There’s a thread you follow. It goes among
things that change. But it doesn’t change.
Psychotherapy as a profession tends to attract those of us who have an interest in the deeper questions of life. Whether this manifests in philosophical, scientific or spiritual form, many of us have chosen this profession because we have a sense that there’s more to life. We want to swim in the depths of meaning rather than skate along the surface, and when a client seems to be testing those deeper waters, we get excited at the prospect of undertaking that exploration with them.
However, talking to therapists about spiritual issues that arise in their client work, there is often a sense of discomfort, a sense of ‘I’d love to explore this but I don’t know how’ or ‘I don’t feel qualified’ or ‘how can I go there without imposing my own beliefs on the client?’ In this article, I’ll offer some thoughts that might help to open up this area, to take away some of the anxiety and enable us to welcome our clients’ spiritual selves – along with the rest of them – into the session.
Part of the perceived difficulty in working with spiritual issues arises from the conflation of religion and spirituality. One way of understanding the difference between the two is that spirituality is our direct experience and inner belief around something greater than ourselves. Religion, on the other hand, describes the structures and practices we put in place to help us make sense of spirituality – an outer expression of spirituality which often occurs in prescribed ways and in prescribed settings. For some people, religion and spirituality are the same, but this is not true for everyone. Some people have a deep sense of the spiritual without ever engaging with a formal religion, while others may be outwardly observant but have no personal sense of spirituality.
What is spirituality?
David Elkins and his colleagues at Pepperdine University came up with a very detailed definition of spirituality as a multidimensional construct consisting of nine major components (which I have paraphrased here from Elkins et al., 1988). They found that spirituality involves:
1. A belief in something more than we can see – which may be a personal God, a higher self, a transcendent dimension, etc.
2. A belief that life is meaningful, and that the existential void can be filled with an authentic life. This will look different for all of us – what is it that gives your life meaning? What gets you up in the morning?
3. A belief that each person has a vocation or calling, something that makes them feel really inspired and fulfilled (this is often confused in our society with a profession, but they are not the same).
4. A belief that life is infused with sacredness and the spiritual person can experience awe, reverence and wonder even in non-religious settings – we know that many people find this in nature, or in music, or in relationship.
5. Challenging material values, that ultimate satisfaction is to be found not in material things but in things of the spirit.
6. Interconnection and altruism – having a sense that we are all connected, being affected by the pain and suffering of others, and having a sense of social justice.
7. Idealism, having a vision of a better world and a desire to bring it about.
8. Awareness of the tragic, that pain, suffering and death are part of life and give it colour and shade.
9. That being spiritual changes all aspects of who we are and how we live.
This study is referenced a lot in the literature on spirituality and psychotherapy, and what is helpful about it is that it is not religion-specific. None of these qualities are exclusive to any one tradition, but each speaks to the human experience, and so shows how we might be doing spiritual work with clients without ever mentioning the word spirit.
We can easily ask our clients about their values, how connected they feel, where they feel awe, or joy or inspiration, what gives their life meaning. I remember working with a client who was an outspoken atheist; over the course of the therapy he moved from a place of disconnection, fear and meaninglessness to a lived sense of love and connection, of creating meaning and significance and finding the courage to follow his dreams. It wasn’t a religious journey, but it was a profoundly spiritual one.
How spirituality shows up
Sometimes a therapist finds themselves working with spiritual or religious issues because their clients keep presenting with them – and the range of issues can be very broad. In my own practice, spiritual and/or religious issues that have emerged include loss of faith, lack of meaning in life, fear of death, rage at a patriarchal church, clerical sexual abuse, desire to integrate mystical experiences, wishing to connect with nature and develop an eco-spiritual practice, curiosity about mindfulness, and existential terror following a psychedelic drug experience.
Sometimes, spirituality shows up as the presenting issue, and sometimes it manifests as a peripheral issue. For example, ‘spiritual bypassing’, a phrase coined by the late American therapist John Welwood, describes what happens when a person tries to skip over the painful emotional work of healing and go straight to a place of ‘I forgive everything and it’s all perfect because I am so spiritual’ (Welwood, n.d.) It’s an attempt to escape pain which is very understandable but ultimately fruitless. Another example is ‘spiritual narcissism’ (Vonk, 2021), where a person believes that the normal rules don’t apply to them because they are spiritual and therefore special (the cliché of the person who starts meditating and stops paying child support…).
Spirituality as a resource
Of course, we should not forget that sometimes spirituality shows up in extremely positive ways for people – as an incredible source of inner strength and support, as well as external community and support in times of hardship. A Gallup & Lindsay national poll taken in the USA in 1999 found that 80% of people said they prayed when faced with a problem or crisis. A similar and perhaps particularly Irish example might involve the numbers of novenas said for Leaving Certificate students each June as the state exams loom.
Research has shown that spiritual and religious practices can help people with mental health problems. In a 2001 study of more than 400 people with serious mental illness in the Los Angeles area, over 80% reported that they used some sort of religious belief or practice to help them cope with their symptoms and daily problems. They had used this strategy for an average of 16 years, so it was something they found to be of long-term benefit (Tepper et al., 2001).
Hefti et al. (2011) also found religious coping to be highly prevalent among patients with psychiatric disorders in Switzerland. Their surveys indicated that 70–80% used religious or spiritual beliefs and activities to cope with daily difficulties and frustrations. Religion helped patients to enhance emotional adjustment and to maintain hope, purpose and meaning. They also found that it helped patients in reframing problems, and persevering in the face of psychosocial stressors.
Benefits for therapists
Similar results have been found in studies of psychotherapists - in particular, spiritual practices such as prayer and mindfulness have been shown to reduce burnout and compassion fatigue in the profession (Case 2001; Giles, 2012; Rodriguez, 2016; Pong, 2022). We know that mindfulness enhances our ability to self-regulate, which is just as crucial for us as for our clients. Several studies also suggest that spiritual practice promotes empathy among therapists (Shapiro, Schwartz, & Bonner, 1998; Aiken, 2006; Wang, 2007).
Mindfulness meditation practice and self-reported mindfulness have been found to directly correlate with cognitive flexibility and attentional functioning (Moore and Malinowski, 2009). Mindfulness practice can also help therapists to be more attentive to the therapy process, more comfortable with silence, and more attuned with themselves and their clients (Newsome, Christopher, Dahlen, & Christopher, 2006; Schure, Christopher, & Christopher, 2008).
It is essential that any therapist proposing to work with clients around spirituality should have, at the very least, tried out the practices they are recommending and asked themselves the ‘big questions’ that commonly arise. Self-awareness is crucial here; we cannot accompany our clients through territory we have never explored ourselves.
Creating a safe space
If you are open to exploring these subjects with clients but they just never arise, it’s worth considering whether you might be unconsciously shutting your clients down. How do you respond when your client mentions such a theme? Spirituality is an area of extreme sensitivity for many clients who may be afraid of being judged negatively as naïve, superstitious or stupid if they mention them. Even if clients are prepared to admit, for example, that they practice mindfulness (which is quite mainstream at the moment), they might be embarrassed to admit that they believe in angels, or consult tarot cards, or other practices for which they feel people might laugh at them. Similarly, younger clients might be reluctant to admit that they pray or go to religious services if this is unfashionable in their peer group.
A simple and non-judgemental way to explore your client’s religious and spiritual life is simply to include a question on your intake form: ‘Do you have a spiritual or religious path that is important to you?’ If the answer is no, you can move on unless the client wants to talk about that ‘no’; if the answer is yes, it’s easy to ask, ‘Can you tell me a little more about that?’ By indicating in an opening session that this is a safe subject to raise with you, you have created space for a discussion that may show up at any point later in the therapy.
Most often, if a client speaks about spiritual issues, they do so in the context of their own particular tradition, and this can be intimidating for therapists who might not be familiar with that tradition.
The spectrum of religious and spiritual belief is vast, even in a relatively small society such as Ireland. Even the Pastafarians (not a misprint, and worth Googling) hit the headlines recently when they objected to their exclusion from an interfaith event in Dublin (Bourke, 2023). And as with other issues that arise in a diverse society, it’s important for psychotherapists to be sensitive to and informed about religious and spiritual diversity.
ASERVIC (The Association for Spiritual, Ethical and Religious Values in Counselling) is a group that is part of the American Counselling Association. It has published a list of 14 competencies (2009) for therapists dealing with spiritual and religious issues. It’s worth reviewing by Irish therapists as a way to self-check and see where further learning might be beneficial. For the sake of brevity, the competencies are summarised under the following headings:
Culture and Worldview
Therapists should be able to describe the similarities and differences between spirituality and religion, including the basic beliefs of various spiritual systems, major world religions, agnosticism, and atheism. They should recognise that the client’s beliefs about spirituality and/or religion are central to their worldview and can influence psychosocial functioning.
Therapists should actively explore their own attitudes, beliefs, and values about spirituality and/or religion and should continuously evaluate the influence of those attitudes, beliefs and values on the client and the therapy process. Therapists should recognise the limits of their understanding of the client’s spiritual and/or religious perspective and should seek information, resources and experts for consultation and referral where necessary.
Human and Spiritual Development
Therapists should be able to describe and apply various models of spiritual and/or religious development and their relationship to human development. (One such model, that of Ken Wilber, is addressed below.)
Therapists should respond to client communications about spirituality and/or religion with acceptance and sensitivity. They should use concepts that are consistent with and acceptable to the client’s spiritual and/or religious perspectives. They should be able to recognise spiritual and/or religious themes in client communication and be able to address these when therapeutically relevant.
Assessment, Diagnosis and Treatment
During intake and assessment, therapists should try to understand a client’s spiritual and/or religious perspective. They should recognise that the client’s spiritual and/or religious perspectives can (a) enhance well-being; (b) contribute to problems; and/or (c) exacerbate symptoms.
Therapists should try to set goals with the client that are consistent with their spiritual and/or religious perspectives, and should be able to (a) modify therapeutic techniques to include a client’s spiritual and/or religious perspectives, and (b) use spiritual and/or religious practices as techniques when appropriate and acceptable to the client.
Finally, therapists should be able to therapeutically apply theory and current research supporting the inclusion of a client’s spiritual beliefs and practices in their work.
Not ‘What’ but ‘How’
Although it is important to engage with what it is a person believes, to me, what a person believes is not nearly as important as the way in which they believe it. This is where the subject of transpersonal psychology really comes into its own and provides therapists with both a model and language for engaging with personal and spiritual growth that can help clients of any tradition or none.
In 1977, the American philosopher Ken Wilber posed the question of whether all the world’s wisdom traditions were actually trying to describe the same process of spiritual development in different ways. He took every model of psychological and spiritual growth he could find and synthesised them into a complex developmental model of human consciousness, with 24 stages ranging from pre-personal consciousness (such as that of a baby that has no concept of itself as separate from the mother) to the highest levels of transpersonal non-dual awareness exemplified by figures such as Jesus or Buddha (Wilber, 1997). Wilber’s work is fascinating, but beyond the scope of this article. However, John Rowan, the British psychotherapist, adapted Wilber’s model and drew out the parts that he felt were relevant to the work of psychotherapy (Rowan, 2005). His adapted model has an elegant simplicity that is far easier to understand; simply put, he shows how the work of therapy applies to the various stages of consciousness.
The task of pre-personal consciousness is the development of the individual ego. When the baby is born, all is one. As it grows, the child must learn to separate, to learn who it is apart from the mother. This is the realm of pre-and perinatal psychology, as well as theories of child development.
When this developmental task is complete, the person has a sense of themselves as an individual – they enter the realm of the personal, which is the realm of most traditional psychology and psychotherapy. The task of this realm is to become a well-functioning, responsible adult, to achieve mental and emotional maturity. Many people are happy to live out their lives here, but some find themselves asking questions like ‘Is this all there is?’ These are the people who find themselves drawn towards the transpersonal, which can be understood as ‘beyond the personal’.
Rowan describes a number of stages in the transpersonal and at the risk of over-simplification, I will outline them briefly, bearing in mind that progress through the stages of consciousness is not linear, and certainly not a one-time journey. It is also important to note that this model is an integrative one:
each stage includes and expands upon the learnings of earlier stages, rather than leaving them behind.
Centaur consciousness: The existential level
The Centaur stage is the entry point to the transpersonal and can be described as aligning with humanistic or existential psychology. A person at this level of consciousness is fully and wonderfully themselves. They may be what Maslow (1962/2022) describes as a ‘self-actualiser’, engaged with existential questions of life, death and meaning, and following their passions and skills in ways that might amaze other people. Maslow described several traits shared by self-actualising people, which have recently been developed further by American psychologist Scott Barry Kaufman (2022). Traits include:
At the Centaur stage, a person’s consciousness is still firmly rooted in the sense of themselves as an individual. They may, however, occasionally transcend this through peak experiences, those moments described by Maslow when the sense of self evaporates and is replaced by a sense of wellness and oneness with all beings. All of Maslow’s subjects reported frequent peak experiences, leading him to hypothesise that there was something beyond self-actualisation. The peak experiences reported by his subjects are similar to mystical and religious experiences reported in various spiritual traditions. Having fully inhabited the individual self, they were transcending, or moving beyond it into a sense of identification or oneness with something greater.
As a spiritual stage, this may be completely atheistic – and I am reminded of my atheist client who did such wonderful work in coming to inhabit his true self and creating a meaningful life. There may be a letting go or disillusionment of old ways of thinking and believing and perhaps the beginning of something new.
Subtle consciousness: The soul level
The next transpersonal level is called the Subtle – this is the level of the soul. This is the level of the imaginal world, where we work with things like symbols and dreams and myth and intuition. On this level we learn to trust non-linear knowing. In terms of psychotherapy, this level aligns very well with Jungian work, or perhaps with psychosynthesis.
This is the level at which we have a really deep experience of living from the soul, or the higher self, and there may be experiences of bliss, development of compassion and so on. We might become quite serious about a meditation practice or spiritual path and feel an excitement about that, a sense of progression. The language of this level is imagination, so we could use tools like visualisation, or active imagination e.g. creating an imaginal dialogue with the wise self. We can explore symbols and archetypes, or work with dreams. Working with dreams in my practice, I’m always amazed at how quickly they can help clients get to the heart of the therapeutic issue. Work at this level is about surrendering the rational mind and opening to inner wisdom.
Causal consciousness: The non-dual level
The Causal (non-dual) level is where we give up the archetypes and all our concepts of God or spirituality. Writers like Eckhart Tolle (2001) or Ram Dass (1971) describe this kind of non-dual awareness. Entering this level of consciousness might mean a letting go, finding that the symbols and forms that once inspired us no longer speak to us in quite the same way. If we explore the teachings of the Christian mystics like Meister Eckhart, who said ‘I pray God to rid me of God’ (Rohr, 2015), we can see that this is a recurring theme. Eckhart is praying that he will be able to transcend his limited conceptions of the divine. There is a formless consciousness here, what the Buddhists call Samadhi.
On a practical level, Rowan asks whether therapy is possible at a non-dual level – if there is no self, what do therapists have to work with? He has a point. Someone who is tapping into this level of consciousness will not be coming to you with the typical therapy issues; probably the main thing a therapist can do for a person at this level is to simply be with them and hold a safe space for them, and that might be all they need.
Finally, the Ultimate – what Buddhists call the void. It is God as the great mystery, perfect unity with the divine. I mention it merely to complete the overview, because my guess is that most of us have never met anyone at this level of consciousness, and if we did, they certainly wouldn’t need therapy.
I find the whole Wilber/Rowan model useful in terms of providing a framework, but when we talk about the transpersonal for the purposes of therapy, we are normally talking about the Centaur (Existential) level, the Subtle (Soul) level and occasionally the Causal (non-dual) level.
If we look at the whole circle, we can see how people can engage with spirituality and religion from any of these levels of consciousness – from an authoritarian God who will punish us if we disobey, to rational disbelief, to perhaps a questioning based on experience and then onto a deeper experience of spirituality that grows from within rather than being imposed from outside. Simply put, it is a progression from fear to love that applies regardless of which tradition a person follows. For a therapist, the ability to locate a client on this spectrum of consciousness is just as important when engaging with spirituality as is information about whichever tradition they may follow.
John Rowan (1998, p. 108) says that the essential element of transpersonal therapy is the therapist’s state of being – rather than having a tool-chest of techniques, we should sit in the unknowing and be open to what happens. And I think he’s probably right, though it can be a whole life’s practice to be able to sit in the unknowing, to get comfortable with the mystery. I will close with a quote from Mary Oliver, one of my favourite nature mystics:
Let me keep my distance, always, from those
who think they have the answers.
Let me keep company always with those who say
“Look!” and laugh in astonishment,
and bow their heads.
As therapists, may we always retain that wisdom and humility - to be surprised, to laugh at our own astonishment, and to bow our heads in the face of mystery.
Margaret Brady MIAHIP is a psychotherapist, spiritual companion and workshop facilitator based in Dublin 6. For more information see www.margaretbrady.ie
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IAHIP 2023 - INSIDE OUT 100 - Summer 2023