Jay Einhorn had been thinking a lot about the intersection of religion and psychology — his entire career, in fact — when he found himself sitting across from a client who was both highly religious and struggling with suicidal thoughts.
The client told Einhorn he believed his sins were unforgivable and that he was going to be condemned.
“I told him that my understanding of his faith was that God judged, and wasn’t he usurping God’s authority and claiming to be higher than God by judging himself?” Einhorn said.
Einhorn calls this a “religious-level intervention," and it succeeded because it met the client on his faith's own terms and challenged his interpretation, Einhorn said.
Einhorn’s integration of the client’s beliefs into therapy is part of a trend in which religion and psychotherapy, once seen as separate and competing domains, now overlap, at times significantly. Studies suggest benefits to patients, but the trend also raises questions about how to approach the convergence.
“A lot of solid research shows that generally, faith is an important resource in people’s lives and facilitates health and well-being,” said Kenneth Pargament, a clinical psychologist and professor of psychology at Bowling Green State University. “Our efforts to help people are really incomplete if we don’t appreciate and integrate that spiritual dimension."
From foe to friend
Religion, spirituality and psychotherapy represent three different but overlapping domains, Einhorn said, each with a particular way of helping people become aware of unconscious perceptions and change their behavior.
“Everyone needs someone to hold up the mirror, and each of these three domains holds up the mirror for us,” he said.
But the three domains weren’t always friendly to each other. Early leaders in psychology and psychiatry, including Sigmund Freud and B.F. Skinner, held religion in contempt, Pargament said.
There has been a thaw in recent decades, in part because psychotherapy co-opted some of religion’s turf, and religion changed in response, said Matthew Bowman, associate professor of history at Henderson State University in Arkadelphia, Arkansas.
“Religion was seeking to assert its influence in an increasingly secular public square, and psychoanalysis was one of many factors that made Americans unwilling to embrace the grimmer aspects of traditional Christianity, like depravity and original sin, so religion adjusted,” Bowman said. He pointed to the work of sociologist Robert Bellah, who wrote that as religion in the U.S. has become more individualistic, it has focused less on the doctrines of sin, redemption and sacrifice and more on the sentiments of happiness and self-fulfillment.
The mental health profession also changed, adopting more nuance, more experimentation and study, as well as spiritual practices like meditation and mindfulness, Bowman said.
“The therapeutic community in America has adopted a secularized set of religious practices in order to speak to the ‘spiritual’ faction of Americans, who also tend to be the same upper-middle-class white people who go to therapy,” he said.
Psychology is beginning to explore topics like forgiveness, gratitude, hope, love and meditation, each of which has deep roots in religious traditions and philosophies, Pargament wrote for the American Psychological Association. He warned that something could be lost in disconnecting these ideas from their religious contexts.
“Unlike any other dimension of life, religion and spirituality have a unique focus on the domain of the sacred — transcendence, ultimate truth, finitude and deep connectedness. Any psychology that overlooks these parts of life remains incomplete,” he said.
Integrating worlds
Emerging research shows that not only do people want to talk about matters of faith in psychological treatment, but such integration is as effective as other treatments, according to Pargament, who edited the “APA Handbook of Psychology, Religion and Spirituality,” published in 2013, and wrote a 2007 book titled “Spiritually Integrated Psychotherapy.”
But psychologists should be careful to approach religion and spirituality with sensitivity and awareness of how their own beliefs and values might impact the client, Pargament said.
One example of how to successfully integrate religion into therapy is in working with depressed clients, who often stop doing beneficial things such as exercising, eating well and spending time with other people, he said.
“They cut themselves off from the things that help the most. That’s true of their spiritual side, too,” Pargament said.
“Just as working with a depressed person you might encourage them to get involved in exercise, get involved socially, or take better care of themselves physically, if they have a religious home or spiritual interests, you might also suggest that they get re-involved in their faith life,” he said. “It’s just one more resource, but one that’s often neglected by mental health professionals.”
On the other hand, mental health struggles can also lead to spiritual struggles, such as feeling punished by God, being angry at God or one’s religious community, or having a sense of guilt for not living up to one's moral code, Pargament added.
“Those struggles need to be addressed in treatment, too, because spiritual struggles can be a source of terrible pain in and of themselves,” he said.
Clients may also want to discuss a crisis of faith, and counselors should encourage that conversation and help normalize what patients are going through, Pargament said, adding that questions about faith and spiritual struggles are a natural part of development.
“Unfortunately, there’s been a lot of stigma around spiritual struggles, so people who have questions about their faith or feel alienated from a religious community … often keep that to themselves because they feel guilty or feel their faith community or family would shun or punish them, which only makes matters worse,” he said.
“Therapy provides an opportunity for open discussion without judgment or criticism that’s helping people sort out where they stand on these very important life issues."
The dual nature of religion
Not everyone thinks integrating religion into therapy is a good idea, however.
“I have no idea why you need to incorporate religion in social work,” psychologist Darrel Ray told Religion News Service last year. He said it’s too difficult for therapists to keep their own religion out of their counseling and that they often have a Christian bias.
Ray, 65, is the founder of Kansas City-based nonprofit Recovering from Religion, which has a Secular Therapist Project that connects clients with secular therapists. This is especially important for clients who have left religious communities and are looking for resources, said executive director Sarah Morehead to RNS.
Pargament noted that research shows religion and spirituality, while generally helpful to people, can also be the source of psychological problems. Spiritual struggles can contribute to psychological distress, declines in physical health and even greater risk of mortality, he wrote for the APA.
That’s why therapists should be aware of the “dual nature of religion and spirituality” and be prepared to address it, he wrote.
A 2015 study of social workers conducted by researchers at Baylor University and the University of Houston found that most (82 percent) felt confident in their ability to integrate clients’ religious or spiritual beliefs into their treatment. Majorities also said discussing religion or spirituality in therapy would be beneficial to their clients.
Yet far fewer said they actually talk to clients about it or link them to religious or spiritual resources that could help, according to the study, which surveyed 442 licensed clinical social workers across the U.S. and was published in the journal Social Work.
Pargament said mental health professionals are willing to talk about spirituality in treatment, but they don’t know how because most graduate programs don’t provide training. Only about a quarter of students have exposure to a course in religion and spirituality.
Pargament and his colleagues are working to get more training into these programs. They have also been teaching continuing education workshops for therapists on spiritually integrated therapy for a number of years and will lead a workshop this summer in conjunction with the Iliff School of Theology in Denver, Colorado.
Choosing a therapist
Religious people can seek counseling in a religious setting or from the general mental health community, Pargament said.
Pastoral counselors are best equipped to help people with issues of anger and forgiveness, those seeking religious direction and those with concerns about religious rituals or death-related issues.
Psychotherapy is designed to deal with depression, anxiety, addiction, personality problems and serious mental illness, though pastoral care professionals may have training in these areas, Pargament said. He sometimes collaborates with pastoral leaders in his clinical practice.
It’s appropriate to shop around and ask potential therapists how they feel about religion and their philosophy of talking about it in clinical work, he said.
When it comes to whether you should choose a therapist with the same faith or a different faith, there are pros and cons each way. Working with a therapist from the same tradition can facilitate comfort, familiarity, shared language and a strong working relationship, which lead to positive change. But it can also cause false assumptions about similarity in background and beliefs, Pargament said.
On the other hand, he said, working with a therapist of a different faith makes some people feel greater freedom to explore a variety of thoughts and feelings, especially if they fear stigma from members of their own tradition.
“I have worked with pastors from various religious traditions who have preferred to see someone outside of their own faith community because of concerns about the potential repercussions of their behavior for their careers in ministry,” he said.
He is hopeful about what could happen as more therapists add religion and spirituality to their treatment toolkits.
“This is an exciting time because people in the mental health community are beginning to broaden and deepen their approach to clinical work and include more spiritually relevant resources,” Pargament said.
“I think it’s enriching the therapy process and adding to the ways we’re able to help people.”
Email: apond@deseretnews.com
Twitter: @allisonpond