What this article cannot do
In an article of this length it will not be possible to discuss the relationship between spirituality and psychotherapy in a comprehensive way because the topic is far too wide and detailed. What follows is a reflection on the experience of one practitioner, in the hope that it will enthuse anyone interested in the subject to think about it and perhaps read a little further.
Most of us who live in 21st century Western-style culture are very familiar with terms such as psychiatry, psychotherapy, and psychology. Sometimes people outside the respective professions are puzzled as to whether they are the same or different, and if different, in what way? The answer is that they are all related, but over the years have developed into separate professional areas. At the risk of over-simplification, they might be differentiated like this:
Psychiatry is practised by medical doctors who have done additional training in the area of mental health. Psychiatrists are trained to diagnose and treat mental illnesses such as schizophrenia. They may prescribe medication as well as other forms of therapy.
Psychology is often focussed on mental functions and includes many specialist areas such as clinical and educational psychology. Apart from clinical psychology, the focus is often on research and does not involve working directly with people.
Psychotherapy generally focuses on behaviour and relationships, including the client’s relationship with him/herself. There are many different types of psychotherapy, e.g. family therapy, cognitive behavioural therapy, sand therapy, play therapy etc as well as therapies aimed at specific issues such as addictions and compulsions. In recent times psychotherapy has gained greater recognition as a separate profession from psychology, and it is the one focused on here.
Neither psychologists nor psychotherapists need be medical doctors and in Ireland they do not prescribe medication (in some countries psychologists are licensed to prescribe specified medications).
Spirituality and religion
Traditionally, spirituality and religion have been seen as going together but now that is not the case.
It’s not easy to define what religion is. It usually involves faith in God and one “common sense” definition is that it is “a set of practices, values and beliefs grounded in a transcendental reference point that is regarded as explaining the order of life and the material world” (1).
Spirituality too is not easy to define. A “common sense” definition might be that it refers to the non-material aspects of life and includes both religious and non-religious beliefs. Some non-religious aspects could be art, literature and music, or any activity that helps to put people in touch with beauty and/or ideas. In itself spirituality does not involve faith, although people of faith may also have a specific spirituality in their lives. It may mean either belief in an ultimate reality or transcendent aspect of life, or the way to find that reality, or to get in touch with one’s own deepest, inner being. It may also refer to the meanings and values on which people base their way of living and the choices they make. In the case of a Christian believer it could mean a particular way of living based on some specific aspect of the Gospel, e.g. Benedictine or Franciscan spirituality. For other people it has no relationship to religion and could be a way of living based on, for example, respect for the environment or an inner quest for enlightenment.
The psychotherapeutic relationship
The type of relationship typically found between doctors (and possibly psychologists) and patients is commonly called the “medical model”. It tends to be impersonal, focussing on the presenting medical problem rather than on the whole person, and does not advert to the person’s beliefs or value system.
Freud, perhaps the best known mental health practitioner, saw religious practice as a sign of weakness because it showed a need for the security of a father-figure. He called it a form of neurosis and this view came to be common among psychiatrists. Until fairly recent times there was a tendency to put religion and spirituality together, so as a result, in their practice psychiatrists rarely if ever referred to their clients’ beliefs or practices, religious or otherwise, and did not see them as potential sources of healing. From the time of Freud on religion/spirituality was practically banned from the consulting room by most practitioners.
Contemporary research and experience have shown that this approach is not the most satisfactory in terms of bringing healing and professionals are beginning to re-think it (3). There is now a greater awareness of the importance for healing of helping people to bring into harmony the various aspects of their lives such as belief systems, social relationships, and physical and emotional experiences, including illness, pain and death.
Psychotherapists generally do not follow the medical model in their work: their model is more holistic. They see those who consult them as clients, not patients, and relate to them as co-workers in the business of sorting out whatever is troubling the client. This relationship is based on respect for the client’s opinions, beliefs and values; it is completely non-judgmental and has no advance agenda or programme for “fixing” either the client or the client’s “problem”. The relationship is by its nature in touch with the client’s belief system, whatever that may be.
There was a time when psychotherapy, like science, was supposed to be “value-free”, i.e. devoid of any attachment to a particular belief-system. However, research and clinical experience have shown that this is an impossibility; people are never “value-free” and don’t relate as if they were. Now the view is that it is part of the psychotherapist’s job to be aware not only of the client’s beliefs and values, but of his/her own beliefs, and not allow them to prejudice her/his understanding of the client’s point of view.
Spirituality and psychotherapy
Does a psychotherapist need to have a personal spirituality? If spirituality is defined as the meanings, values and attitudes that shape one’s relationships with other people, the answer is probably “yes”.
So, does psychotherapy carry with it a specific spirituality, or suggest a preferable or more suitable form of spirituality? My experience suggests that it does. Psychotherapy seems most at home with a spirituality that is one of complete openness to the unexpected, and of respectful silence and listening while the client tells his/her story. The therapist may have heard stories like it before – broken relationships, family violence, parenting difficulties and so on – but as an experience, each story is unique to this person at this time. The therapist must bring to the conversation a sense of freedom – freedom to be different, to try something else, to say the unsayable without fear of criticism or condemnation. To do this s/he must have a strong sense of self-identity and be well grounded and secure in that identity.
Working with clients in psychotherapy is an ongoing process of learning for the therapist. Every person one meets is unique and brings that uniqueness to the conversation, and the insights gained are invaluable to the therapist. The psychotherapist brings to the conversation her/his experience and training and puts them at the disposal of the client; together they look at possibilities and probabilities, ways to move forward, avenues to explore, but always tentatively and respectfully on the part of the therapist.
The bottom line
No profession can be summed up in one sentence, but in the case of psychotherapists this one comes close: I am here for you. What is fundamental and irreplaceable is respect, especially for difference, but respect also for the fact that no one knows the whole story of another’s life, and no one – not even the most highly qualified professional in the world – has the right to tell anyone else how to be or how to live her/his life.
(1) Nick Couldry: “Media rituals: From Durkheim on Religion to Jade Goody on Religious Toleration”. Pp 43 – 54 in Deacy, C. and Arweck, E. eds (2009) Exploring Religion and the Sacred in a Media Age. Ashgate Publishing Ltd: Surry, England.
(2) Spiro, M. E. (1996) Postmodernist Anthropology, Subjectivity, and Science. A Modernist Critique, in Comparative Studies in Society and History. V. p.759-780.
(3) Psychiatrists and Traditional Healers (2009) Edited by Mario Incayawar, Ronald Wintrob and Lise Bouchard. New York: John Wiley & Sons, Ltd
Berger, P. and Luckmann, T. (1967) The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Anchor: New York.
Casey, P. (2009) The Psycho-Social Benefits of Religious Practice. Dublin: The Iona Institute
Steve Bruce (1996) Religion in the Modern World. From Cathedrals to Cults. OUP: Oxford
Catherine Gibson is a psychotherapist working at mind and Body Works.