Rogers also believed that a certain style of relationship was of the essence but it is an open question whether his view really coincided with that of Buber. Rogers was interested in a relationship "in which the development of the person is the goal" (Rogers 1986, p.135) and his theory concerned the conditions that a therapist may provide that will be "necessary and sufficient" to promote therapeutic change (Rogers 1957). Buber’s I-Thou relationship has no such goal. The relationship as Rogers describes it is asymetrical. I took up this question in an essay entitled "The Necessary Condition is Love" (Brazier 1993) where I argued that what is good for the therapist must be good for the client also and that it may be that rather than activating "vast resources for self-understanding" (Rogers 1986, p. 135) it may be that therapy reactivates a "primary altruism". Although I did not spell this out in that essay, it would seem that such a notion might go some way toward bridging the gap between therapy and spirituality.
Therapists who favour a rapproachement between spirituality and psychotherapy may see the cultivation of a special quality of relationship as the essential common ground. Thus Thorne talks about times when he and a client "attained a level of communication which could certainly be described in terms of am altered state of consciousness or as a breakthrough into the transcendental" (Thorne 1991, p.106)
Of course, Buber’s philosophy reflects his metaphysics and his position within a monotheistic religion in which it is the relationship with God that is all important. Psychotherapist’s might be startled to think that the enormous emphasis that many of them place upon the relationship has its roots in the sacredness of the relation between man and God. Though Buber is Jewish, this sacredness of relationship is most particularly characteristic of the Protestant lands since it was a primary assertion of Protestantism that here could be a direct relationship of this kind and this relates to the question of enthusiasm that we have already considered. In Japanese religion, by comparison, it is not through relationship with a personal being but through absorption in nature that people sought healing (Doi 1986).
Nonetheless, psychotherapy has become established in Japanese society; "Indigenous spiritual and religious culture and its belief in the soul (tamashii) no doubt helped to shape the emergence of a distinctive therapeutic environment in Japan. Buddhism, imported into Japan in the sixth century, also had a long traditin of psychologically oriented thinking and practice." (Shigehiro 2006, p. 105). While Buddhism has been able to impart a distinctive flavour to Japanese psychotherapy and given rise to wholly new psychotherapies such as Morita and Naikan, it has also had considerable influence in the West. Viewed by many as a religion that is not a religion, it occupies arguably occupies a unique bridging position.
The Drama of Life and Death
Spirituality concerns itself with life and death as a drama on a big stage. Psychotherapy concerns itself with the same dama in an intensely personal way. These two dimensions need not negate each other. However, whether it is possible to operate well on both dimensions simultaneously is an open question. Psychotherapists do learn from spiritual people. C.G.Jung is a classic example of a great therapist who concerned himself deeply with spiritual questions but never really left the domain of the personal. Spiritual practitioners also have much to learn from therapists. The borrowing is not all one way. A familiarity with psychodrama can make the practice of ritual vastly more moving and alive. An understanding of group dynamics can make meetings for worship less vulnerable to degeneration into factionalism. A grounding in empathy can make spiritual accompaniment healing rather than harsh.
To perform any discipline one must work within parameters. These condition perceptions and guide action. As a practitioner one can, though many are not, be aware that these parameters are nothing more than the conventions of one’s own profession. Even if one has such awareness, however, this does not necessarily mean that one can or even should transcend them. Different players may simply have different parts to play. There is currently a growing interest in spirituality within psychotherapy but this does not necessarily mean that psychotherapists are going to become spiritual practitioners nor that they are going to shift the essentially secular grounding of their own profession. Nonetheless, there are areas where the disciplines meet or even overlap.
Conclusion
Psychotherapy has its roots in the dilemmas facing Western society and in particular in the process of secularisation that may now have reached its limit. Spirituality has its roots in the same processes and in some ways is the other side of the secularisation coin. Secularisation and spirituality represent two alternative ways of coping with the breakdown of institutional religion. Psychotherapy has, broadly speaking, been on the secular side of this coin, but this has not stopped it borrowing, on a large scale, from the spiritual disciplines. At present, interest in spirituality is rising and the momentum of secularisation may be slackening. Psychotherapy may come to be seen as catering for the aberrant cases while spirituality caters for the normal ones. Psychotherapists continue to take an interest in spirituality and it may be that there will be some rapprochement between the two. It is certainly possible to make a case for saying that the psychotherapeutic endeavour is ultimately spiritual or for saying that the essence of spirituality is to do with the attainment of wholeness, and so is essentially therapeutic. It is also possible to argue that they are separate specialisms with their own domains, the spiritual being concerned with the ultimate concerns of well adjusted people and the therapeutic being focussed upon aberrant psychological conditions and pathology, but in fact practitioners do not stay within these boundaries nor do their clients or charges. So it seems that we have to say that although there is some common ground, much mutual interest, some complementarity and much for each discipline to learn from the other the basic attitudes between the psychotherapeutic and spiritual approaches remains broadly in opposition to one another. They are, substantially, alternatives rather than allies. The future remains uncertain.
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David Brazier