Spirituality and Psychotherapy

This series is intended for information purposes only and is not intended as a guide for any reader’s specific mental health situation. If you are struggling with mental or emotional symptoms, see your physician for a physical checkup and consult a mental health professional.

Fifteen years into my career as a psychologist, I believed that the combination of my training in psychology and my personal spiritual practice would always keep me mentally healthy. Then, during a period of chronic pain and personal loss, I plunged into an 18-month period so dark I felt like a stranger on the planet. I had no idea if I’d ever make it back to simple things such as laughter, enjoyment, and a sense of purpose. My shame and failure were so deep that I didn’t know if anyone would ever see me as a full human being again.

I saw a number of therapists during that time. One sat what seemed like a mile across the room and mainly said things like “Tell me about your mother” that revealed his Freudian training. Others asked about my emotions, reflected them back to me, and tried their best to give advice. I remember only one moment from all those sessions. The kind physician who had tried me on various medications, none of which touched my profound dysphoria, said, “You’ve heard of fight or flight. Well, the third one is: Sit tight and make it right.” Essentially he was saying that something needed adjusting in my inner world, and he was giving me his assurance that I would eventually discover and make the needed changes.

What I did not find in all my experiences of therapy was anyone who knew how to create a relationship with me that was deep enough to consistently reach me in the depths. The attempts to help seemed to be offered in a package from a distance. No one just looked me straight in the eye and said, “What the heck is going on with you, Kevin? What’s all this suffering about?” and then dug in for the long haul to sort it out with me. No one shared about being the slightest bit familiar with the terrain I was in. I felt like a mental patient more than a person, and not even a very good mental patient.

From 1989 to 1990 I spent a year-long internship at a psychiatric hospital along the Allegheny River in Pittsburgh. Years later, after my dark night of the soul, the image of the point in downtown Pittsburgh where the Allegheny and Monongahela Rivers merge to form the Ohio River came back to me and helped me make a pivotal career decision. I chose to let my clinical training and experience in psychotherapy flow together with my lifelong interest in spirituality. I wanted to offer my full self to the people who consulted me. I desired to be, as best I could, the therapist I could not find when I needed help. I decided to offer far more self-disclosure to clients than I had been trained to give. (Only recently have I discovered a number of published articles about how important, even essential, a therapist’s self-disclosure can be in therapy.)

One of the questions on my general exams in my doctoral program was about the three levels of relationship in therapy: the therapeutic alliance, the unreal relationship, and the real relationship. The therapeutic alliance includes a sense of connection, collaboration, liking, and role-taking (therapist, patient). The unreal relationship goes back to Freud’s insight that patients sometimes treat the therapist as a mother- or father-figure, or the therapist might react to the patient based on personal issues instead of professional training. The real relationship consists of two human beings creating a deep bond best captured by what theologian Martin Buber called an I-Thou relationship. Such relationships are permeated by an awareness of the innate sacredness of both people. I decided, as part of allowing the clinical and spiritual rivers of my life to flow together, to make the real relationship the foundation of what I would offer to each client. When this real, human-to-human connection is made, spiritual energy is already part of the therapy, whether or not overt spiritual language is part of the dialogue. Presence, vulnerability, and compassion flow in the real relationship of psychotherapy, and these are spiritual energies.

Most of the people who consult me now want to explore a spiritual perspective on their life situations. Many say finding a therapist who would integrate spirituality into therapy was not easy. Most therapists are still trained to avoid making spirituality a focus of therapy, except to note a client’s religious practices or lack thereof in an assessment. The most common exception is Christian counseling, which can be a good fit when the therapist’s and client’s ideas of Christianity are similar. I view it as part of my job to learn a person’s spiritual meaning system. I want to meet my clients in their spirituality and go deeper into what’s helpful or not helpful about it for the problem situation for which they have consulted me. If we encounter places in which the client’s existing spiritual ideas have become part of what is keeping her or him stuck, we explore new daily practices that allow spirituality to support his or her best life.

Here are a few ideas if you choose to seek therapy that embraces spirituality as an important part of healing. Bring your whole self to therapy. If that includes your spirituality, pay attention to how that is met. If your spirituality is respected and integrated, and perhaps respectfully challenged at times, you and the therapist may be a good fit. If it is ignored or minimized, try processing that with the therapist. If that goes nowhere, search for someone who is open to all of what you want to bring to therapy.

Be attentive to a therapist’s willingness to be open with you—to create a real relationship that is not defined only as therapist-patient. Feel free to ask about who she or he is as a person, including spiritual practices or beliefs. If all you get is deflective statements like, “I notice you want to know more about me—what’s that about for you?,” just say, “Yes, I do want to know more about you—I understand our relationship is limited to therapy, but coming to know you as a person is an important part of letting you know more of me and my struggles.”

I view spirituality not as one part of life but as something present in every part of life. Spirituality is relevant to love, work, health, sex, money, friendship, loss, and every form of human suffering, including every diagnosable mental health condition. It can also be deeply relevant to the human-to-human healing process we call therapy.