Re-Posted: December 8, 2008
SPIRITUAL ISSUES IN PSYCHOTHERAPY
Adam Blatner, M.D.
(See also: Articles on Spirituality and Psychotherapy; or Re-Story-Ing the Soul. )
Clients in psychotherapy frequently are troubled by conflicts regarding their spiritual life. Generally they will not bring these issues up unless the therapist specifically inquires about such matters. The issues are so personal and subtle that I've come to think that for many people spirituality is even more emotionally loaded than sexuality. (An Appendix below lays out some of the issues in outline form.)
Perhaps we need to recognize a category of what I call "sub-traumatic" disorders. They aren't as bad as trauma in that they don't shatter the individual's underlying orientation to the world. Rather, they are the result of a combination of stress and misunderstandings in the belief system. Cognitive therapy addresses these kind of problems–what used to be the more run-of-the-mill "neuroses" that folks came with for therapy. But those beliefs that had to do with one's experiences in learning about religion often had the effect of worsening other life problems and in addition, alas, leaving many feeling spiritually alienated.
For some it was merely a lack of relevance, a growing up either without religion or, more commonly, with an exposure to the superficial, social traditions which never achieved a state of psychological, personal meaningfulness. For others there were a host of sub-traumatic events, ranging from the petty tyrannies of religious school to the imposition of arbitrary norms which restricted one's sense of freedom or emotional coherence.
Another common stressor--and in most cases there were elements from many different categories--was the feeling of betrayal when people's childish prayers to a protective God for healing or rescue were not met. A not uncommon variation of this was the alienation from the stream of faith which accompanied the alienation from the petty politics or social neglect by the other church members (and/or the pastor).
Dangers on the Spiritual PathFor those who dared to actively engage in their spiritual development, whether within their own family's tradition or in exploring alternative paths, the journey is perilous. False prophets and over-simplified teachers abound. We are in a time in which the trans-denominational revitalization of spirituality as an ecumenical process is becoming recognized as a valid social role. In other words, you don't have to have a nameable religion in order to be recognized as being "religious" in the broader sense of the idea (Bragdon, 1990).
It should be noted, though, that the term "religious" is often rejected, being associated with a degree of commitment to a specific denominational creed; and for these people, the term "spiritual" is used in a more generic, open-ended fashion.
The "New Age" movement, a category as broad as "Feminism" or "Liberalism," has become overly associated with more magical and irrational practices. The more conservative, intellectually rigorous people who lean in this direction haven't found a term yet, but many at a recent Transpersonal Psychology conference were using the more general term "transpersonalism" to include many aspects of this movement which were not specifically psychological, including ecological, feminist, political, philosophical, and other arenas (Battista, 1996).
A number of books have recently been published citing the dangers on the spiritual path, particularly from those teachers who present themselves as being beyond the ordinary moral constraints. Their practices, under the guise of attempting to disrupt their follower's "ego-patterns" in the service of a short-cut to enlightenment, not infrequently leave those disciples traumatized and wondering if they had been exploited.
Of course, incidents of using one's office as a leverage for sexual harassment or abuse have been increasingly reported within the mainstream churches, also. And therapists are not infrequently faced with the casualties of such incidents, which tend to destroy the victim's faith in general, aside from the specifics of the personal trauma.
Another pitfall in the spiritual life is the tendency to shame, as perceived failures or shortcomings are all the more stark in contrast to the high ideals of the endeavor. It's one thing to lack certain managerial skills, but for many the lack of certain capacities for self-discipline or piety takes on a different, more qualitatively blameworthy category of weakness. With these remarks in mind, let us then consider some of the more specific issues:
Feeling "Called"Many people have had moments of inspiration, in which they felt a special sense of connectedness, and even perhaps a profound sense of mission. If they experience a feeling of insight, they are then challenged by their doubts: Who will listen to them? Who will help them develop their perhaps inarticulate or still-rudimentary and thus somewhat fragile ideas? We don't have much of a tradition of drawing such ideas forth and helping them become expressed more fully. Indeed, our culture has a peculiar tradition in its medium-distant past in which beliefs had to fit the norms or be severely punished as "heresy." Those who know anything about this tradition, or those who sense the fearfulness of others when hearing what seem to be "blasphemous," "heretical" or grandiose ideas often remain silent.
After all, how should one discriminate whether the vision, voice, or intuition was arising from something good and true or perhaps misleading and self-deceptive? We have a tradition that believes the Devil tempts people with prideful illusions. What could be more prideful than a mystical experience of connectedness with the Divine Source? Only recently is mysticism becoming recognized as a valid, perhaps even necessary dimension in spirituality in a world in which stable community (as a source of religious practice) is lacking.
Thus, just as in dealing with the more conventionally psychodynamic issues, patients in psychotherapy who address spiritual issues are faced with the challenges of discriminating the source or wisdom of their impulses. They need to be helped to maintain the tension of respecting these philosophical intuitions while at the same time examining their purposes, practicalities, and/or underlying contaminations by other motives.
Joseph Chilton Pearce noted that in some cultures such as in India, spiritual sensitivity was considered a talent and knowledgeable adults would watch for and draw out those children who seemed to possess this talent. He pointed out that this was a way of selecting out those one in a million who were "geniuses." Pearce (1981, p. 25) alluded to the way the geniuses of music were cultivated in the European subcultures of the Eighteenth Century, and wondered what would happen if we began to value spiritual sensitivity in this culture. Might we find young people possessed of startling new and challenging insights who could help us all become illuminated?
The point is that we should respect those who report what Carl Jung termed "numinous" experiences. These phenomena are characterized by a feeling of being grippingly momentous, significant, and very "real." In our culture which values understatement and being "cool," young people filled with idealism, having such "peak experiences," might well react to them with fear or avoidance. Occasionally, on the other hand, the person having these experiences might react with what Jung called "ego inflation," wanting to carry the "truth" to the world without themselves being tempered in the path of spiritual discipline. As a result, they may become clinically manic or in other ways psychotic (Grof & Grof, 1990; Nelson 1990).
More dangerous are those who have a modicum of this sensitivity mixed with a significant tendency to sociopathy. Such persons become cult leaders and can do significant damage to others.
On the other hand, an interesting source of subtle psychological stress arises in those who experience difficulties in experiencing "closeness with God," much less mystical union. If they don't particularly care, it's not much of a problem. But many do care, they do want to experience something of the realm of the holy, and tend to feel ashamed by their inability to "get it." Or perhaps they might feel consciously or unconsciously rejected by God, undeserving of Grace, or frustrated by God's seeming capriciousness at refusing such earnest desires. Of course such experiences are often significantly contaminated by transferences from early childhood family relations.
Others are significantly conflicted in their desire for a relationship with God, Jesus, or other spiritual entity. Some lean towards a desire contaminated by doubts or fears; others lean towards a reluctance mixed with a subtle yearning. At root, there tend to be fears of closeness contaminated by memories of experiences with an over-intrusive or over-controlling parent. Or the over-control may have come from religious figures, teachers or ministers or harshly judgmental church members.
Patients may feel guilt over their own perceived resistances as prideful, cowardly, lazy, or in other ways morally vulnerable. Or they may reject such feelings and devalue the system that served as the source of guilt, which then leaves them bereft of a containing and supporting faith. The idea that they can distill out the best elements and leave the rest seems to be an option that hasn't occurred to many.
Only in the last third of a century has there been a figurative explosion of books and other materials, workshops, classes, etc. on new directions in spirituality. Nevertheless, this remains apart from the mainstream, and most of the population would have difficulties in imagining choosing or constructing an individualized spiritual path. And then there's the problem of finding a path that's shared by others, so that one could participate in community. Similarly, there remains a relative dearth of information or accessible teachers regarding the challenge of actually growing, improving one's skills on a given path. (The new vision of spirituality recognizes the nature of ongoing development rather than mere propriety in fulfilling one's obligations or following the rules.)
For those who are beginning to learn about the deeper lessons of spiritual development, there will also be mixed feelings regarding the desire or will to proceed. Depending on the path chosen, the degrees of study, having to learn a foreign language, physically uncomfortable (or frankly painful) physical exercises, dietary or sexual restrictions, and other requirements generate conflict between being accepted as necessary discipline or perceived as mere onerous residuals which are superficial and unnecessary.
We live in an era of individualization. Psychotherapy may be thought of to some extend as an individualized form of experiential instruction in the skills of self-awareness, communications, and emotionally laden interpersonal problem-solving. We customize our cars with selected options and colors, and similarly customize our clothes, homes, and life styles. But is it fitting to ask that our spiritual paths cater to our individuality?
Our psychological awareness tends to bias this question. Considering the unique blending of temperament, personal history, interest and ability which makes up the individual, one could argue persuasively that a personally relevant spirituality must be constructed over time so that it fits these elements of individuality. It just doesn't work otherwise. It's not experienced as "connecting." But is this pandering to personal preference? It remains an issue for careful discrimination.
A corollary issue is that of the search for a spiritual path that seems "authentic," or "real." This may involve one's sense of intellectual coherence, the encompassing of the whole range of existence, or a path that on a feeling level seems more human, with "real" needs, tears, hugs, sweat, contact. Others might need to find their path through relative solitude, needing to relate to nature more than to the creations and concepts of people.
The stresses relating to the spiritual dimension of being should not be underestimated. Some people actually fear that they are "crazy" because of their inability to reconcile their own path with the practices of their subculture or family, or even what seems like society as a whole. Fears of being or going "crazy" can also accompany the process of extensive searching in many different spiritual traditions and finding no connection or becoming simply bewildered.
Certain spiritual practices such as meditation in certain sensitive individuals may become accompanied by uncomfortable or even painful or disorienting somatic symptoms (termed "kriyas," "kundalini energies," or "spiritual emergence" in some systems). Psychosomatic illnesses can become overwhelming. On the more purely psychological side, people may have become frightened by psychic experiences, visions, clairvoyance, precognition, seeing auras, out-of-body experiences, etc. Of course, for others, such experiences tend to reinforce their beliefs and commitment to their path.
Mainstream ProblemsAside from the exploration of any alternative religious paths, many patients suffer from continuing or residual struggles with previous religious experiences. A number of young people, lacking the dimension of socioeconomic "leftist" or "Marxist" struggles of the previous generation, are nevertheless challenging the social order in their rejection of certain components of their family's church because of socio-political overtones, such as the dominant concept of God seeming to be patriarchal, homophobic, Eurocentric, Caucasian, and most of all, judgmental and condemning. The modern economics of religion also evokes a good deal of conflict, monies being allocated to materialist adornment of a church instead of charity or social action. And yet others object to a church's social action agenda which may be offensively at odds with their own political inclinations. Of course, the whole problem of pressure for giving money to religious organizations raises another host of emotional reactions.
There's also the challenge of how "in" or "out" one feels in relationship to one's perceived or chosen peers in any religious community. Is the person a relative beginner or in other ways fairly inexperienced in comparison to others in the group? Do the others subtly or overtly exaggerate or minimize this gradient?
An associated problem reflects the aforementioned reality of individuality. In therapy patients have shared their distorted fears regarding their perceived innate, relatively unchangeable qualities. Some, because of history or inclination, feel themselves to be incapable of being acceptable to God or the community. Perhaps they feel burdened by the guilt of their sins or misfortunes. Those ashamed of their present attitudes may feel themselves to be irredeemably evil, perverse, or stubborn.
Others struggle with their spiritual paths, feeling themselves to be incompatible for a variety of reasons. If the path is emotional and devotional, they may feel they are too intellectualized. If the path requires rigorous intellectuality, they may feel apart because they're too emotional, vague, or inarticulate. Similarly, depending on the nature of their religion's norms, individuals may feel they are too much in any of the following directions: intuitive; overwhelmed by significances and visions; practical, caught up in concrete particularities; introverted, needing solitude; or extroverted, feeling stifled by solitude. In group activities, people can feel themselves at fault and feel alienated because their inner rhythms or pace of processing are perceived as overly quick, feeling impatient with the group, or, on the other hand, as too slow, needing to have one's own time to process.
There are people who refuse to feel intimidated or that they are wrong in the way they feel about religion. Instead, they are more or less determined to assert their own vision, but that they feel they have to struggle, dispute, defend, or even fight for their right to choose their own path, to construct their own path, and/or celebrate (such as through artistic endeavors) their individuality in that path. On an intellectual level, they may feel they need to challenge what seems like a significant issue or truth that's being ignored by their chosen group, or to advocate for the the rights or concerns of a subgroup within a larger group.
Existential IssuesOne of the more common sources of a sense of spiritual alienation is a feeling of being betrayed by God or in other ways angered because of other issues. Frequently the individual has been faced with an unresolved trauma or tragedy which seems inconsistent with the idea that there is either a benign, all-powerful or a caring God. Many people were reaised with this idea and are unprepared for the kinds of life crises which bring up the theological problem of evil, what theologians call "theodicy." In spite of books such as Kushner's Why Bad Things Happen to Good People, a continuing parental transference is carried forward.
For some people, it seems as if God changed, and that God is a concept which evolves, develops, and may not fit conventional beliefs is still a new idea. An interesting variation of this is the sense that one's inability to feel a deeper level of faith is a result of God's withholding of grace, because God is coldly uncaring, excessively demanding of virtue, or even absent and unreachable.
Facing death also raises existential issues in patients' minds. This may refer to a heightened awareness of one's own death, whether it looms in the impending future or even remains seemingly far off. The death of a loved one also raises questions relating to meaning, the afterlife, the sense of the course of life as a success or failure. Of course these in turn raise underlying metaphysical questions, which in our culture tend to be interpreted in terms of one's spiritual beliefs.
Problems with the Spiritual PathThose who have taken on the yoke of religion may find themselves intimidated by the demands of their inherited or chosen path. Commitments are demanded regarding money, perhaps even through tithing; volunteer work; or regular participation and attendance. There may be pressures in the course of the religious practice to engage in such activities as confession or full self-disclosure; to proselytize; to keep away from family or old friends, or renounce the "worldly" outer culture; to engage in physical austerities, fasting, long periods of sitting still, or painful exercises; to buy study books or correspondence courses, expensive worship materials, tapes or videos, or attend workshops or retreats; and/or to monitor oneself regarding temptations, mistakes, or subtle fluctuations of commitment to the teachings or leader.
Many of these practices are embraced without ambivalence by a fair number of people. The problem is for those who feel their range of choices is limited, either through lack of awareness of alternatives or other social pressures.
Perhaps the most ominous source of psycho-pathology is the use of spiritual teachings to use fear systems, either stated or implied in the path. The concept of Hell and eternal punishment or purgatory is most familiar, applied to those who do not follow the leader's or dominant group's beliefs or requirements. If not the prospect of torture, which can be really somewhat traumatic, the idea of being "lost forever" or other frightening concepts may constitute a form of religious "abuse." Some religions' doctrines of reincarnation can also be used in this fashion, with threats of being born in "hells" or as animals or other unpleasant modes of existence for those who err. In addition to the afterlife, many religions threaten miscreants or apostates (those who want to leave the fold) with misfortune or no rescue in the face of misfortune.
Aside from these threats being applied to those who actively "sin," there can even be a more subtle or implied threat of distinctly unpleasant consequences should an individual fail to achieve significant progress or "liberation" on the designated path.
SummaryThis review of some of the more common types of spiritual issues raised in psychotherapy is not meant to be comprehensive, but rather to suggest the rich variety of themes that need to be addressed. We should not underestimate the way these problems interface with and affect other psychological issues. So many patients have at the root of many of their interpersonal and intrapsychic frustrations and anxieties a lack in their feeling connected or supported in the wider context of a person's relationship to the universe.
Psychotherapists in the coming years will need to become somewhat conversant in the range of new developments in spirituality, whether as part of or beyond the traditional religious denominational practice. More important, the idea that a therapist can only take a patient as far as s/he has traveled, it behooves therapists to cultivate their own spiritual journeys, maturing them as much as possible. One of the more challenging aspects of doing psychotherapy is that one can develop one's own philosophy of life, and in the face of increasing changes in the world and new trends in intellectual thought.
Battista, J. R. (1996). Offensive spirituality and spiritual defenses. In B. W. Scotton, A. B. Chinen, & J. R. Battista (Eds.), Textbook of transpersonal psychiatry and psychology. New York: Basic Books.
Bragdon, E. (1990). The call of spiritual emergency: From personal crisis to personal transformation. New York: Harper & Row.
Grof, C. & Grof, S. (1990). The stormy search for the self: A guide to personal growth through transformational crisis. Los Angeles: Jeremy P. Tarcher.
Grof, S. & Grof, C. (Eds.) (1989). Spiritual emergency: When personal transformation becomes a crisis. (Anthology of writings.) Los Angeles: Jeremy P. Tarcher.
Nelson, J. (1990). Healing the split, madness or transcendence: A new understanding of the crisis and treatment of the mentally ill. Los Angeles: Jeremy P. Tarcher.
Pearce, J. C. (1981). The bond of power. New York: E. P. Dutton.
Appendix A: COMMON SPIRITUAL ISSUES: An Outline
If therapists would enquire, they would find that many patients suffer considerably from conflicts relating to their religious or spiritual lives. The following list suggest some of the more common themes:
1. Not feeling connected to their religion or rooted in some system that gives meaning to their lives.
a. Affirming a traditional religion but "in name only," with little feeling of comfort or guidance, little "relevance"
b. Having drawn or drifted away from the religion of their childhood or of their family, and yet not feeling that "shopping" for an alternative spiritual path was an option, or didn't seem interesting.
c. Ambivalent, devaluing religion, but knowing no alternatives.
d. Spiritually seeking but having found nothing satisfying
(1) Having explored a few (or many) alternative spiritual paths and having become disillusioned
2. Feeling angry at God, because:
a. unresolved tragedy
b. sense of betrayal
c. inability to attain mystical experience perceived as a withholding of grace, God as cold, absent, unreachable
d. "God changed" in some way for the person
3. Worried about the "fear system" implied (or even explicitly stated) in the chosen spiritual path or religion, specifically:
a. Hell, eternal punishment, or purgatory
b. being spiritually "lost" forever
c. a less pleasant or even more ominous reincarnation
d. misfortune or no rescue in the face of misfortune
4. Problems finding a dimension of spirituality which emotionally connects or resonates with one's individual needs or temperament
a. finding a path which seems "authentic," "real" (more human, with real hugs, sweat, needs, tears, contact)
b. needing to relate to nature more than to the creations and concepts of people
5. Continuing or residual struggle with previous religious experiences, such as:
a. rejection of certain sociopolitical overtones, such as God as patriarchal, homophobic, caucasian, condemning
b. traumatic experience with an overzealous spiritual teacher, church, cult or or leaders who overstepped boundaries (e.g., sexual or financial exploitation)
6. Being interested in a religion or spiritual path that one's family finds unacceptable (either for leaving one's "inherited" tradition or for other reasons); being accused of being "weird," "flaky," or "part of a cult."
7. Becoming bewildered by extensive searching in many different spiritual traditions and finding no connection.
II: For those who have (at least for a while) found or re-committed to a spiritual path, there then ensue a number of common problems:
8. Concerns over attaining the goals of this path, such as having difficulty experiencing "closeness with God," or mystical union:
a. feeling ashamed by inability
b. fears of closeness contaminated by overintrusive or overcontrolling parent or early religious experience
c. guilt over one's own (perceived) "resistances" as prideful, cowardly, lazy, etc.
9. Difficulties in imagining or in other ways participating in the spiritual path of one's choice
a. having no idea how to improve one's ability
b. having mixed feelings regarding the desire/will to proceed
10. Intimidation by demands of the path, such as:
a. a commitment of:
(1) money, tithing
(2) volunteer work
(3) participation, attendance
b. pressure to:
(1) fully self-disclose, confess
(3) keep away from family or old friends, etc.
(4) physical austerity, fasting, long periods of sitting still, painful exercises
(5) buy study books, worship materials, attend workshops
(6) monitor oneself regarding temptations, mistakes, subtle fluctuations of commitment to the teachings or leader
11. If strongly experiencing the call or the process of spiritual opening, there may even be fears of being or going "crazy"
a. overwhelmed by somatic symptoms, "kriyas," psychosomatic illnesses, "kundalini energies," "spiritual emergence"
b. frightened by psychic experiences, visions, clairvoyance, precognition, seeing auras, etc.
12. Even if the patients feel "called," they may worry about:
a. discriminating the source or wisdom of impulses, respecting them, yet examining their purposes, practicalities, and underlying contaminations by other motives
b. noting that "numinous" (or momentously gripping) experiences sometimes seem overwhelming, either leading to
(1) fear, avoidance
(2) "ego inflation" and injudicious committment, hypomanic states, grandiose assumption of leadership roles, etc.
13. The interpersonal stress of subtle or not-so-subtle shame, guilt, or self-consciousness about perceving oneself as less experienced, having more trouble, or in other ways lacking in comparing oneself with others in the group.
a. Or possibly the group or certain people might say or do things to reinforce this self-consciousness.
14. Distorted fears regarding one's perceived innate qualities
a. irredeemably evil, perverse, stubborn
(2) emotional, vague, inarticulate
(3) intuitive, ovewhelmed by significances and visions
(4) practical, caught up in concrete particularities
(5) introverted, needing solitude
(6) extroverted, feeling stifled by solitude
c. one's inner rhythms or pace of processing as overly:
(1) quick, feeling impatient with the group
(2) slow, needing to have one's own time to process
15. Within the group, church, congregation, a continuing sense of having to struggle, dispute, defend, aggressively affirm, or even fight for:
a. one's right to one's own path, and even one's individuality in that path
b. what seems like a significant issue or truth that's being ignored by one's chosen group
c. the rights or concerns of a subgroup within a larger group
16. Struggling or worried about achieving or attaining stages of progress on the path (stated or implied).
This list is meant to be suggestive rather than comprehensive. The art of observation consists largely in knowing what to look for, and in medicine, it means knowing the full range and variety of types of pathology--that is, what can go wrong in a system's function. This list, then, illustrates the variety and complexity of genuine concerns regarding spiritual issues in people's lives, themes which may involve not just intrapsychic conflicts, but very real issues having to do with overgeneralized doctrines; distorted group process dynamics; misuse of power disguised by spiritually "noble" affirmations or manipulations; and cultural themes in a civilization in the process of major change.
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