“When people walk into the therapist’s office, they don’t leave their spirituality behind in the waiting room.”
Dr. Ken Pargament has for decades examined the “peculiar tension between psychology and spirituality.” His book, Spiritually Integrated Psychotherapy, manages to release some of that tension by precisely and respectfully questioning the sensitive spots and taboos that have developed between these two fields of human inquiry.
As whole-person approaches to mental health and therapies continue their positive development, Dr. Pargament’s pioneering experience offers both clergy and psychology professionals several lines of questioning and reasoning that manage to create the space and clarity needed to move these imperative dialogues forward… Dr. Pargament’s genuine search for a productive, workable understanding between the psychological and spiritual disciplines serves also to benefit our overall appreciation of human balance. Please refer to Journal Entries 006 and 007 for additional materials on Dr. Pargament’s work, which includes a Windhorse Journal podcast dialogue between Dr. Pargament, Windhorse Senior Clinician Marta Aarli, and from the Interfaith Network on Mental Illness, Rabbi Deborah Bronstein and Rev. Alan Johnson. Look for Part 2 of that podcast discussion in upcoming Journal Entry 013.
We have excerpted here a section of the introduction from Dr. Ken Pargament’s Spiritually Integrated Psychotherapy.
Spirituality is an extraordinary part of the ordinary lives of people. From birth to death, spirituality is manifest in life’s turning points, revealing mystery and depth during these pivotal moments in time. In crisis and catastrophe, spirituality is often intertwined in the struggle to comprehend the seemingly incomprehensible and to manage the seemingly unmanageable. But this isn’t the full story. Spirituality is not reserved exclusively for times of crisis and transition. It is interwoven into the fabric of the everyday. We can find the spiritual in a piece of music, the smile of a passing stranger, the color of the sky at dusk, or a daily prayer of gratitude upon awakening. Spirituality can reveal itself in the ways we think, the ways we feel, the ways we act, and the ways we relate to each other. Paradoxically, the presence of the spiritual dimension can also be felt through its absence, in feelings of loss and emptiness, in questions about meaning and purpose, in a sense of alienation and abandonment, and in cries about injustice and unfairness. Spirituality is, in short, another dimension of life. An extraordinary dimension, yes, but one that is a vital part of ordinary life and what it means to be human. We are more than psychological, social, and physical beings; we are also spiritual beings.
When people walk into the therapist’s office, they don’t leave their spirituality behind in the waiting room. They bring their spiritual beliefs, practices, experiences, values, relationships, and struggles along with them. Implicitly or explicitly, this complex of spiritual factors often enters the process of psychotherapy. And yet many therapists are unaware of or unprepared to deal with this dimension in treatment. How does the therapist understand spirituality? How does the therapist address the spiritual dimension in psychotherapy? These questions are the focus of this book. In this introductory chapter I consider the peculiar tension between psychology and religion, and discuss several reasons why it makes sense to move beyond this tension to integrate spirituality into psychotherapy. As a prelude to what’s to come in the chapters that follow, I briefly characterize the essential features of spiritually integrated psychotherapy. I conclude by making explicit some of my own values and beliefs that underlie this approach to treatment. Let me start with a story.
ALICE’S STORY
Several years ago, I worked with a client named Alice. At first glance, there was nothing remarkable about her, but I was to learn otherwise. She came to my office dressed in formless polyester pants and shapeless sweatshirts, perhaps as a way to conceal her heavy frame. Her hair was clean but cut short and unstyled, and the scattered lines and wrinkles on her face were untouched by makeup. What Alice did convey was a deep sense of sadness. It showed in her slow walk, in the slight bend in her shoulders, and most of all in her eyes. They had the look of a puppy that had been mistreated, fearful of what might come next but still hopeful that something better might come along. It was hard for Alice to tell her story. Her face reddened, she directed her gaze downward, her words seemed to get caught in her throat, and she frequently apologized for her difficulty in speaking with me. At times, though, she offered a small joke that lifted the deep melancholy that had settled in the room. During these moments her eyes would sparkle and her sad face would break into a delightful almost child-like smile.
Alice had experienced emotional pain for most of her 45 years. Overweight as a child, she had been mercilessly teased and taunted by her father until he abandoned the family when she was an adolescent. Convinced of her own unattractiveness, Alice had avoided romantic entanglements. In late adolescence, Alice developed symptoms of bipolar disorder and over the next decades suffered from a terrible roller-coaster of emotional upheavals. Medications had helped her achieve a modest level of emotional stability, but she was still subject to unpredictable and powerful shifts in moods that occasionally resulted in hospitalization. In spite of her illness, Alice had succeeded in creating a meaningful life for herself, one that centered around other people. She was devoted to the care of her elderly mother. She was a loyal volunteer at both the local hospice and the school for the blind. She was a good friend to several people with serious mental illness and spent many hours helping them through their own emotional crises. In our sessions, Alice showed a genuine interest in how things were going in my life. And yet Alice was unable to derive any satisfaction from the knowledge that she was an exceptionally caring and compassionate person. She described herself in the same language her father had used: “big and stupid.” Her contemptuous view of herself was deep-seated. Through our conversations, Alice learned more about the root causes of her self-contempt, but her insights led to minimal change. My other efforts to buoy her self-image were just as unsuccessful.
Over many months, I watched Alice go through the full spectrum of her moods: exuberance tinged with the unsettling recognition of where it was leading her, depression that seemed to wash over her like huge waves plunging her into the sea of despair, and total exhaustion that followed her emotional whirlwinds. Yet, time and again, she emerged from these cycles intact, picking up the pieces of the life that she had created, reconnecting with the people she loved and cared for. How, I wondered, did this remarkable woman manage to sustain herself through her periods of emotional upheaval when she was so weighed down by the added burden of her self-contempt? What could I do to help make her life more bearable?
A pivotal moment in therapy occurred when Alice was in the midst of another deeply depressive period. She had been withdrawing from social contact for a few weeks (always a danger sign for Alice) and was thinking more and more about suicide. In this session, Alice was wracked with pain, sobbing so hard it was difficult for me to follow her. I was about to suggest her need for hospitalization when Alice spoke in a kind of language that was unusual for her. “When will my suffering end?,” she cried. The question had a spiritual, almost biblical, sound to me, like a lamentation. Understand that I had talked with Alice about the role of religion and spirituality in her life earlier in therapy. Although she had mentioned that she was a churchgoer, she left it at that and showed no interest in pursuing the subject any further. So I had put the topic aside. But now I was struck by the spiritual tone of her question. I responded in kind with a question of my own: “I’ve often wondered, Alice, how in the midst of your terrible suffering, you are able to find some consolation?” She didn’t seem surprised by the question. Instead, she paused for a long moment and then told me a story.
“When I was first hospitalized,” she said, “they put me in restraints and threw me in a seclusion room. I was only 16 at the time and I didn’t know what was going to happen to me. I was so frightened. I was so scared. I thought I was going to die. And then, lying on my bed, I felt something warm in the center of my chest. And the feeling spread through the rest of my body.”
“How did that feeling affect you?,” I asked.
“It calmed me down. I felt comforted.”
“Did that feeling speak to you in some way?”
“Yes, I knew that God was speaking to me, God was with me, telling me that He would always be with me no matter how badly I felt. I would be okay.”
Alice and I sat quietly in the room. From a corner of my mind, I noticed that her sobbing had stopped.
“Alice,” I went on, “have you felt this presence at other times in your life?”
“Oh, yes,” she said immediately. “I feel it sometimes when I’m with other people who are going through hard times. And sometimes,” she paused, “I feel it with you.” She hesitated for a longer period of time, looked down at her feet, and softly asked, “Do you feel it too?”
Every therapist knows that there are some special moments in psychotherapy. I experience them as “sacred moments” when immediate realities fade into the background, when time seems to stand still, when it feels as if something larger than life is happening. In these moments, I believe, a meeting of souls is taking place. This was one of those times.
So I answered Alice, “Yes, I do.”
Alice sat quietly and seemed to be at peace with herself—quite a dramatic change from the intense pain she was feeling just minutes earlier. After a while, I said, “I’d like to talk with you some more about this presence in your life. Would that be alright with you?” Alice agreed.
In the following months, Alice and I spoke often about her sense of spiritual connection. It had been, for much of her life, the source of her resilience and strength. We explored ways she could draw more fully on this powerful resource as she went through her emotional ups and down. And we discussed the implications of her spirituality for overcoming her own unmerciful sense of herself. There was no miracle cure. Alice would continue to struggle with her illness and with her own sense of inadequacy. However, armed with a more fully realized spirituality, Alice was far better equipped to face her challenges. She became more aware of herself, more confident in her own capabilities, and more hopeful about her future. In the process, her mood swings lost much of their ferocious intensity and her visits to the hospital became rare.
As she was leaving the room that day, I asked Alice whether she had ever mentioned her sense of spiritual presence to the other mental health professionals who had worked with her over the years.
“No,” she said.
“Why not?”
Alice gave me a quizzical look as if the answer was only too obvious. “Why would I do that? They already think I’m crazy.”
Spirituality is another dimension of the lives therapists encounter in psychotherapy. Yet, oddly enough, as Alice’s parting words suggest, psychologists and other mental health professionals are often uncomfortable with spirituality. No decent clinician avoids the most private and sensitive of topics; love, sex, death, jealousy, violence, addictions, and betrayal are grist for the therapist’s mill. Questions about spirituality and religion, however, are routinely neglected. Spirituality is separated from the treatment process as if it were an irrelevant topic or a subject so esoteric that it falls outside the bounds of psychotherapy. “Priests should stay out of therapy and therapists should stay out of spirituality” is the way some have put it, as Prest and Keller (1993, p. 139) note. Of course, clients do bring “God,” “religion,” or “spirituality” into therapy on their own, but when they do many practitioners admit to feelings of irritation (“Damn, we’re going to have to talk about this stuff?”) coupled with the desire to punch through this language of illusion and magic to get to the stark truths of reality. Not all therapists are so dismissive of spirituality. Many would like to be more responsive, but they feel uneasy when spiritual issues are raised. They fear entering potentially dangerous, uncharted waters, and find themselves at a loss for ways to proceed. This is a strange state of affairs. As Allen Bergin and I. Reed Payne (1991) commented, “It is paradoxical that traditional psychology and psychotherapy, which fosters individualism, free expression, and tolerance of dissent, would be so reluctant to address one of the most fundamental concerns of humankind—morality and spirituality” (p. 201). Why should this be the case?
Kenneth Pargament is professor emeritus of psychology at Bowling Green State University and Adjunct Professor in the Menninger Department of Psychiatry at Baylor Medical School. He has served as Distinguished Scholar at the Institute of Spirituality and Health in Houston. He has published over 300 articles on religion, spirituality, and health, and authored The Psychology of Religion and Coping: Theory, Research, Practice and Spiritually Integrated Psychotherapy: Understanding and Addressing the Sacred. Dr. Pargament is Editor-in-Chief of the 2013 two-volume APA Handbook of Psychology, Religion, and Spirituality.Among his awards are the Oskar Pfister Award from the American Psychiatric Association in 2009, the Lifetime Achievement Award from the Ohio Psychological Association in 2010, the Distinguished Service Award from the Association of Professional Chaplains in 2015, and the first Applied Psychology of Religion and Spirituality Award from Division 36 of the American Psychological Association. He received an honorary doctor of letters from Pepperdine University. He was recently acknowledged as one of the 50 most influential living psychologists.