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It has been suggested that the reason psychotherapy is consistently linked with medicine and a medical model is an artifact of Freud’s profession as a neurologist. Had he come from another discipline, what is considered to be therapeutic might be altogether diﬀerent. If, for example, he had been a member of the clergy then perhaps the relationship between psychotherapy and religion that has persisted in the twentieth century might be less adversarial. The politics, economics, and social forces that have been behind the formation of the relationship between religion and psychotherapy are beyond the scope of this research paper. The intent here is to present the parallel paths of religion, particularly that with Judeo–Christian roots, and psychotherapy as it has developed in the industrialized West. We will consider at which points these paths have crossed, where they have diverged, and, ultimately, what eﬀect this has had on the practice of psychotherapy as it is understood at the beginning of the twenty-ﬁrst century.
1. Establishing Common Language
Prior to our exploration of the paths of religion and psychotherapy, a common language for health and pathology must be established in order to accurately read the road markers. Miller and Thoresen (Miller 1999) have proposed a construct of health that includes the domains of suﬀering, function, and coherence. As they point out, suﬀering is a state that can be understood as a ‘form of unhealth and a common reason for seeking help, from either spiritual or psychological professionals.’ Second, functional ability also is a term that is understood in either discipline. Third, the domain of coherence or inner peace is also deﬁned in the language of both disciplines, although perhaps more subjective and less easily observed than the other two.
Due to a lack of speciﬁc focus on behavior, these overlapping domains often add more confusion than clarity, as in the case of certain extreme behaviors diagnosed as psychotic when considered from a therapeutic standpoint. Within this context, this cluster of behaviors suggests that an individual’s normal aﬀective and cognitive functions have gone awry. Common manifestations include audio and/or visual hallucinations, delusions that may appear grandiose or paranoid in nature, hypersensitivity, and an apparent disregard for those personal care habits consistently linked with health. However, these same behaviors in the context of religious tradition might be deemed a mystical experience or even the pinnacle of spiritual health. William James conceptualized the mystical state as merely another form of consciousness, albeit rare, that could be stimulated either by internal states or external substance. This mirrors Hunt’s (1985) sentiment that mysticism is a direct manifestation of normal but usually inaccessible semantic operations. Therefore, it would appear then that speciﬁc target behaviors are unlikely to be the most fruitful ground for establishing common deﬁnitions for health and pathology. Perhaps a more useful approach would focus not on the speciﬁc behavior itself, but on the individual’s experience of it, which is completely in line with the Miller and Thoresen (Miller 1999) domains.
James described four aspects of the truly mystical experience that appear to be rare in the experience of psychosis. The ﬁrst is presentience. Mystical transcendence is more similar with an intuitive sense of knowing than it is with knowledge derived from either thought or sensation. Additionally, this transcendental experience aﬀords the individual a new awareness of ‘self’ and ‘other.’ Armstrong (1989) adds that true mystics then demonstrate that this inner identity has come to fruition in outer world behavior. In other words, to be ‘an integrated inner person is to be a productive outer person,’ which is rarely the experience of the person in the midst of a psychotic episode. The second characteristic has been termed a noetic quality, or that of a being knowing about itself. This knowledge can be similar to a successful outcome in psychotherapy, but rarely of the psychotic experience. The third quality is that the mystical experience is usually transient, even in the most devout and saintly. It apparently is impossible to hold on to the presence of the Absolute for any length of time. The ﬁnal characteristic of the mystical that was suggested by James was that of passivity. While an individual can dispose oneself to incorporate a deeper understanding and knowledge of the Divine, this wisdom cannot be called up like a specter. James noted that it was not uncommon for mystical union to be methodically cultivated as an element of religious life, similar to the actions of medieval mystics. But, he added, it is possible to stumble into the mystical, perhaps if one is inherently of the appropriate nature. What is also important in this regard, is that both Eastern and Western traditions have suggested that the mystical experience is not pure if the person is unprepared for or unwilling to lead a better life based on the knowledge imparted. This is a vital distinction given the common and profound sense of unpreparedness of persons experiencing severe psychopathology.
As has been previously suggested, when these four attributes of the mystical are compared to psychotic experiences, one may ﬁnd some common observable traits. However, in studies comparing the experiences of people with schizophrenia and mystics, Buckley (1981) found that while both share a sense of noesis, heightened perceptual abilities, communication with the divine, and exultation, only in psychosis was there the experience of thought disruption, and therefore an inability to incorporate the knowledge in an eﬀective way. It is also true that individuals with schizophrenia can go for extended periods of time without any relief from these experiences, where the mystic, as noted above, sustains this experience only brieﬂy. And, in spiritual people, mystical experiences correlate signiﬁcantly with psychological well-being, self-actualization, and optimism. Conversely, psychotic episodes tend to be marked with more negative emotional aﬀect.
To summarize, what is aberrant and what is healthy, regardless of whether one is following a psychological or religious model, is not so much the events themselves but the experience of the events. Although psychospiritual experiences can be present in many diﬀerent contexts, it would seem that both psychotherapists and religious practitioners can agree on an optimally healthy state for any individual. While cultural variation will no doubt exist, this target state would allow the person to function, for the most part, within the aﬀective and cognitive norm, supported by and supportive of a community that could foster these goals. This common deﬁnition of health will allow better exploration of the paths of religion and psychotherapeutic practice, regardless of psychological sophistication or religious beliefs.
2. Historical Perspective
In the late 1800s there was little divergence in the paths of religion and psychotherapy. The period was replete with schools of thought that outlined methods generally considered to be faith healing or mind cures. These approaches had strong support from some of the most inﬂuential writers of the time, such as Alcott, Emerson, and Thoreau. Overwhelmingly positive in their beliefs about an individual’s potential for rekindling the divine spark believed by some to be inherent in all of us, one can well imagine their appeal when contrasted to the methods and practices common to the nascent psychiatric science of the time. These approaches held that illness, whether mental or physical, was the direct result of one being out of sync with some universal law. In contrast, the faith healing interventions, whether called down by external sources or fostered through self-help, merely required the realignment of one’s beliefs and actions to be more attuned with the ultimate reality and truth. The writings of William James, the Mental Hygiene movement, and the resurgence of interest in the use of the group as an optimal setting for the healing of the individual all were well in line with religious beliefs of the day. However, this openly parallel course did not last.
By the early century, psychoanalytic and behavioral theories of the time seemed to suggest that humans were either unsuspecting victims of various drive states or unformed blocks to be molded by external cues or forces. Humans had lost their status as the pinnacle of creation. In retrospect, it is interesting to note that this portrait of human beings as rather hapless characters, lacking control over some of their most basic qualities, was not so diﬀerent from some of Fundamentalism’s tenets about the inherent evilness of humankind in the absence of God’s grace.
Convergence began again toward the middle of the twentieth century. In response to the eﬀects of the Second World War and the coming of the nuclear age, Western thinkers, both religious and psychotherapeutic, again began to re-evaluate the nature of humankind, its inherent qualities, and its potential for change. Important to both was a movement toward a more positive view of human nature with less of the pessimism that had marked some of psychotherapy’s models in recent history. The existential shift that had aﬀected so much of the Western world was incorporated into current thought. The nationalism that underlay much of the global conﬂict gave way to greater acceptance of ‘that which is diﬀerent’ as being something other than ‘that which is worse.’ Prevalent again was the idea that humans were capable of virtuous acts, but this time the element of choice was worked strongly into the equation. And, while a number of religious leaders appeared to have understood that religion and psychotherapy were moving toward another conﬂuence, many of today’s psychotherapists question whether religion and psychotherapy can be reconciled. It is on this discrepancy that we now focus.
3. Current Perspective
The tradition of professional detachment regarding the spiritual beliefs of patients is reﬂected in current survey data indicating a profound disconnection between the religious beliefs and desires of the general population and mental health providers. For example, while 72 percent of the population view religion as an important inﬂuence on their lives, only 33 percent of psychologists respond similarly. In academic settings, psychologists are twice as likely as physicians to report that they have no religious preference (Shafranske 1996). Clinically, the issue of client religious beliefs typically is ignored or may be viewed as pathological. In contrast, survey data consistently reveal that religious beliefs are important to the general population, those presumably treated by mental health practitioners. Over 86 percent claim that they believe in God and 70 percent believe in a God who answers prayer (Barna 1992). Importantly, over half of responders state that they would prefer religious to secular mental healthcare regarding certain issues, especially marital and family problems (Privette et al. 1994).
There is reason to believe, however, that mainstream professional indiﬀerence to religious beliefs in psycho- therapy has been overestimated. While mental health providers are less likely to report that religious beliefs are a major inﬂuence on their lives, 77 percent of them do claim to try to live their lives according to religious beliefs, which closely mirrors the general population (Bergin and Jensen 1990, p. 5). According to Miller and Thoreson, there is a growing recognition in the mental health ﬁeld that religious beliefs in clients are correlated with longer life, and lower incidence of suicide, divorce, and alcohol abuse (Miller 1999). When the impact of religious beliefs is measured upon ‘hard’ variables, meaning those that are observable and easily measured such as longevity, the correlation almost always indicates a protective eﬀect of such beliefs. When the impact of religious variables is measured upon ‘soft’ variables, those that are not observable and easily measured such as rigidity, the results are mixed. Several researchers have noted that the antireligious bias of mental health providers may lead to a lack of attention to the obvious beneﬁts conferred by religious beliefs in important domains of human functioning, while overemphasizing the negative eﬀects of religious beliefs in intrapsychic domains (Bergin et al. 1996).
Mental health providers clearly are moving toward a more egalitarian approach to the spiritual and religious beliefs of their clients, with momentum. For example, in 1992 the American Psychological Association included religious beliefs among the spectrum of diversity which is to be protected by psychologists, who are expressly forbidden to discriminate or tolerate discrimination on the basis of religious beliefs (Bergin et al. 1996). Additionally, a suggestion to add a new code to the DSM diagnostic formulation to indicate psychoreligious or psychospiritual problems (Lukoﬀ et al. 1992) has been accepted. Perhaps more importantly, psychologists and other mental health providers are beginning to examine empirically the impact of religious beliefs upon the process of psychotherapy. Initial ﬁndings indicate that integrating religious beliefs into psychological treatments may oﬀer superior results for anxiety (Propst et al. 1992) and depression (Razali et al. 1998) in controlled studies with random assignment, for clients with religious beliefs. The impact of incorporating a spiritual dimension to psychotherapy is perhaps nowhere more visible than in the treatment of addictions. The long tradition of incorporating spiritual renewal found in the 12-step approach has received empirical support in a growing number of correlational studies (Miller 1999) and rigorous research studies (Project MATCH 1997), regardless of client’s pre-existing religious beliefs.
Another factor that may be inﬂuencing psychology’s consideration of religious beliefs and practices is the large number of assessment instruments, with psychometric validation, currently available for the measurement of a wide variety of religious and spiritual constructs (see Hill et al. 1999). Many of these are relatively brief, but provide useful information on such topics as coherence, purpose in life, and spiritual well-being. The work of Pargament and Brant (1998) has addressed systematically an individual’s coping strategies, their roots in either religious or spiritual beliefs, and where they are related to negative or positive health outcomes.
It appears, therefore, that the roads have once again begun to converge and that more practitioners of psychotherapy are recognizing the potential importance of assessing religious beliefs and incorporating them into practice. This is a marked change from the belief that client’s spiritual beliefs are pathological, irrelevant, or damaging to the therapeutic process (Shafranske 1996).
4. Future Directions
Ultimately, however, if the relationship between religion and psychotherapy is to continue to grow, there are several areas that will continue to challenge us. First, it is no longer the case that the vast majority of persons in industrialized Western countries are descendent from Anglo–European lineage. By the middle of this new century it is estimated that Whites will be a racial minority in the United States. Subsequently, both psychology and religion will have to incorporate this divergence. This will mean that the concepts of health and spiritual well-being probably will come to include philosophies prominent in Asian and African cultures and religions. These cultures have often looked at the inherent value of a single human being, the role of suﬀering, and the connection with the environment in a manner not typical of current psychological and Judeo–Christian tenets. Second, the role of women has changed radically since the early days of both Judeo–Christian religions and psychotherapy. In this case, feminist voices from both disciplines are likely to continue to express conﬂict with the goals of therapeutic intervention and mechanisms of change. Last, as scientiﬁc understanding of the working of the human brain and nervous system continues to progress, it will be important for both psychotherapy and religion to remain ﬂexible enough to incorporate this new knowledge.
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