1
And there you are âŠ
Introduction
Many psychotherapists, at some stage in their relations with religious clients, find themselves having to respond to psychological difficulties related to religious life. Clearly, to be effective, they must be informed about faith and its possible significance for clients and to be at ease thinking and talking about this aspect of life. There are also some questions and options that it would be valuable for them to consider in advance.
Let me open with a clinical example of intertwined physical, psychological, relational, ecclesiastical, and spiritual problems. It is unusually complex, but as such it is very illuminating.
1.1And there you are âŠ
Vignette 1 (fearing a religious calling)
From a session with a Roman Catholic stomach patient:
âEvery time I have to stop eating something really good, I get angry!â
I spontaneously sat down on the floor in front of her, so she had to look down on me. âI am your stomachâ, I said, âwhy are you angry with me?â
For a moment she was taken aback. Then she jumped up and blew a storm.
When she was done, I repeated: âI am your stomachâ and added: âI keep trying to tell you something, but I cannot speak with words. Please articulate for me what your stomach is telling you!â
After a while she said softly: âThat I have a callingâ.
A bit later she added: âBut that is impossible, because I am divorced, and I have small childrenâ.
After another silence she told the story of how her ex-husband had insisted that their marriage should be annulled so that he could remarry in the church. She told how she was pressured to sign a declaration that their marriage had never been consummated, âand that while we have four children!â
When I drew the conversation back to her calling, she told me that she had never told anyone about this because she was afraid. She was worried that it would be seen as an âirrational delusion, âa sign that she had a screw looseâ. At the same time, she was deeply concerned that it could be a genuine callingâŠ
Well, there you are as a therapist who is unfamiliar with Roman Catholic religion and spirituality!
1.2Reflection: What would you do?
How would you react to this woman if, at any time during your sessions with her, she suddenly articulated all these concerns?
Take your time to make notes on (a) your gut feeling after reading this story, (b) what your professional reaction(s) would be, and (c) what you do not understand in the patientâs use of language.
I suggest that you keep these notes, so you can go back to them later.
1.3What does this example illustrate?
This example shows that the religious life of a client can pop up in therapeutic conversation at the most unexpected moments and in the most unexpected ways. Clearly, one has to be prepared, so as not to be taken by surprise, when such a situation arises.
What does this mean for the psychotherapist?
1. It is important to have considered in advance how one would like to react to clients who bring up problems related to their faith.
When something like this happens, there is simply no time to think through how to respond. On the other hand, problems related to faith are often a very sensitive matter for clients. After all, such issues involve their ultimate sense of identity: the significance of their entire existence.
2. For many therapists, this also means having (or acquiring in advance) the knowledge and skills that enable them to converse with an open mind on matters concerning religion and spirituality.
Those skills are not available as a matter of course, either to therapists or to the clients themselves. However, they are important. In many cases, they determine what religious clients feel they can and want to bring up in therapeutic conversation. And the clientsâ openness can be key to finding out whether and how their spirituality is relevant to the problems for which they have sought help. If it is relevant, it can play a pivotal role in the diagnosis, in the strategy of treatment, and in the choice of whether or not to consult a minister of religion.
3. In a clinical situation like this, there is always the danger of a breakdown in communication if the client and the therapist understand the emotional meaning of religious terms differently.
For instance, in the case outlined above, we are dealing with a distinctive Roman Catholic understanding of what it means to âhave a callingâ. When the phrase is used by a woman, its primary meaning is that she has a vocation to become a nun. And that is indeed not possible as long as she has parental responsibility for her children.
4. Clearly, this language problem is not just about the literal meaning of such words: it is also about the existential connotations of religious language.
For example, to understand this clientâs story, her therapist has to understand why she was being pressured into stating that her marriage was never consummated. In the Roman Catholic Church, marriage is forever. However, it is binding in church law only after the couple have had sexual intercourse. Once consummated, a marriage cannot be ended. An unconsummated marriage, however, can be annulled by the church. For this and jurisdictional reasons, civil divorce is not recognised by the church as dissolving a Catholic marriage. In Roman Catholic Church law, a person who has been married in the church and undergoes a civil divorce continues to be married to the previous spouse: a second marriage then counts as adultery, which is a grave sin. In the example above, the womanâs husband had already civilly divorced her and civilly remarried. Now he wanted to file a petition for the annulment of their Roman Catholic marriage on the basis of a signed statement that they had never had sex. This could have freed him to confirm his second marriage in the church. It is far from certain that his ploy would have succeeded with the canonical tribunal, but that is not relevant here.
At this point, we have to ask:
Is it realistic to expect a nonreligious therapist to know all this, let alone to have a real sense of the meaning of âsacredâ at an existential and emotional level? In other words, is it possible for a nonreligious therapist to appreciate what it means when something which a client experiences as sacred is being cynically manipulated? âSacredâ is just one of many words in religious discourse which therapists have to fathom for their deeper significance for religious clients.
5. The great diversity of religious traditions, which sometimes ascribe different meanings and connotations to the same word, complicates matters.
Obviously, it is not feasible for a psychotherapist to be familiar with all the various Christian subcultures and their use of language. Nor is it necessary. No one expects a psychotherapist to be a specialist in religious matters in the same way they might expect a minister to be. In the same way, no one expects therapists to be experts in dealing with problems pastorally, from the perspective of the church or of personal faith life. That is the role of the minister. However, therapists can certainly be expected to have a broad understanding of spiritual matters and to listen to expressions of religious faith with an open mind, making a genuine attempt to understand their significance for their clients.
6. For therapists to listen professionally to their clientsâ expressions of religious concerns, they must be able to register and interpret their own responses, being alert to the influence of their own life experience.
Clearly, especially where religion and spirituality are concerned, restricting themselves to their own direct life experience is not enough. One cannot possibly grow up in Western culture without forming an image of church and religious belief, even if only through the media. Critically, then, therapists should be aware of how their own cultural socialisation may affect their listening and responding to clients.
7. Therapeutic methods are not ideologically neutral, so therapists must be aware that subconscious prejudices implicit in a particular method and its concepts can inhibit communication with some clients.
The method followed in the above example involves drama techniques. When an issue is bothering a client as much as it is here, it will probably surface at some point, no matter what therapeutic method is used. That is fortunate, for keeping it suppressed could well adversely influence the treatment. But in all cases, the therapeutic value of the revelation is significantly shaped by the therapistâs response.
This raises the question of how much space your therapeutic method allows for helping clients with problems relating to religion or spirituality. What are the possibilities? Where are the ethical boundaries?
Every clinical theory and every clinical action is based on an implicit ideology which you, as a professional therapist, must understand explicitly how to negotiate questions such as: What are you trying to achieve? How do you justify that goal? What means do you use? The answers to such fundamental questions are necessarily informed with a philosophy of life (Pargament 2007, Sisemore 2016, Wampold and Imel 2015). The objectives, the conception of human nature, and the values of this philosophy are all tacitly conveyed in yo...
