By John T. Chirban
Psychologists today feel free to discuss and assess religion and spirituality in psychotherapy, yet there is little uniformity, much less standardized guidelines, for general practice and assessment. Over the years, in fact, several distinct clinical approaches have evolved.
Freud (1927) and Skinner (1953), whose approach characterized that of traditional mental health care providers, maintain a critical and reductionist approach. Skeptical of religion and spirituality, they explain these areas exclusively in terms of their respective theoretical perspectives. Rizzuto (1979) and Meissner (1984), demonstrating a neutral perspective, present a descriptive approach, which seeks to explain why individuals develop and how they process religious and spiritual concerns. Jung (1933) and Frankl (1985) embraced a positive approach to religious and spiritual issues, considering this dimension as essential and innate. Most recently, Richards and Bergin (1997) advocated a theistic approach, proposing a spiritual strategy for mainstream psychology and psychotherapy. This posture assumes, “God exists, that human beings are the creations of God, and that there are unseen spiritual processes by which the link between God and humanity is maintained” (Richards and Bergin, 1997).
Albert Einstein noted, “It is theory which decides what we observe” (Watzlawick, 1977). Our values influence what we understand as fact. Indeed, the clinician’s theories, understandings, and feelings about religion and spirituality will influence what he or she will observe or allow in treatment. There is significant disparity among clinicians, ranging from those who neither consider religion or spirituality relevant to the patient’s psychology nor perceive it as their role to pursue such matters, at one end of the continuum, to those who advocate a theistic position, at the other end.
To address the religious and spiritual dimension, the clinician must feel both personally and professionally prepared. Just as patients should feel free to address or not to address religious and spiritual matters, this same freedom must be afforded clinicians. It is one thing to require psychologists to be sensitive to religious issues (as required by the ethical guidelines of the American Psychological Association, 1992) and another to expect that psychologists will assess religious and spiritual concerns uniformly or in ways that are not affected by their own beliefs. Because of the personal, educational, psycho-philosophical, and psycho-theoretical issues involved for the clinician in the assessment of religion and spirituality in psychotherapy, clinicians should clarify their readiness in the following four areas:
First, clinicians should clarify their own psycho-religious stance. Although clinicians are not expected to be religious or spiritual guides, or to specialize in this area, they cannot pursue this critical dimension effectively without having a consistent perspective. The clinician should establish one that corroborates his or her personal and theoretical beliefs but does not limit attention to the broader possibilities and dimensions of religious matters.
Second, clinicians should acquire a basic knowledge of patients’ religion and spirituality. In order to interpret and understand the role and function of religion and spirituality in a patient’s life, the clinician must have a basic appreciation of the patient’s traditions, rituals, and beliefs.
Third, clinicians should differentiate between legitimate and problematic uses of religion and spirituality. The clinician must balance the goals of supporting the values held by the patient and resolving conflicts within these values.
Fourth, clinicians should address the transferential and counter-transferential dimensions of religion and spirituality. Spiritual material inevitably intensifies transference, resistance, and counter-transference, which may complicate the therapeutic process. While religious and spiritual issues provide opportunities for understanding the patient in greater depth, the mismanagement of such issues creates opportunities to confuse boundaries and roles and to misunderstand the content of the patient’s struggle.
As psychology continues to recognize the significance of religion and spirituality, and as research distinguishes aspects of the dimensions that constitute healthy and unhealthy experiences, sensitivity to bias and assessment measures will continue to be refined. While this work affirms the integrity of the complex considerations of religion and spirituality, this significant dimension should never suffer sweeping reductionism, be approached as uni-dimensional, or, worst of all, be discounted.
John T. Chirban, Ph.D., Th.D. is a clinical instructor in psychology at Harvard Medical School and author of True Coming of Age: A Dynamic Process That Leads to Emotional Stability, Spiritual Growth, and Meaningful Relationships. For more information please visit www.dr.chirban.com and www.sexual problems.com.