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It’s Christmas and I’m leading a group of carol singers at my local shopping centre. Out of nowhere, I hear a furious voice: ‘It’s all this religion that spoils Christmas.’ And the irate shopper marches off before I can sufficiently recover from my astonishment to reply.

This comment typifies for me the secular backdrop and widespread confusion about religion and spirituality with which the therapy profession contends if it attempts to bring these issues into our encounters with clients. As a profession, we have made progress on addressing issues of difference and diversity,¹ although we still have a long way to go. I believe we have even further to go when it comes to religion and spirituality.²

Every client offers a different encounter. Some of these take us to the edge of our abilities and often beyond our comfort zone. Working with clients is exhilarating and reinforces the joy of being human and being alive, and this is what clients want from us. For many, being fully human in a totality of being involves a spiritual dimension. This includes people without an explicit commitment to a faith tradition or spiritual practice, who still encounter a range of experiences that can best be described as spiritual. These are important for the client, and may have a bearing on the successful outcome of therapy, but such experiences are often overlooked or ignored.

Take May, for example. (Please note that all names and identifying features in this article have been changed to preserve confidentiality.) She had been seeing her therapist weekly for four years. She had been diagnosed with a form of depression expressed by mood swings, and possibly borderline personality disorder. Unfortunately this was at a time when a borderline personality disorder diagnosis was used indiscriminately for clients who did not fit other classifications. For May, the link between the two was her inability to regulate emotion. During the course of therapy May started attending a church, which she found very helpful. Here was a community of people who seemed able to accept her, whatever mood she was in, and she decided she wanted to become a Christian as a further step towards belonging. But when May told her therapist, she replied, ‘I’ll give it six months’. The therapy did not survive, although May’s faith commitment did.

I was saddened when May told me this, as it confirmed other reports that I have heard all too often. It seems many therapists still do not know how to work with religion or spirituality.

At this point I want to acknowledge my potential bias. Before becoming a therapist and academic, I was a minister of religion (Baptist). I am still part of the Christian tradition, and this is expressed in some of my writing.^3-5 Inevitably some of my clients and supervisees have experienced dismissive, damaging or prejudiced responses from therapists or supervisors. I also work with many colleagues who have no faith commitment and who are baffled by religion and spirituality. As one colleague said, with affection and honesty: ‘How can a seemingly sane and intelligent person believe in all that stuff?’ I am an enigma to them.

Let’s start by locating where we are philosophically and therapeutically. The prevailing discourse in Western societies is one of implicit or explicit atheism. Counselling and psychotherapy are built on philosophical foundations rooted in a Modernist view of the world that has no place for religion, other than as a quaint relic from the past. The founders of two of the most dominant therapeutic traditions, Freud and Rogers, were explicitly committed to this atheistic agenda and its view of human growth. Yet Freud, in his last book, Moses and Monotheism,⁶ was still trying to solve the puzzle of religion. Likewise Rogers in his latter years was more amenable to a spiritual dimension.

So counsellors and psychotherapists need to wake up to the fact that, despite lip service to issues of difference and diversity, there is still bias against religion and spirituality in our profession and our individual practice. At best this bias is expressed in these words of a psychoanalytic colleague: ‘It’s not that I’m actively against religion or spirituality; it’s just that I never think to ask the questions. They just don’t seem relevant.’ At worst it is manifested in the prejudice reported by another colleague: ‘The only mention of religion or spirituality in my four-year psychotherapy training came in the form of psychopathology presented in case studies.’ Perhaps May’s therapist had been on the same training course.

Redressing the bias

So how do we address this situation? There are five steps we can take to enhance our thinking and practice.

1. Recognise our resistance

Let’s begin with our resistance. This can be active or passive. I like scrambling up and down mountains, but I stop short at vertical cliff faces requiring ropes. I actively resist learning to climb for reasons of age, arthritic joints, and because, when I tried climbing walls when younger, I didn’t enjoy it. Yet in order to continue to scramble I need to work at my fitness, requiring me to go to the gym. I note in myself a passive resistance; I do end up going, but I can always think of excuses, including writing this article.

It is all too easy to resist, actively or passively, the idea that religion or spirituality can be an important part of our clients’ experience. The whole range of life is presented to us: presence of belief or unbelief; faith in a God or gods; a committed atheism, implicit or explicit; a transcendence or transpersonal connection to that which is beyond; or an acceptance that this is the only life we have and our end really is earth, dust and ashes. Yet when we respond from a position of agnosticism or with a benign assumption of the irrelevance of such issues, we fail to enter into the client’s lived experience. Our empathy is dulled, our insight flawed and our interpretation is awry.

In psychodynamic thinking resistance is a vital part of the therapeutic process as it tells us about the client’s intrapsychic world. It touches on something they want to defend themselves from. This is a classic defence used unconsciously to reject thoughts or feelings and avoid underlying psychological pain. But what about the resistance on the part of the therapist to engage with religion, faith, belief, tradition, spiritual practices and spiritual experiences? What does this reveal about the intrapsychic world of the therapist? Nina, a therapist I worked with once, claimed never to have dealt with any issues to do with religion, as her clients never raised the matter. How was this, I asked, given that she grew up in Spain, in a strongly Roman Catholic family? She looked shocked and said, ‘Oh my God. I’ve never thought of that before’. She wasn’t being ironic.

2. Avoid splitting

One form of resistance or disavowal is expressed by splitting: we compartmentalise something problematic as either good or bad, and avoid the bad. Like a child, we want the sweet chocolate icing on the top of the cake, not the cake itself. We have seen this in Western culture over recent decades – the growing emotive distinction that religion = bad; spirituality = good; spirituality is cool, religion is uncool. This view has become entrenched with the rise of religious fundamentalism.

In addition, spirituality has expanded to include existential or emotional experiences, to become an expression of something we cannot quite put into words. Spirituality is now a term commonly used throughout early years education, nursing, psychiatry and mental health, psychology, psychoanalysis, palliative care, and in a wide range of health settings. Yet, while the word ‘spirituality’ is used in counselling and psychotherapy, there is no agreement as to what this means.7 So what we face, as therapists, is a cultural trend that diminishes both religion and spirituality in a defensive split, rather than addresses the more uncomfortable challenges of the human capacity for fundamentalism, whatever forms that takes.

We need to acknowledge the fundamentalism of our own profession as it is expressed within our professional bodies and across modalities. It is easier to set up an opponent than it is to work out how to collaborate.

3. Begin at the beginning

When did a client last describe a religious or spiritual event or experience to you? How do they know if it is acceptable to do so? Clients learn very quickly how to be clients – the unspoken rules of therapy. Should they shake hands? Do they always have to sit in the same chair? Are they allowed to show solicitude towards the therapist and ask after their health? Can they text the therapist between sessions?

Although not all therapeutic traditions use a formal process of assessment, it can be helpful if, at this explorative stage, the therapist gives clues to the shape the work may take. It would be perfectly acceptable to ask, ‘Do you have a faith tradition, religious or spiritual resources or beliefs that sustain you?’, or ‘Do you find it helpful to pray or meditate?’ Such questions, even if they elicit a negative answer, tell the client that it is OK to talk about these issues and experiences if they wish.

It does also need to be said that some religious clients can use their belief system to avoid facing psychological pain. They retreat back into a dependent facet of their faith tradition, handing over responsibility to their god. It is always better if this is identified early in the work, as it may be that they are too defended to engage in a reflective or critical exploration of who they are. I was once asked to see a couple urgently, as they were in a crisis. Although not a trained couples therapist, I agreed to see them to help identify what might be the best next step forward. In our first exploratory session it emerged that the husband had ‘touched’ another woman, consensually; in part, he said, it was because his wife would not let him ‘touch her’. When I mentioned that I could refer them to a couples therapist, the wife refused; the experience of counselling with me had been bad enough. ‘I was expecting five minutes of counselling and 55 minutes of prayer and all I got was 50 minutes of counselling,’ she snapped angrily. They did not come back. The husband went for counselling, she went for ‘prayer ministry’. Their marriage did not survive.

4. Cultivate curiosity

Synchronicity happens. I work in Oxford, but I live in Solihull (it’s a long story). I see a few clients in both locations. At one point I was seeing two new clients, one in each city, both from a Mormon background, both wanting to leave that religious tradition. I had a general knowledge of the Mormon religion but I was curious to hear their perspectives on what this meant for them. What I discovered was the very great difference between the cultural experience of Mormonism in Utah (my Oxford client was American) and Birmingham (my British client was from Surrey). Both had re-located and wanted to find a new way of belonging that was distinct from their Mormon past but still embraced a spiritual outlook on life. Both had been fearful about coming for counselling but also recognised the importance of this period of transition. They wanted someone who would understand their past and engage with them in some kind of psycho-spiritual journey in the present in order to enable them to be different in the future. Intriguingly, one of them knew of my religious background, and the other had been given my name as a recommendation without knowing how and why this would be important for them.

I was able to be curious with them, and they were able to help me understand the importance of where they were coming from. They could educate me as to some aspects of their background and why it was significant, while I helped them identify the psychological dynamics at work in moving from one faith stance to another. Clients long to know that we are interested in them; after all, the therapeutic profession is based on relationship, and this works best in a two-way process. This interest should extend to the totality of their being, including the religious or spiritual. As Brian Thorne once observed,⁸ it is important that neither the therapist nor client leaves their religion at the door to the consulting room.

5. Understand the diverse nature of spiritual experience

I recently conducted a piece of research on the nature of spiritual experience found in therapy.⁷ After spending some time trawling the psychological and therapeutic literature, I composed a list of phrases that captured experiences that could generally be described as ‘spiritual’. I then used a thematic analysis to create 36 categories and three headings (see table 1). I’ve grouped the categories under three headings but am aware there is clearly some overlap and you could argue that some belong in a different category. This is, of course, at the heart of spiritual experience – that by its personal nature it is difficult to isolate, apart from the interpretative context of the person.

I distributed this list to a sample of therapists, ranging from students in training to experienced practitioners working in a wide variety of contexts, to gauge their own awareness of and the frequency with which they encountered these 36 categories in their clinical work.

Before I analyse this further, it might be helpful if you were to do a personal audit of your own encounters with these phenomena, so you enter into this subject as a participant and not some distracted reader, remote from the words on the page. Even if they do not exactly capture your experience, try to free associate and note what comes to mind. Acknowledge what feelings or emotions are being stirred in you. Capture the memories that are evoked.

In total 104 people replied to the questionnaire. Participants identified as being part of one of four theoretical strands: pastoral counselling; person-centred/humanistic; integrative, and psychodynamic. (It needs to be noted that the pastoral counselling approach, like the integrative, encompasses pastoral and religious dimensions alongside another therapeutic orientation. I previously identified as a pastoral counsellor but always from a psychodynamic perspective, as in Jacobs’ Still Small Voice,⁹ which was an early influence.) Using a simplified scoring system I obtained a mean average score.

The topmost heading for pastoral counsellors was a spirituality of the self, although they recorded the highest score overall for a spirituality of the sacred. Person-centred/humanistic therapists were equally balanced between a spirituality of the senses and a spirituality of the self. Overall this group recorded the lowest score for a spirituality of the sacred. Integrative therapists were the highest scoring for a spirituality of the senses. Psychodynamic therapists were low scoring for the spirituality of the sacred and the spirituality of senses, but primarily opted for a spirituality of the self.

What does this tell us? First, it tells us that the theoretical tradition we are trained in does make a difference to the way we encounter spiritual phenomena and the particular shape of spirituality these phenomena represent. Yet the danger is that, if we do not recognise spirituality or spiritual experiences, we are colluding with a ‘blind spot’. The sphere in which such ‘blind spots’ are normally addressed is supervision yet, elsewhere in the questionnaire, the majority of these therapists indicated that their supervisors did not think religion, spiritualty, or spiritual experiences were important issues to bring to supervision. All my own supervisees have told me that an important reason for wanting me as a supervisor was my willingness to recognise a spiritual dimension at work in the therapeutic process.

Second, there is within the therapy profession a matching trend to that seen in society that divorces religion from spirituality. Yet belief is undoubtedly still important, as 49 per cent of the sample said they had a general belief in a god/being/other. Clearly this is not being brought into the therapeutic space through the use of any religious or spiritual traditions, practices or rituals. Too many therapists are still leaving their spirituality outside the door of the consulting room. In so doing they are perpetuating a split where religion is seen as limiting while spirituality, especially that feeling of being alive in the presence of another, is seen as thriving.

Third, it is never too late to develop our own spirituality. In the words of Freud: ‘How enviable, to those of us who are poor in faith, do those enquirers seem who are convinced of the existence of a Supreme Being… compared with the laborious, paltry and fragmentary attempts at explanation which are the most we are able to achieve.’⁶ Although he is being ironic, developing our own spirituality or expressing our spirituality and openness to spiritual experiences could add a new dimension to our work as therapists.

Alistair Ross is Associate Professor of Psychotherapy, Director of Psychodynamic Studies and Dean of Kellogg College, Oxford University.

References

1. Wheeler S (ed). Difference and diversity in counselling: contemporary psychodynamic practice. Basingstoke: Palgrave MacMillan; 2006.
2. West W. Spiritual issues in therapy: relating theory to practice. Basingstoke: Palgrave; 2004.
3. Ross A. A story of falling. Therapy Today 2014; 8: 22–25.
4. Ross A. The stag and the doe: archetypes of the Spirit. In: Burns S, Slee N, Jaegassar M (eds). The edge of God. London: Epworth Press; 2008 (pp 217-226).
5. Ross A. Psychodynamic counselling, religion and spirituality. In: Wheeler S (ed). Difference and diversity in counselling: contemporary psychodynamic practice. Basingstoke: Palgrave MacMillan; 2006 (pp171–179).
6. Freud S. Moses and monotheism. Standard edition. Vol. 23. London: Hogarth Press; 1939.
7. Ross A. Identifying the categories of spiritual experience encountered by therapists in their clinical work. British Journal of Guidance & Counselling 2016. doi: 10.1080/03069885.2016.1145192.
8. Thorne B. In: Mearns D, Thorne B. Person-centred counselling in action. London: Sage; 1988.
9. Jacobs M. Still small voice: an introduction to pastoral counselling. London: SPCK; 1982.

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