Spirituality in Clinical Practice

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SPIRITUALITY IN CLINICAL PRACTICE

Interview #1: “Research”

THOMAS PLANTE, Ph.D.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Thomas Plante, Ph.D. Professor, Psychology Department and Director, Center for Professional Development Santa Clara University 500 El Camino Real Santa Clara, CA 95053-0333 (408) 554-4471 E-mail: [email protected] www.scu.edu./tplante

Welcome to ON GOOD AUTHORITY. I‘m Barbara Alexander. You are listening to or reading Interview #1 from our program on ―Spirituality in Clinical Practice.‖ Although this is an area where ethical issues are very closely intertwined with clinical issues, we have separated the two topics. You will find the ethics topics related to spirituality in clinical practice in Ethics 5.

When I began thinking about producing this program, I thought of Spirituality as something one does in a particular session or with a particular client or patient. But the more I researched and read and listened to our speakers, the more I realized that of all the definitions of Spirituality that you will hear, and of all the things that Spirituality is, Spirituality is NOT an intervention. Nor is it a technique. You can‘t say, ―Well, this method isn‘t working; let‘s try spirituality.‖ While certainly religious and spiritual issues arise in our work, you can‘t just decide to INCLUDE spirituality in your practice. It has to be part of who you are and who the client is.

The spiritual direction of the therapy/counseling process is highly influenced by the basic perspective of the therapist. The issue for each of us to consider is this: to what degree are we open to discussing spiritual and/or religious issues? At a minimum, we need to have an openness to hearing spiritual content and not shudder at the thought of it. More and more, our clients want to discuss this part of their lives. They want to be able to draw on their spirituality as a resource and as part of their recovery, and they want to do this with a therapist or counselor who shares their sentiments, if not their faith tradition, 1 to at least some degree. If we want to have access to this part of our clients‘ worlds, we have to be open to this in ourselves.

It is our mission, should we chose to accept it, to discover our spirituality and to determine where to go with it. To help you in this mission, this program is dedicated to bringing to you the latest in thinking from some of the leading experts on this topic. We will begin with some surprising research on what is called, ―distance prayer,‖ plus some statistics on spirituality and religion. Then we‘ll hear from a researcher who has found the brain‘s center for religious activity and who has demonstrated in his book that whatever our individual beliefs are, human beings are hard-wired for spirituality.

Now, many people are uncomfortable with that phrase, ―Hard-wired for spirituality,‖ because of its use by some ultra-fundamental religious groups. But, like it or not, neurological findings indicate convincingly that this is the case.

Last, we‘ll have an overview from an experienced clinician and teacher on how spirituality works in actual practice.

Before we go on, I have a preface: of all the programs I‘ve produced over the years, and of all the topics I‘ve covered, the subject of spirituality has been the most difficult. Fascinating, yes, but also personally conflictual. It is my observation that the mental health world is coming to –and maybe has already reached -- a collision between the scientific/empirical approach and the spiritual. On Good Authority takes no position on this and has arrived at no conclusions. But as in the past, we are hopeful that by listening to this program and to these varied speakers, you will gain some insight into what others are doing, and that this will enable you to evaluate -- or reevaluate your thoughts on the topic.

Now to our speakers.

Our first speaker, Dr. Thomas Plante, is a Professor in the Psychology Department and Director of the Center for Professional Development at Santa Clara University in Santa Clara, California. He conducts research in religious faith and health outcomes, on the psychological benefits of exercise, and psychological issues among Catholic clergy. He has published over 100 professional journal articles and several books, including Do the Right Thing: Living Ethically in an Unethical World, and Bless Me Father, For I Have Sinned: Perspectives on Sexual Abuse Committed by Roman Catholic Priests. In addition he has appeared and been featured on CNN, PBS News Hour with Jim Lehrer, National Public Radio, as well as in numerous national magazines including Time, US News and World Report, and Newsweek.

ALEXANDER: Dr. Plante, I‘ve observed a stunning increase in interest in spirituality in the mental health community, certainly among listeners to the On Good Authority programs. Is that something that you‘ve observed in your research?

PLANTE: The American population, and this is true through most of the world, tends to be religious and spiritually oriented anyways. So when Gallup does frequent polls asking questions about, ―How connected are you to religion and spirituality?‖ in the United States, the findings are always that somewhere around 96% of the American population believes in God, about 75 % report that religion is very important in their life, and for the past 50 years, approximately 40% of all Americans have attended a religious service within the last seven days. Now this is much higher in some areas of the country than others. In the San Francisco Bay area, where I live, it‘s approximately 16%, whereas probably in the Deep South, it‘s much, much higher than that 40 % figure. So people tend to be religious/spiritual in general.

Curiously, although the vast majority of the American population experience themselves believing in God and being religious, this is not true of the mental health community. Studies on psychologists and psychiatrists and so forth have found that only 50% of that population has any kind of religious affiliation at all, and only a third reports that religion plays an important role in their lives, whereas that figure is 75% in the general American population.

ALEXANDER: Why don‘t mental health professionals get into spirituality? Why haven‘t they come upon that more?

PLANTE: Well, I‘m glad you asked that because it is an intriguing question and there is some interesting data about that. I think part of it has to do with several things: first, the world of psychology and religion used to be more closely connected years ago in the sense that when people were troubled by things going on in their lives, they would typically turn to clergy. Some of the very early writers in psychology actually did publish books and articles about psychology and religion.

Then a couple of things happened, one of which was the mental health world, psychology and other disciplines, decided that they wanted to be more scientific. They wanted to be more empirical and religion was something that they saw as really not empirical. So there was a movement away from that. Furthermore, some of the leading figures have been very anti-religion. Freud had some very negative things to say about religion; Albert Ellis, B.F. Skinner -- there‘s a variety of giants in the field who have been sort of anti-religion.

Another reason is that there tends to be an inverse relationship between education and religiosity and spirituality in the sense that people who tend to be more religious tend to be more spiritual, tend to be lower on the education spectrum, and of course, by definition, mental health professionals have master‘s degrees and PhDs and MDs, so by definition you‘re talking about highly educated population.

Third, has to do with training; for the most part it is ignored in training programs. There are very few training programs at the graduate school level, internship level, post doctoral level, that really do much of anything when it comes to integrating religion/spirituality into practice. So even if people want to do it, they don‘t know how.

Then finally I think something has happened over the last handful of years where there‘s more interest in this topic at the professional level and some of our leaders in the field have started to do more research. There are special practice sections that are coming out. The memberships in some of the organizations that are interested in this have grown substantially. So something has been going on over the last handful of years. In fact, a remarkable statistic is that if we ask the general population, ―Do you need to grow spiritually?‖ In 1994, 54% of the American population said that they need to grow spiritually, but four years later, by 1998, 82% said that they needed to grow more spiritually. This is according to Gallup polls.

ALEXANDER: Dr. Plante, could you please tell us about the study that you did on religious faith and spirituality?

PLANTE: Okay. The subject has to do with determining the mental health benefits of religious faith and spirituality in substance abuse recovery.

ALEXANDER: What did you find?

PLANTE: Well, we were interested in conducting a study -- and we‘ve done a variety of these studies -- looking at how religious faith and spirituality helps people cope with a variety of both physical and mental health problems. In this particular study, we looked at 236 people recovering from substance abuse who were in social service agencies such as in-patient treatment facilities and halfway houses and so forth. So they were pretty severely troubled by substance abuse problems. We were looking at strength of religious faith, religious affiliation, and spirituality.

Basically, what we found was that those who are more spiritually connected or involved with a religious faith were more likely to be optimistic, receive social support, more stress-resilient, lower anxiety, and a variety of other positive mental health outcomes. We measure spirituality and religious involvement in a variety of different ways and no matter how we sliced it, you still see these positive sorts of mental health benefits associated with connection to spirituality and religious faith among substance abuse populations.

ALEXANDER: What are some of those definitions and measures?

PLANTE: Well, first off, religious faith: there are a variety of ways and measures to assess that. There are a variety of techniques commonly used in the literature. We used a scale called the ―Santa Clara Strength of Religious Faith‖ questionnaire, which is a brief questionnaire that‘s been validated and is found to be reliable It‘s a non- denominational measure of strength of religious faith or connection to the subject‘s religious faith.

There are other ways too that are used to measure what we call ―extrinsic religiosity‖ and ―intrinsic religiosity.‖ Measuring extrinsic religiosity is very simple: ―Do you actually show up to services and if so, how often?‖ That‘s a very fairly simple question which is

4 basically, ―Do you tend to show up to religious services once a week, once a month, never, several times a week?‖ Other questions measure people‘s particular religious tradition: do they affiliate with a particular tradition whether it‘s Catholic, Protestant, Jewish, Islam, Buddhist, or whatever it may be?

Intrinsic religiosity is a little bit more challenging to assess because it‘s speaking to what is going on in someone‘s mind and heart. There are a variety of questionnaires that tap into intrinsic religiosity: do you pray; meditate; do you feel that God is close to you? Now, spirituality is a harder thing to assess but there are a wide variety of questionnaires that are used. There are a number of different ways to define it, depending on which author you‘re reading and which researcher you‘re looking at, but basically it‘s being in touch with the sacred, a search for the sacred, an openness to the sacred or to something that‘s transcendent in a search for God or some kind of deity figure of some sort.

That‘s a vague definition. People could be spiritual but they don‘t experience themselves as being religious. Some people experience themselves as being religious but not spiritual. We‘ve done a variety of studies, and others have too, that have looked at some of those differences to try to figure out whether it‘s spirituality or religiosity that seem to be associated with better outcomes.

ALEXANDER: So there‘s a lot of research on this?

PLANTE: There have been about 1600 articles published in this area over the past century. There have been about 400 published academic reviews of this area. Some of the top journals in psychology and medicine in general, such as The Journal of Health Psychology, Annals of Behavioral Medicine, Journal of the American Medical Association have done special issues on spirituality and health, both physical and mental. It‘s really a quite legitimate area of science and more and more people seem to be intrigued by it.

It‘s clear that for the most part over the number of decades, the mental health community has ignored religion and spirituality. I think that‘s clearly changing and that‘s a positive thing. However, there are some troubles. There are ethical issues involved; you don‘t want to be in a situation where people are proselytizing or using their clinical practice as a way of converting people to their particular religious point of view.

You also don‘t want people to practice beyond their area of expertise. We have an ethical responsibility to be competent and to be well trained in what we do, and we don‘t want to be dipping our toes in areas that aren‘t quite our areas of expertise. But I think if mental health professionals at least are open to some of this and work collaboratively in consultation with clergy or other appropriate people, they may find that engaging a patient‘s spiritual side may be a useful and productive way to help them heal. Whether or not they‘re doing the actual ―spiritual intervention‖ -- they have to decide that for themselves -- they can work collaboratively with others. So I think if they‘re careful about not working beyond their area of expertise, if they‘re careful with the ethical issues regarding how to best manage their own spiritual tradition or their own biases regarding

5 religion and spirituality, whether it‘s positive, negative, or whatever, and they also don‘t go beyond the data, I think they‘re on the right track.

ALEXANDER: What do you mean don‘t go beyond the data?

PLANTE: One place where people sometimes go beyond the data is that they‘ll say that everybody should be more spiritual or religious or whatever. For example, one important area is in the cancer area because some people will say, ―Gee, if you just pray hard enough you‘ll likely be cured of cancer,‖ and things like that. This is kind of nutty and the research doesn‘t support it.

The research in religion and mental and physical health still has a long way to go; there‘s still a lot of research that has to happen. Thus far, the support for some of these things is more consistent in certain areas than in others. For example, the research on spirituality and anxiety and depression and well-being is fairly compelling. Research on cardiovascular disease is fairly compelling. It‘s a mixed bag with cancer. So I think it‘s important to be attentive to what the data tells us and not go beyond it in the sense that for example: ―All people with cancer should be praying,‖ and things like that. We don‘t want to be in a situation where we‘re blaming people for their illness if they don‘t get better. The jury is still out on some of these important questions.

ALEXANDER: When people are sick or when they‘re having surgeries, they say, ―Pray for me.‖ Is there any research that shows this actually helps?

PLANTE: Yes. There are about six or eight studies now that have looked at what we call, ―distance prayer,‖ which is people being prayed for and then, do they get better? That data is very interesting and compelling. Again, there have been a good number of studies in things like cardiovascular disease, cancer, AIDS, infertility. These are double blind, randomized clinical trials. The patients do not know they‘re being prayed for; they have no idea.

For the most part, in just about all of these studies that have been published in reputable, peer reviewed, the findings suggest that distance prayer does seem to have an effect. Now that makes you scratch your head and say, ―Gee, what‘s that about?‖ The classic study is by a fellow named Randolph Byrd at San Francisco General Hospital, looking at 300 or 400 cardiovascular disease patients in an ICU. Out of approximately 19 outcome measures like death, whether or not the patient needed to be intubated, and length of stay, in somewhere 16 out of those 19 variables, the prayed-for group did better than the non prayed-for group.

When you look at that research which used state of the art methodologies in terms of randomized clinical trials and you get an effect in a variety of different ways from a variety of different studies with different researchers and different patient populations, you‘ve got to pay attention to that.

One has nothing to lose to pray for people; there‘s nothing to lose. I think part of the

6 challenge is what you do if that prayer isn‘t answered in the way you want it to be answered. Who knows how and why prayer may or may not work? Who knows what that‘s all about? But I don‘t think you want to get into a situation where you would say, ―I guess God doesn‘t want to heal me if I‘m not better through prayer.‖

ALEXANDER: Well, thank you, Dr. Plante. This has been very interesting.

PLANTE: Thank you

This concludes our interview with Dr. Thomas Plante. We hope you learned from this and that you enjoyed it. To order Dr. Plante‘s books, contact the Greenwood Press, 800- 225-5800, or amazon.com.

I must say here that the views expressed by their speakers are theirs alone and do not necessarily reflect the views of On Good Authority. On behalf of On Good Authority, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #2: “Neurology and Meditation”

ANDREW NEWBERG, M.D.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Andrew Newberg, M.D. Director, Nuclear Medicine University of Pennsylvania Hospital Philadelphia, PA (215) 662-3092 E-mail: [email protected] www.andynewberg.com

Welcome to ON GOOD AUTHORITY. I‘m Barbara Alexander. You are listening to or reading Interview #2 from our program on ―Spirituality in Clinical Practice.‖

In this interview, we‘ll hear from a researcher who has found the brain‘s center for religious activity and who demonstrates that whatever our individual beliefs are, human beings are hard-wired for spirituality

Dr. Andrew Newberg is Director of Nuclear Medicine, Director of NeuroPET Research, and Assistant Professor in the Department of Radiology at the Hospital of the University of Pennsylvania. Upon graduating from the University of Pennsylvania School of Medicine, Dr. Newberg trained in Internal Medicine at the Graduate Hospital in Philadelphia. Newberg‘s research now largely focuses on how brain function is associated with various mental states – in particular, the relationship between brain function and mystical or religious experiences. The results and implications of this research are delineated in Dr. Newberg‘s book, Why God Won’t Go Away.

ALEXANDER: Dr. Newberg, is it true that religion is linked to mental health? In other words, is a spiritual or religious person possibly going to be more mentally healthy?

NEWBERG: There are actually a lot of studies which have tried to establish how religion and spirituality are related to mental health. What I think has been very interesting from the perspective of our research is that we have looked at what goes on in

8 the brain when people have different religious or spiritual experiences, and those effects can actually be very, very positive and sometimes can actually be negative.

When people look at clinical studies, a number of practices such as meditation and prayer, and perhaps even just going to church and participating in the congregation, tend to be associated with improvements in depression and anxiety. These people tend to have a better sense of self-esteem and well-being. We sometimes have referred to an issue called ontological anxiety in which religion and spirituality help us find our place and purpose in our world and then help us make some sense out of that.

There are both very direct as well as indirect reasons why there could be positive effects. So certainly we could talk about the direct effects of meditation, which can induce what has sometimes been referred to as a ―relaxation response,‖ where your blood pressure and heart rate are lowered; you feel overall just a sense of relaxation. Religion and spirituality can also bring about social interaction with other people in a congregation. And through the different things that somebody does as part of their religion, there are indirect effects that are very beneficial from a mental health perspective.

Now there are also some circumstances and certain examples where religion and spirituality has been linked to a more negative side. Some people (researchers) have actually looked at pathological conditions like seizures or schizophrenia and have noted that there is a preponderance of spiritual experiences and unusual kinds of experiences-- such as visions and so forth-- that might be associated with these kinds of diseases. Then of course there are researchers who have looked at practices like mediation or prayer and have found that they actually can have a negative effect, especially in certain populations of people, like patients with schizophrenia or depression. It might not be a good thing for somebody who‘s already depressed and in the course of meditation to experience ―nothingness,‖ Or the loss of the sense of self may not be a good thing for somebody who already has schizophrenia.

Also, I think one of the interesting areas of research in the last couple of years is looking at the elderly population. I think one of the things that have been found for the elderly is that religion and spirituality has a very beneficial effect and can be utilized in a positive way to help them cope with whatever disabilities and problems they face. But sometimes if they can‘t participate in church or can‘t do the things that they used to like to do as part of their religion, then they can develop a more negative perspective to what religion is about. They may feel like they‘re being punished or something like that. Then religion can actually contribute to a negative response and can actually cause increases in disability and even mortality.

So I think it kind of swings both ways, and one of the things that our research is looking specifically at-- how the brain works during religion and spiritual practices and experiences-- is to help us understand better when positive things happen and when negative things happen.

ALEXANDER: You have several pages in your book talking about the differences between hallucinations and mystical experiences, and why they‘re not the same.

NEWBERG: Right. Well I think that if one does look at the phenomenology--what happens to the person during these different types of experiences--there are some pretty dramatic differences between the two.

First, schizophrenia or seizures are chronic processes that tend to happen over and over again during a person‘s life. It‘s something people can‘t really escape unless they‘re taking medication or something like that. A lot of times it‘s very repetitive, and that‘s particularly the case in seizure patients where they tend to have a very similar kind of experience each time. We can contrast both of those issues with regards to religion and spirituality where typically, when people are religious or spiritual, it goes throughout their life. It is not something that hinders them in their lives, and it is not something that affects their ability to think or to hold down jobs. That is what you do see in the pathological conditions. Also a lot of times-- especially when we‘re talking about mystical experiences--these are frequently once-in-a-lifetime experiences. They happen one, maybe two times for a person, and it seems to me at least to argue against a seizure disorder which would be something that would happen repetitively, or schizophrenia which would also be something that would happen throughout the person‘s life.

These individual kinds of experiences-- mystical experiences themselves-- tend to be very unique and very different. If we were to look at the religious figures of history, and if they were to have had more than one [mystical experience], or even if they may have had just a fairly limited number of experiences where they [envisioned themselves] in the presence of God, then in general, they [mystical experiences] were fairly different each time. So I think that when one looks at those overall differences [between hallucinations and mystical experiences], then those people who have mystical experiences tend to view them very, very positively, and they tend to have very beneficial impacts on their lives, whereas people who have pathologies and psychoses and so forth tend to view them as negative. They tend to view them as being disordered and not representing reality. So I think there‘s very clearly a distinction between those two.

On the other hand, of course, we do see a subset of patients with seizure disorders or with schizophrenia who do have these unusual religious feelings or experiences. I think, again, we should try to understand why, when these people have religious feelings, it‘s viewed more negatively than when people have what might be called a ―true‖ religious or mystical experience. These are very important issues that we need to work out. I think alternatively we also have to be open to the possibility that just because somebody has schizophrenia, for example, that they can‘t have a very normal kind of religious experience. And just because somebody is an otherwise normal person doesn‘t mean they can‘t have some kind of pathological or abnormal type of spiritual experience.

So I think again that the door really goes both ways and there‘s a lot of interesting and rich issues for research as well as for clinical practice.

ALEXANDER: I‘d like to ask you to talk about the work you did in imaging the brain of a person who was meditating very deeply, because that was very interesting.

NEWBERG: Sure, well the experiment itself was designed to be able to detect changes in the brain‘s activity during different types of spiritual practices. We started actually by looking at people doing Tibetan Buddhist meditation. We would have some very proficient meditators--people who had been practicing for over 15 years on a daily basis. They would come into our laboratory and after we went through all of the explanation of how the study was going to be performed, we would put a small intravenous catheter in their arms. We would set them up in a small room and let them relax a little to get them into their baseline brain state. Then we actually injected a radioactive material that follows the blood flow into their I.V. catheter; they don‘t really feel that. This material goes up into the brain and wherever there‘s more activity there‘s more blood flow, and more of this radioactive material goes there.

The interesting thing about how this material works is that it actually gets locked into the brain at the time of the injection. So if I were to inject somebody right now and they were to go and have something to eat and then watch some television, and then a couple of hours later come into our scanner, it would tell you what was happening in their brain at the moment we did the injection. So we did the injection with the person in just a resting state without actually doing any meditation at all, and we would see what their brain‘s baseline state was. Then after that scan, they would come back to the room and they would begin a meditation session which usually lasted for about an hour. We had discussed with them about when we should do the meditation injection, and usually we were outside of the room so that we were trying not to disturb them as much as possible. They could pretty much do the meditation exactly the way they wanted to.

Then, we would do the injection again. This would take place either at an agreed upon time into the meditation or when we observed them and could elicit some kind of signal from them. The material would go up into the brain and they would finish their meditation practice. We would bring them back into our scanner so we could see what was going on in their brain during the meditation state. At this point, we were able to compare the mediations state to the baseline state of the brain and see what parts of the brain were turned on or what parts of the brain were turned off during the meditation practice.

ALEXANDER: Let‘s talk about the parts of the brain that light up.

NEWBERG: Ok. We had actually thought that when people meditate there are a number of different changes that go on in the brain. There are some particular areas that are involved in different processes both in terms of how we think about things and the emotions that we have. The sensory experiences that we have suggest to us that at least there are a lot of different things that would happen in the brain when people meditated. What we saw on the scans was actually fairly consistent with what we thought would happen, based on how we understand the brain works in general.

One of the things that we saw was that the frontal lobe--the area located behind the forehead-- was activated during meditation. This is the part of the brain that allows us to focus our mind and our attention on whatever tasks or things that we‘re doing at a particular moment. When we are solving a mathematics problem or driving our car and trying to concentrate on where we‘re going, the frontal lobe is activated. So it made sense to us that during meditation people would activate the front part of their brain because this is exactly what meditation is all about. Meditation is the ability to focus the mind or focus the attention on a particular phrase, out of the bible for example, or in the case of the Tibetan Buddhist meditators, on a visualized object that had some kind of sacred significance to them.

Another part of the brain that we were very interested in is called the parietal lobe. This part of the brain is located toward the back top part of the brain. It typically functions by taking all of our sensory information and trying to use that information by trying to create a sense of our self and helps us to orient that self in the world. This part of the brain guides us through a room telling us where the chairs and tables are and allowing us to move around them to avoid bumping into anything.

What happens in meditation is that people have an alteration in that experience of their sense of self. They might experience a sense of ―spacelessness‖ and timelessness. We hypothesized that during meditation, the person would actually begin to block the sensory information as he or she went into that area. While the person progressively blocked more and more of the information getting into that area, however, it [the brain] still tried to give him a sense of self and an orientation of that self, but it no longer had that information upon which to work. The result of that ultimately would be a sense of no self-- a loss of the sense of self and time.

In our brain scans, we saw a decrease of activity in this area during the meditation state. So this was very much in line with the idea that you‘re blocking the sensory information. That area is less active than it was in the normal state where you are aware and oriented towards your surroundings.

Interestingly, we saw this decrease not only in the Tibetan Buddhist meditators, but also in people doing prayer. We had a group of Franciscan nuns who participated in our study. Both groups had increased activity in the frontal lobe and had decreased activity in the parietal lobe, which is the orientation part of the brain.

Based on our scans, several other areas [of the brain] were also involved. One of them is called the thalamus, which is a key relay in the brain in terms of sensory information. It is also a key area just in terms of enabling different areas of the brain to communicate with each other. Activity in this area was significantly increased during the meditation scan. We also noticed some increased activity in regions called the limbic system, which most people know is very involved in our emotional processing. Again, that makes sense because these spiritual and religious experiences and practices are typically very emotional for people and they have a great deal of meaning.

So what we seem to be demonstrating is a fairly complex and rich network of different brain structures that we had hypothesized would be involved. The evidence to date that includes our imaging studies as well as other published imaging studies suggests that this network of brain structures does seem to be having a number of changes during these kinds of practices. Our hope ultimately is that this provides a framework for us to begin to explore lots of other types of religious and spiritual states so that we can look beyond Tibetan Buddhist meditation to other types of meditation in different traditions—or maybe even within the same tradition. We could begin to look at a whole array of other types of experiences that people have that they consider to be spiritual and perhaps even some that are non-spiritual. This could include listening to music or doing art, artistic creativity and so forth. So I think all of these things happen to some of the same basic mechanisms in the brain. It‘s our hope that current imaging studies and studies in the future will clarify exactly how the brain does work. We will see how we respond to these very compelling and very profound types of experiences.

ALEXANDER: Why is it so hard in meditating, so difficult to quiet what they call the ―chattering monkeys?‖

NEWBERG: Well I think that the brain always has a certain degree of activity and it is used to processing lots of different pieces of information. We don‘t realize it but we are always inundated with sensory information: noise and different sounds, visual light, and all the different things that we see. In addition, there‘s all the cognitive chatter that goes on within our brains that we think about. I think that is what you‘re referring to. The brain likes to be active so it‘s very difficult sometimes to shut that off. It has to be typically a very active and in some instances forceful process.

So one of the things that frequently come up in our conversations with our meditation subjects is: ―Just what does happen to the brain during meditation?‖ Most people think that during meditation you turn off your mind and relax. But usually, especially for spiritual purposes, mediation is a very active process. It can actually be very tiring because there is this continual effort to suppress the different thoughts, experiences, and things that we sense and so forth. And it‘s not an easy process but I think it‘s also something where the more we experience it, the more we practice it, just like a lot of things in the human body.

You know, when you first start working out you can‘t lift 150 pounds, but if you start with 30 pounds, then 50 pounds, and then 70, you‘ll be able to work yourself up to eventually doing 150 pounds. It‘s sort of the same with the brain. I think that when people start meditating that‘s when it‘s particularly difficult. But then as they get used to it, as those connections in the brain begin to form, the person begins to get better at it and is able to do it in a much deeper and more effective way.

ALEXANDER: Ok, here‘s a hypothesis for you. Is it possible that if you can quiet your mind, that that helps to heal your brain? Or is that just too simplistic?

NEWBERG: I think that there is some truth to the fact that as we quiet our mind, there are benefits. And that is especially the case when we‘re thinking about issues related to depression and anxiety where the mind really starts to race. For those with such mental health challenges as Attention Deficit Disorder, it is very difficult to maintain attention and to focus the mind on the things that need attention. As we begin to learn how to quiet the mind, I‘m not sure it‘s so much a quieting of the mind as an ability to focus attention as well. It‘s kind of a combination of the two that allows us to begin to handle those kinds of issues in more detail. But going back to the potential negative consequences, a concern is that meditation may not be so good in patients with Attention Deficit Disorder if it‘s severe enough that they really can‘t even focus their mind at all. At that point, meditating becomes a frustration for them, and it‘s something that they can‘t utilize in any way.

So I think that to be beneficial, we have to be careful about how some of these practices are utilized clinically. The more clinical data we can derive through studies and so forth, the better able we‘ll be to learn who will benefit the most from these kinds of practices and training programs. We‘ll also learn who may not do so well ultimately. So while there appears to be a ―simplicity‖ to it initially, it does begin to get more and more complex as one dives into it.

ALEXANDER: For those of us who are non-medical practitioners, pastoral counselors per se, or members of the ministry at all, what has been found that would be most useful to us?

NEWBERG: I think the most relevant thing is to help people realize that having a spiritual dimension in their lives can be a positive force. If we engage people to understand what that spiritual dimension is, they will learn to rely on it, what to do with it in their lives, how important it is in their lives, how they derive meaning from it, and how they even can use that spiritual dimension to help themselves cope with various issues. These issues could be health issues, life issues with family members, monetary issues, whatever. I think people should find ways to allow spirituality to be a positive force in their lives. For people where it is a positive force, encourage them to pursue it. Even though they might need to go on medication for something, they should still pursue the spiritual dimensions of their lives-- if they feel that it‘s beneficial and it‘s helpful for them.

On the other hand, we also want to be aware of those instances when the spiritual dimension may be a problem for some people. Is this somebody who had been raised very religious but now has serious questions about that and they are really struggling internally with those kinds of issues? For those with alcohol or substance abuse problems, do they view God as punishing them? Is the reason they have all these problems because they haven‘t been good and God is now punishing them? Are there ways in which we can help them either directly or at least indirectly by trying to allow them to seek out the appropriate pastoral care people to find a way of turning that around so that the spiritual dimension can be used in a positive way? Can they be helped in the pursuit of dealing and coping with whatever issues that they are facing?

ALEXANDER: Now, the title of your book is, Why God Won’t Go Away. You say in your book that it is part of humanity that we‘re hard-wired, so to speak, for God, and that there is a human longing for some kind of faith, for some kind of spiritual experience.

NEWBERG: The argument that we have tried to make is that when we do look at religious and spiritual experiences across the board that this is something that does seem to be intimately tied in with our biology, and particularly the biology of the human brain. We have an ability to ask questions about our world to help us understand our world. We have the ability to experience a connection to something that‘s greater than our selves, and that doesn‘t mean that we have to define it as a specific kind of God or ultimate reality or whatever it is that a person wants to describe it as. In fact we tend to be fairly broad and inclusive as far as religion and spirituality go in our particular work. But I think what does seem to be the case is that the brain is designed in such a way that it tries to maintain and to transcend ourselves to be better individuals and to better understand our world. And religion and spirituality have also helped to a great extent towards those ends. So that is what religions and spirituality do for us, if I can use that kind of terminology. And what the brain is trying to do for us seems to be very mapped into that.

That has been our argument as to why the concepts of religion and God are something that will be here for a very long time-- regardless of what the actual reality-- unless the human brain actually undergoes some kind of radical change in terms of what it does for us. When we do look at how we perceive our world, how we think about things, how we understand things, and how we understand ourselves, we can see that there‘s a very deep relationship between that and the types of ideas and experiences that people have through religion and spirituality.

ALEXANDER: You‘re saying that the capacity for belief, or that the biology for belief is in us, and that‘s not the same as saying that there is this creator or source out there.

NEWBERG: In my mind actually one of the most interesting issues that comes up with this kind of research is the whole discussion about what reality really is. And it raises some very fascinating problems for us, both in terms of the mental health area as well as the philosophical and theological areas. This is because the thing that we always have to contend with is what is real, and the corollary to that is what is normal. I know that there is certainly a very big issue in psychology and psychiatry: how many times have we mused over the possibility that the schizophrenic who thinks he is Jesus Christ, may really be he! So we have to acknowledge the fact that how we experience reality is very complex.

What we‘re showing in our kind of research is that when people have a spiritual experience-- a mystical experience about God or about ultimate reality-- that experience is associated with changes that are going on in their brain. And that what is happening within the brain itself is associated with that kind of experience of reality.

Now we can find changes in the brain that are associated with other experiences of reality. What my colleagues and I have realized is that--for better or for worse--the only

15 way that we really know what is real, or really have some sense of what is real, is just that. How real does it feels? What is the sense of that reality -- so that when we bump into a table we feel it? It feels solid, it invokes a sensory response in us and we say, ―Ok, it‘s real.‖ When we have a dream, we may feel that it‘s very real when we‘re in it, but when we wake up we recognize that it was not as real. It wasn‘t as sharp and clear and it wasn‘t as compelling as our usual sense of reality.

What‘s fascinating is that when people have mystical experiences, they feel that it is in many ways a more real experience of reality. It represents a more fundamental level of reality. What‘s also interesting is that when they no longer are having the mystical experience, they still think that it‘s more real. So it‘s not like a dream state that you might feel is very real when you‘re in it, but when you wake up it‘s not real. When these people have the mystical experience, they feel like it‘s very real and when they are out of it, they still recognize that as being as real-- if not more real-- than our everyday sense of reality.

So it raises some very interesting questions about what the spiritual perspective is on reality and about the existence of God, and what science can say about these questions as well. One of the things that I‘ve tried to be very clear about in our book and in our research is to be able to separate what a brain scan can tell us about reality and about the world. So if I have a brain scan of a Franciscan nun who had the experience of being in the presence of God, all I can really say is what changes are going on in her brain when she has that experience. I can‘t address, just on the basis of that scan, whether or not she was actually in the presence of God. So that becomes more a philosophical and an epistemological question (epistemology is the field of study of reality and how we come to know things).

So there are some fascinating issues that come up, and of course this ultimately has implications for mental health: how different people experience reality, what is real and how we acknowledge hallucinations, and different types of visual experiences. Why are some things a hallucination and other things a vision? I think to some extent, it is how an individual defines it and how the society ultimately defines it.

ALEXANDER: Would there be any implications of your research for addictions counselors and specialists?

NEWBERG: As far as the field of spirituality and the brain go, there are some very interesting relationships between drugs and these kinds of experiences and particularly about substance abuse as well. When one looks at things from a clinical perspective, some of the most successful programs like Alcoholics Anonymous and the twelve step programs heavily rely on a spiritual conceptualization about the world and about the individual. These approaches tend to be very effective, at least as effective as anything else in helping people deal and cope with substance abuse problems. So there seems to be some similarity-- some relationship-- between the types of desires and cravings that are associated with drug abuse and the need to have different kinds of feelings and emotional responses and experiences associated with spirituality and religion.

There‘s also a very interesting relationship between drugs and religious experience because there are certain traditions throughout the world that have specifically made use of psychotropic substances that induce different kinds of trance states and hallucinogenic type of experiences as a way of becoming closer to God or entering into some kind of spiritual world. Shamanism exists in a number of different cultures throughout the world and refers to the ―medicine man‖ or person who would contact the spirit world in order to help the people in our regular reality. They would very routinely take in some kind of substance that would induce a very unusual kind of experience in their mind and they would use this as a way of entering into the spirit world. One of the interesting things about this is that they didn‘t perceive that as somehow diminishing that experience of the spiritual world; it wasn‘t like it was an artificial thing. It was a way--it was a door so to speak--of entering into that world and then they would do whatever it is that they were going to do. That was part of their whole tradition.

A lot of people have looked towards other types of psychotropic substances-- different types of hallucinogenic materials, LCD and the like-- as ways of accessing these kinds of experiences. And on one hand I think there is a relationship from a physiological perspective that it‘s very interesting to see where the chemicals and substances go in the brain. For example, we know that LCD affects the serotonin system and obviously it‘s associated with some very unusual kinds of sensory phenomena. How we ultimately make sense of all this depends on what research says about these experiences-- about what these kinds of different drugs ultimately do for us-- and I think when we get down to these-- what people typically consider to be spiritual experiences-- we find that there is still a difference.

There is still something that distinguishes the religious or spiritual experience from drug experiences, whether those are drug experiences that are designed specifically for some kind of hallucinatory type of thing or whether it‘s part of a substance abuse problem. These are all issues that can help us tease out the differences between them and help us to ultimately decide if and when any of these substances are ever really appropriate to be used, and obviously I would never condone using any of these. I think that it‘s something that we need to be able to explore better and evaluate more.

As far as actually taking care of people in the clinical setting, I think it goes back to the idea that the more we can identify and understand how people utilize their own spiritual dimension and how that plays a role in their life -- how that plays a role internally with their own substance abuse and the kinds of issues that they are dealing with in their life -- the more we can know how use that dimension, or alter that aspect of themselves in a positive way.

Again, I don‘t know that mental health care providers, if we feel that it needs to be altered, should actually go and try to alter it themselves unless they feel incredibly comfortable with that or unless they have an additional degree in pastoral care or in divinity. Without that, they have to be very careful about treading into those areas, but they should know who to contact and to make sure that they have available to them the resources in their community to be able to refer people to the right place.

That‘s actually another important issue: people who are interested in these questions should probably take the opportunity to find out who are the people in their community who would be able to help with these types of issues and problems and across a lot of kinds of traditions, and who they can refer people to in the event that it is an issue that really they can‘t quite deal with completely within the mental health care paradigm.

ALEXANDER: With people who‘ve been meditating for many, many years, say twenty, thirty years, does that change their brain?

NEWBERG: That‘s a great question. We don‘t know for sure at this moment whether or not meditation really can change the brain over time. It would ultimately require our ability to do longitudinal studies to take people before they really start and to see what happens at the end. That being said, there‘s no question that different types of practices and different things that we do affect the brain and can affect the brain long term.

In our particular brain imaging studies, the one interesting finding that addressed this issue somewhat, was that the meditators in their base-line state had some differences particularly in the thalamus, that very central structure that we had talked about earlier. There were some significant differences in the activity in that structure compared to a group of healthy controls who were not meditators.

The real question-- it‘s the chicken and the egg question though--is whether or not they were built that way and that‘s why meditation became such an important part of their lives and became so relevant to them, or whether they really had affected a change over time and that was why we were seeing it. There‘s some deep interest in pursuing some of these questions by doing some longitudinal studies to be able to see how people do actually change over a fairly long period of time, on the order of several years. But I suspect that we will be able to find some long term changes that are associated with these kinds of practices.

Certainly when one looks at very compelling mystical or spiritual experiences such as near death experiences and the like that can happen to anybody -- and they don‘t have to happen to a specifically religious person--these tend to have life changing consequences and it really argues for not only a clinical change, but a physiological one as well. But when people have these experiences, even if they‘re not religious to begin with, they change how they look at their inner personal relationships, they change their perspective on their job, and they change their perspective on life and death. For something that could be a moment in their life, like a near death experience, to have that kind of radical change over the course of the rest of their life--which is what most of the research has shown-- it really speaks to the fact that these kinds of phenomena are extremely powerful and can really create some very, very strong physiological, as well as clinical changes within a person.

Most of these experiences are very positive, but still there can be times when they are

18 negative, especially when a mystical experience, like a near death experience, seems to have nothing to do with their religion of origin. That can create a great deal of anxiety and embarrassment and so forth. So I mean there are certain times where we have to look at the negative, but we certainly have a long way to go to understand exactly how all of these different kinds of experiences affect us as human beings. But we‘ve made some great strides over the last ten years or so and hopefully with the kind of research that my colleagues and I are doing as well as other people around the world, we are really coming to look at these kinds of questions and hopefully we‘ll begin to unlock better answers as time goes on.

ALEXANDER: Well, Dr. Newberg, I think you are certainly opening the door to a new world and a new understanding about how our minds work.

NEWBERG: Thank you. I certainly hope we are. I think the main thing is that it‘s so important for people to open up this dialogue where we look at what science tells us about our world as well as what the spiritual perspective tells us about our world. The more that we can find ways of bringing these forces together in a positive way, the more valuable they each become. Ultimately, the real goal is to better understand ourselves. I think that to continue this research is going to be very valuable regardless of whether people are doing empirical work, just thinking about it, or looking into the clinical side of things.

ALEXANDER: Thank you, Dr. Newberg, so very much.

NEWBERG: Thank you.

This concludes our interview with Dr. Andrew Newberg. We hope you learned from it and that you enjoyed it. His book, Why God Won’t Go Away, can be ordered from all major booksellers.

I must say here that the views of our speakers are theirs alone and do not necessarily reflect the views of On Good Authority. On behalf of On Good Authority, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #3: “An Overview to Spirituality in Clinical Practice”

TERRY NORTHCUT, Ph.D.

Interviewed by Barbara Alexander, LCSW, BCD (Edited slightly for readability)

Terry Northcut, Ph.D. Loyola University of Chicago School of Social Work 820 N. Michigan Chicago, IL 60611 Phone: (312) 915-7034 E-mail: [email protected]

Welcome to Interview #3 in On Good Authority‘s program on Spirituality in Clinical Practice. I‘m Barbara Alexander.

Our speaker in this interview gives us an overview on how spirituality works in actual practice.

Terry Brumley Northcut is an Associate Professor at Loyola University School of Social Work in Chicago. She received her MSSW at the University of Tennessee and her Ph.D. at Smith College School for Social Work. Director of the Doctoral Program in Social Work at Loyola, Dr. Northcut is the coeditor with Dr. Nina Heller of the book, Enhancing Psychodynamic Therapy with Cognitive-Behavioral Techniques. Her writing and research has led her to publish and teach in the areas of integrating theory and practice, postmodernism, the development of clinical social workers, and religion and spirituality in psychotherapy.

ALEXANDER: Dr. Northcut, let‘s talk about your orientation to this topic.

NORTHCUT: Certainly. I began this interest because I practiced in the south where a large number of clients came to therapy either requesting a Christian therapist or wanting to include this in their therapy. I realized as I got training and taught in different sections of the country that there always were clients wanting this, but there were not always clinicians comfortable with this or academic settings comfortable with it. So over the

20 years I developed a course to help students in a sense ―come out of the closet‖ about their interest in the topic.

My primary concern was that I did not want clinicians or beginning practitioners to assume anything was ok in practice. There should be some clear guidelines that should be followed. It‘s not just any religion or spirituality that should be brought into treatment, but rather there should be some principles to go by. So that‘s how I got interested in it. I am coming at this as a trained psychodynamic clinician and a clinician that practices bringing different theoretical models into practice. My premise is that you don‘t throw out everything you‘ve learned when you‘re seeking to include this in the treatment.

ALEXANDER: What are some of the principles of including spirituality in your practice?

NORTHCUT: I think one of the principles is that this should not alter what good practice includes: an assessment of the client at this particular point in time; current therapy goals; assessing whether religion and spirituality function in a way that‘s a strength a hindrance to resolving the client‘s problems that brought him to treatment. So I think seeing the client as they are, meeting them where they are, doing a thorough assessment of their strengths and vulnerabilities remains the same.

The next step would be to determine how explicit or implicit is the spirituality going to be in the treatment. I do think it‘s important as you take a history to determine what role spirituality plays in this client‘s life. I always try to include both the terms ―religion‖ and ―spirituality‖ because some clients will respond differently to those words. For some clients it will be an introduction to a new idea that they can be separated.

One ethical dilemma that always comes up is when a client‘s religious beliefs or training contradicts or interferes with their behavior, for example, or their sexual orientation, let‘s say. So it‘s sometimes very liberating for clients to realize that they can be spiritual without necessarily adhering to their religious upbringing. I think going back to assessing whether the person can get comfortable with the idea that this is a part of who they are and whether it‘s going to play an important role for them. It‘s like understanding any value or cultural belief: introduce it so the client knows that this is not a subject that‘s off limits. While most Americans profess some belief, they‘re not always sure where and when to discuss their ideas about it.

ALEXANDER: Maybe we ought to take a moment and talk about the difference between religion and spirituality.

NORTHCUT: Sure. I think that‘s a very important clarification. Not that they‘re exact definitions, but generally the literature talks about religion as being the external expression of faith. That also includes ethical codes and different beliefs and worship practices. Spirituality usually relates to some quest for personal meaning and relates to more of an internal experience.

The caveat to those definitions is that for some people, spirituality is also a connection to history and legacy, particular cultural groups. These terms aren‘t so nice and neat always. Usually you see in literature that the term ―religion‖ is referred to as the external organizing system, and ―spirituality‖ is what is experienced internally, as long as it‘s understood that it‘s hard to have them be mutually exclusive. Getting clear about that often is very helpful for clients as well as for clinicians so that they can feel more comfortable.

Generally students are very cautious when they want to take the course because they always want to know whether they have to believe a certain thing to be in this course. Generally I have students that cross the range from atheists to conservative Christians so I think the idea of introducing or including this in treatment is much less frightening once students realize it‘s an open ended thing and there‘s no agenda of forcing any particular religious belief on clients.

ALEXANDER: As you talk about spirituality being a quest for meaning, it seems to me that spirituality fits beautifully with the psychodynamic models of therapy and counseling. I wonder if it fits with the cognitive/behavioral model at all. Can you see that happening there?

NORTHCUT: Yes, one of the interesting things that I‘ve noticed is that both theoretical schools-- cognitive behavioral and psychodynamic—have moved to looking at meaning. In the cognitive/ behavioral arena they‘re looking at schemas and how these organizing schemas -- it goes back to Ericson‘s world views - shape how people behave and think in the world. So I think one of the nice things at this point in theory development is that both schools are moving toward looking at how we construct meaning in our lives. This is encouraging, because then you don‘t have to be locked in. I think it was George Kelly who talked about ―hardening of the categories.‖ We don‘t have to be so exclusive in our theoretical framework. I think more and more clients are searching for some way to think about and organize and find meaning in their lives.

ALEXANDER: Is spirituality something that can be used with clients who are non- religious or who are atheist?

NORTHCUT: I think so. The way I try to frame it for clients is to ask whether this is something that‘s been helpful in the past. If they say, ―No, it‘s been troublesome,‖ I explore a little further. Often, they will recall that there were certain things that were helpful--whether it was the ritual aspect, or the routine, or whether there was somebody in the organization that was helpful.

I generally do not come up with solutions for clients, in terms of prescribing practices such as, ―I think you should meditate every day.‖ It‘s more of a mutual exploration: ―Is there anything about your religious beliefs or practices that were helpful and that might be helpful to you now as you experience this current crisis?‖ If the client says, ―No and it‘s not something I‘m interested in,‖ then that‘s where I think we‘re bound to respect that

22 decision and not insist that the client must consider spirituality.

While I think none of the ethical guidelines preclude clinicians practicing their own spirituality, I think once clients have indicated that they‘re not interested, and/or not able to discuss it, then we have to respect that decision. Let me say what I mean about that. Sometimes when you assess clients, what comes through is that their belief system is pretty--I hate to use the word ―rigid‖-- but very structured in a way that introducing the element of another perspective is very distressing, and/or maybe disorganizing. I think that when a clinician makes his or her assessments, they determine how able will the client be to consider an alternative viewpoint.

As an example, I‘m thinking of a former client who came early in the AIDS epidemic, and was struggling with discovering both that her son was homosexual and that he was HIV positive and that it had progressed further along. She was struggling with her belief system. It created enormous anxiety even when I raised the questions about how she thought about it and acknowledged that it was difficult for her -- acknowledging the contradiction and empathizing with that and beginning to suggest that there be other ways of looking at it created enormous anxiety. Often that‘s when an adjunctive person from the client‘s belief system is helpful, because sometimes it‘s a misunderstanding of the client‘s belief system-- sometimes not. But sometimes it‘s helpful to bring in somebody the client values in his or her world and religious community. So I think to get back to the question, I think it‘s not always appropriate and if the client indicates that they‘re not interested in bringing that in or able to, then ethically we should not.

ALEXANDER: It seems to me also that if a person is not interested in anything spiritual or religious, and in fact may be hostile to subject, then that‘s a great point of exploration that could lead somewhere else.

NORTHCUT: Yes. Actually, yesterday I was actually looking up Freud‘s quote that if you have one location for asylums, all the criminals will run there! The idea is that often, if there‘s an area that‘s loaded and you agree to not discuss it, then there‘s all kinds of material that should, in fact, be included in the treatment. It‘s an indicator that there is a lot of energy there and perhaps we should explore it more. So I‘ll acknowledge to clients that it‘s obviously something that‘s very distressing and depending on what the client says, I will say, ―When you feel ready, we can talk about this,‖ or I just raise the possibility that it just may be helpful for us to at least understand what makes it so difficult.‖ And sometimes there may be an extreme disappointment or abuse. Any number of things surface at that point.

ALEXANDER: In your really excellent article that was in the Clinical Social Work Journal, a couple of years back, you talk about ―post modernism.‖ Can you explain how that fits in with spirituality and clinical practice?

NORTHCUT: Sure. One of the things that is freeing about post modernism is the idea that we‘re no longer held to this kind of a positivistic viewpoint --that we‘re searching for the truth or the definitive answer, for solutions or whatever. Post modernism allows

23 us to consider that there are many truths and our job is not to find the truth with clients but help them come to terms with and create their own sense of meaning. It takes us off the hot seat of trying to have solutions and/or answers for our clients, and it also takes us off the judgmental seat because it suggests that our belief system does not have the corner on truth. It moves us out of the center stage a bit and allows for the fact that client‘s truth is just as important as our own. So I think postmodernism gives us a nice philosophical framework in that with all the different cultures we are seeing these days, that no one culture is superior to another.

ALEXANDER: I‘m going to give you an example from my own practice where a client came to me very confused and dissociative, although I didn‘t realize it at that time. She was going to a church where one of the principles of the religion was that some people were, in a sense, ―better‖ than others, whether it was by birth or by activities. And she really clung to that in a sense, and I tried to sort of counter that and say, ―Well why don‘t you think you are as valued as these others?‖ and ―Why is it important to you?‖ and ―Do you think that‘s really fair?‖ But it was not helpful to her. I think she wanted to hold onto that as something to strive to. I‘m not really sure what the meaning was, but I wasn‘t into the meaning of that surface experience of going to that particular religious organization. Rather I was dealing with sort of a self-esteem issue. So I wasn‘t differentiating. What I got into was a sort of clinical and ethical problem.

NORTHCUT: I think that‘s a good illustration. And you let me off the hook on that topic with your first line where you described her being dissociative in terms of figuring out how she is using this in a way to maintain her psychological structure. It‘s interesting, there‘s a man whose name is Balmingay who wrote a book about self psychology and religious and spiritual experiences. His point was that religious beliefs often they occur as an attempt to repair the self. I tell the students that we‘re not trying to minimize the importance or the validity of these experiences, but if we can understand that they may serve a psychological function as well, then we go further.

It‘s hard when clients are using the belief system to hold it together. This goes back to how we were all trained in terms of appreciating their defenses. If they‘re trying to hang together with this belief system, however skewed, then we have to kind of not try and take it away without replacing it or providing support. The danger is when the belief system is dangerous or poses an imminent threat, as clinicians we want clarity. We hope for a situation where it‘s clearly a physical danger and then we can step in.

The trouble seems to be more that some of them may be psychologically dangerous to their self-esteem as you say, and it‘s a problem because it‘s a matter of an opinion in terms of how dangerous is it? So then it goes back to the idea: is it functioning in a way that helps her connect to others? That‘s a good assessment theme. Sometimes this comes up with schizophrenia as well in terms of delusions: is the spiritual experience something that helps them connect to others or is it interfering? If for some reason that particular client needed or identified with this particular group, you kind of have to go back to in what way then does it fit into why they come to treatment. It may be a question of timing.

In a similar way the question comes up is with substance abusers who are trying to abstain or change their behavior. Generally the first year of treatment is not the best time to take something away or develop all this brilliant insight. The first year is really about changing and monitoring their behavior and titrating all the emotional insight as well as any kind of challenging of their belief system.

Sometimes clinicians find it so annoying -- the belief system seems to be just another form of addiction. My thinking on that is that‘s ok if it allows them to maintain sobriety or abstinence until they‘re at a place where they‘re more secure and confident. When they can abstain or change their behavior pattern, then you can look. Generally, I think research indicates that after the client‘s first year, it may be a more appropriate time to look at meanings and things that have filled in for the substance. A lot of it has to do with timing I think.

ALEXANDER: Also to the subject of rigid or maladaptive religious beliefs: what about in a situation where you‘re doing couples counseling and the man, or the wife but more likely the man, believes that it is his religious right in a sense to chastise or even to beat his wife. That‘s often a tough one isn‘t it?

NORTHCUT: That‘s also a common question, because it so clearly violates our values and our profession and our code of ethics. So sometimes there are different religious belief systems that do kind of lend itself to that, either by interpretation, or depending on your opinion -- misinterpretation.

It‘s easier to understand when their behavior is in violation of the law. I‘m thinking of families new to the country, where you can talk about their struggles around this new place they are living. You can describe this country‘s laws, and that certain behaviors are not ok. You can help them come to terms with what they‘re giving up, etc.; that‘s the empathy piece.

Where it becomes dicey, at least for most clinicians, is when there is physical and domestic violence and/or psychological abuse of the spouse? In an ideal world, we would have a nice address book of practicing ministers and different belief systems that could work with you. Then you could bring in somebody that the person would respect who could talk to the couple in a way that is not biblical, whatever the literature is saying. Sometimes that is helpful, that you can get them to get it from somebody that they respect.

Often, when it‘s a male talking about dominating a female, you could question his view of working with a female therapist as well. You have to kind of think about how they view authority? Students always ask, ―Can you get the wife alone and tell her she doesn‘t have to put up with this?‖

One of the things that we talk about is the competing values in the code of ethics in terms of what does it mean to value the person. Does the sanctity of the individual taking

25 precedence over the family? So one of the things you look at is how the family is functioning and why are they currently in treatment. In some sense you have to empathize or support the father, or else you lose them because he‘s the one that is probably making the decision about coming for treatment. But then you also have to help him or talk to him about what is his thinking about that, where did that come from, what is his understanding of that? And then ask the wife for her opinion. You have to work at it so it‘s a systemic point of view.

When it‘s physical violence, then I think you can interview the family members separately and ascertain what‘s going on. The same applies when there‘s physical, corporal punishment of the children. When there‘s physical violence, you have some clear responsibilities in terms of reporting to the authorities.

The psychological piece is the harder part, I think, because it‘s a matter of your clinical skills at assessing the damage, and/or what‘s transpiring. But I think what it goes back to is whether the wife comfortable with this, what is the presenting issue, is there some way that this is facilitating or producing the problem that has brought them into treatment. Sometimes I‘ve seen clients where the husband will quote from some biblical passage referring to, ―I‘m the head of the household,‖ and not read that the next line in the passage referring to respect and so forth. One of the dangers in countertransference is my tendency to want to rush in, ―But you didn‘t read the second verse,‖ trying to correct them. I have to slow myself down to try and understand the meaning of that role to that person.

One of the misunderstandings about post-modernism that can be kind of a danger or slippery slope is ―Does this mean that there are no ground rules or clear guidelines?‖ I don‘t think that‘s what we should take from post-modernism. It doesn‘t mean we throw away what we know about how human beings develop. That kind of treatment of another human being does not facilitate development so you have to align with your client‘s wish to be a good parent or a good partner and try and bring that out and educate. It‘s kind of a slippery balance.

This concludes part one of our interview with Terry Northcut, Ph.D. We hope you learned from this interview and that you enjoyed it. The interview continues On Good Authority‘s program, Ethics 5: Ethical Issues in Spirituality in Clinical Practice. You may reach Dr. Northcut at the Loyola University School of Social Work in Chicago, 312- 915-7034, and her book is available at Amazon.com.

I must say here that the views of our speakers are theirs alone and do not necessarily reflect the views of On Good Authority. Until next time, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #4: “The DSM and SPIRITUAL EMERGENCIES”

DAVID LUKOFF, Ph.D.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

David Lukoff, Ph.D. Professor of Psychology Saybrook Graduate School 1035 B. Street Petaluma, CA 94952 (707) 763-3504 E-mail: [email protected] www.internetguides.com

Welcome to ON GOOD AUTHORITY. I‘m Barbara Alexander. You are listening to or reading Interview #4 from our program on ―Spirituality in Clinical Practice.‖

Years ago, in my clinical internship at a psychiatric hospital, there was a schizophrenic patient who said, in a moment of great clarity, ―There‘s an angel of God sitting on my shoulder, but the devil is in my panties!‖

For the last hundred years, we would have viewed this statement as a metaphor, a conflict between superego and id, perhaps. Or, in the past twenty five years or so, we would view this statement as calling for another shot of Prolixin. However, from the beginning of time until the last hundred years or so, such a statement would have led this patient to a shaman, a witch doctor, or an exorcist. It‘s only recently in the history of humankind that healing was not done through some kind of spiritual or religious practice.

Now we have a big U-turn, back toward the notion of faith or belief as capable of healing. So, who are the aberrant ones? Thousands and thousands of years of our ancestors or the empirical science folks of today?

These notions and images from the religious upbringings of our childhoods don‘t go away. We may be too embarrassed to talk about them and we may be push them to the backs of our minds, but they remain as powerful parts of our selves and of our psyches.

With that in mind, and with the recognition that there are such things as crises of faith, spiritual emergencies, etc., we will hear about the inclusion of these syndromes and symptoms in the DSM, The Diagnostic and Statistical Manual. And we‘ll hear about the importance of differential diagnosis.

Now to our interview.

David Lukoff, Ph.D., is a licensed psychologist in California, professor of psychology and chair of the faculty at Saybrook Graduate School and Research Center in San Francisco, and he is a part-time staff psychologist at San Francisco VA Medical Center. He is the author of 50 articles and chapters on spiritual issues and mental health, one of which won the ―Exemplary Paper Award‖ from the Templeton Foundation. He is coauthor of the DSM-IV category, ―Religious or Spiritual Problem,‖ and he lectures internationally on spirituality in mental health and mental illness. He is the Webmaster of the Online Guide to the Transpersonal Internet, the Spiritual Emergency Resource Center, and he recently founded Internet Guided Learning website.

ALEXANDER: Dr. Lukoff, what I‘d like to focus on today is your diagnostic considerations for the V Code. How was it that you included the topic or became interested in lobbying for the inclusion of spiritual emergencies with the DSM people?

LUKOFF: The impetus for proposing this new diagnostic category for the Diagnostic and Statistical Manual came from the field of transpersonal psychology. Historically, transpersonal psychology has been interested in spirituality, intense religious and spiritual experiences and spiritual practices. Starting in the late sixties and through the seventies, these things were becoming of great interest to many people throughout the world and particularly in the United States. People embarked on spiritual practices like meditation and yoga, experimented with psychedelic drugs, did a lot of reading about mysticism and so on. Many people were having very intense religious and spiritual experiences that were leading them to hospital emergency rooms or getting relatives and other family members very concerned about them. This became recognized as a type of spiritual emergency within the field and there was a lot of concern about that.

In 1980, Stanislaf and Christina Grof founded something called the Spiritual Emergency Network that was set up to provide referrals for people who were having spiritual emergencies. I got involved in that at its inception in 1980, and we had many conferences on this. I wrote some articles on this as did other people and got some of the word out into the mainstream. We were still concerned that because these practices were being disseminated even more widely out of California and all over, that this was a recurring problem and we wanted to address it on a much more mainstream level.

In 1990 a few other transpersonal psychologists and I--two of whom are actually psychiatrists (Frances Lou and Robert Turner)--decided that the best way to get anything into the mainstream was to get it into the Diagnostic and Statistical Manual. We knew

28 that a new version of that was being prepared, so we contacted the task force on DSM IV and said that we wanted to submit a proposal and started to prepare it. Initially we called it ―Psycho-Spiritual Crisis.‖ As we got further into the work of preparing the proposal and preparing to lobby for it, we realized that there was an organization within the American Psychiatric Association called ―The Committee on Religion and Psychiatry,‖ and we began having conversations with its members.

In the course of working with them, it became clear that we should combine religious problems to the definition. We also changed the word ―crisis‖ to ―problem‖ to be more in line with the other categories, which are all called ―problems.‖ So we looked into the section of the DSM that is reserved for ―conditions that may be the focus of clinical attention but are not mental disorders.‖ That was a big concern for us. We didn‘t want these spiritual emergencies and religious-type problems to be considered mental disorders, but rather issues that patients bring up repeatedly in therapy and that therapists may not be prepared to treat.

We demonstrated this in our literature review. Psychologists, psychiatrists, social workers receive little or no training on how to deal with religious or spiritual issues. (It‘s changed a little bit since we did our lit review in the early 90‘s.) And yet surveys show that these issues come up regularly in therapy. So we submitted the proposal for publication in the Journal of Nervous and Mental Disease, which published it, and having the proposal in a major psychiatric journal helped give us some credibility.

I think in January of ‗93 it was accepted by the task force as a new diagnostic category. It was certainly considered a big step in mental health: The New York Times and San Francisco Chronicle had articles on it as well as the major psychiatric and psychological newsletters. So it was recognized as a major step in broadening the scope of mental health practice to be able to address religion and spirituality. It certainly has resulted in more courses at medical schools, in psychiatric residency programs and in psychologist training incorporating some material on religion and spirituality.

ALEXANDER: It‘s quite an accomplishment, I must say, because you‘re dealing with such a big establishment. To make such a change is pretty incredible.

LUKOFF: Well, I do think it‘s kind of the ―crest-of-the-wave‖ phenomenon. I do think our culture is undergoing a kind of psycho-spiritual revolution. There‘s much more awareness within the general population of these topics, and I think people bring these things up more and more in treatment. I think mental health professionals and the field are beginning to recognize that these are important considerations. Spirituality has certainly taken a very strong hold overall in healthcare. There are many workshops, books, conferences, and research publications on this topic. A book came out recently reviewing over 1,600 articles on the topic of religion and health, and the overwhelming majority show positive associations between religious practices, spiritual practices, attendance of church, intensity of religious belief and so on with the health indicators.

ALEXANDER: Interestingly, when I was preparing and outlining this program, one of the subjects I wanted to cover was whether there could be reimbursement, under a managed care system, for doing any kind of spiritual counseling. I called Medicare and I spoke to the spokesman there and he said, ―This would absolutely not be covered.‖

LUKOFF: My understanding is that the only time that people get reimbursed for this kind of work is if they happen to have those types of health plans that allot a certain number of visits that can be used any way they want. There are health plans like this. So if people are dealing with a religious or spiritual type of problem, they can certainly come into therapy, not be assigned a diagnosis of a mental disorder, and still receive treatment. Also people who are seen in therapy and paying out of their own pockets now have an option of being assigned a non-pathological diagnosis for the types of issues that they‘re dealing with. So I‘ve gotten a number of letters from people in private practice thanking me that there is now a non-pathological category to cover what they‘re doing.

Also because it‘s an Axis I diagnosis, it can also be assigned together with an Axis I mental disorder. I have done this myself on many occasions working at the San Francisco VA Medical Center. I‘ve certainly assigned a diagnosis of a religious and spiritual problem with some of the patients that I‘ve worked with who have substance abuse problems. If they make a smooth transition into a twelve step program, this issue may not come up at all because they‘re dealing with it in their twelve step work. But I have found a fairly high percentage of people who are referred to twelve step programs by chemical dependency programs and who really have trouble with the notion of a higher power. They may have had a very problematic religious background, and then for me to work with them, we need to get into that. For them to have an effective substance abuse program that includes a twelve-step component, there has to be some therapy directed towards their religious and spiritual issues.

I‘ve also assigned it together with patients I‘ve worked with who have chronic illness and chronic pain. Quite often, religion is a great resource for people who have illnesses and chronic pain conditions. Some of them would like to reach out and become more spiritual and maybe attend a church and so on, but sometimes they‘ve also had very difficult childhood experiences in the area of religion. Or they‘ve never taken it seriously and really have no background in it but they have a yearning and don‘t know which way to turn. I‘ve also worked with people in therapy who present without additional medical problems, but then an additional religious or spiritual issue comes along with it.

ALEXANDER: Let me go back to the DSM and how you can combine an Axis I diagnosis and a V Code, unless there are two diagnoses. How does that work?

LUKOFF: That‘s exactly what the DSM assumes. It is a multi-axial diagnostic system that assumes that people can have more than one diagnosis. They even give an example of the situation of somebody who has bipolar disorder and also a co-occurring marital problem, which they call partner relational problem. But they specifically say that even if the marital problem is due to issues surrounding the bipolar symptoms, it still would merit an additional diagnosis of partner relational problem, if that becomes the

30 focus of clinical attention. So the point being that even if somebody has a bipolar disorder-- and I‘ve worked with patients in this situation-- who says he or she had a lot of religious delusions and religious hallucinations but is no longer delusional due to medication and treatment, he or she may still want to explore those experiences and see if he would like to get more involved with a mainstream religious organization based on his experiences. So it is very possible in the DSM to have more than one diagnosis including a religious or spiritual problem. I would say in the mainstream of mental health treatment that‘s probably much more common than a pure religious or spiritual problem--even though those obviously do occur.

ALEXANDER: Let‘s talk about spiritual emergencies and spiritual crises. What characterizes a spiritual emergency?

LUKOFF: Well, there are a number of subtypes of spiritual emergency. As this field has progressed since 1980, it has become more differentiated, as happens in most areas of scientific investigation. There‘s more sensitivity to there being a range in variation of this phenomenon of spiritual emergency.

There are kinds that are related specifically to a spiritual practice, such as kundalini, which is a well known phenomenon seen by adept yoga practitioners. Kundalini can occur spontaneously to people who are new to yoga. It happens when they are learning yoga at a YMCA or from a video tape and they‘re not working with a yoga teacher who knows how to handle those experiences. When someone experiences kundalini, he or she can become totally overwhelmed by the experiences in the yoga practice.

That‘s the same thing that can happen with intense meditation. It‘s not likely to happen if the person does TM (Transcendental Meditation) type meditation -- 20 minutes twice a day. But some people start meditating for twelve, fourteen, sixteen hours a day for three days or a week long, ten day, or month long retreats and so on. It tends to be in those much more intense situations that people develop unusual reactions.

There‘s also spontaneous forms of spiritual emergencies such as people who start having psychic experiences, and that‘s not to say that their psychic experiences are valid or not, but just that they‘re having them and the experiences are troublesome to them. These can be known as spontaneous mystical experiences.

So the first step in recognizing a spiritual emergency is to have some sensitivity to the types and presentation of these various sub-types. There‘s a book by Stan and Christina Grof on spiritual emergencies, and I have an online course which covers many of these types. So it is important for the clinician to be aware of and recognize a behavior that is possibly related to a mystical experience.

I‘d say the second step in recognizing a spiritual emergency is to consider whether there are good prognostic signs. There are a number of research validated predictors of good outcomes from psychosis--for example, one of which is acute onset. Did the episode occur and develop over a relatively short time span? Three months is considered a cut off

31 of that, in the research at least. Did the person have good social and occupational functioning before the episode? Was he or she working or completing school at a normal pace? Does he or she have friends or held jobs, those kinds of signs? Those are all very positive predictors of a good outcome.

ALEXANDER: Could we just go back a second for you to explain what a kundalini experience is?

LUKOFF: What it looks like can vary, but the person may experience rushes of energy up and down their spine. I mean in some ways, yoga is actually designed to move energy in the body and sometimes people open up. If you‘re thinking about it in their own system, their chakras align at a rate at which they‘re not ready to handle. They can have experiences of seeing halos and light, they can have trembling, heart racing. There are some people who have presented with this kundalini syndrome. I‘d say that if they go to an emergency room, the most common diagnosis is a panic attack: a great deal of physiological symptoms such as heart racing, anxiety, and the inability to sleep and the person is usually pretty scared of these symptoms. So there‘s the differential diagnosis.

ALEXANDER: Also in your course you mentioned something a reaction that I don‘t know how to pronounce.

LUKOFF: Chi kung.

ALEXANDER: … a chi kung psychotic reaction.

LUKOFF: Yes, and that is actually described in the DSM form as a sub-cultural syndrome. It‘s a similar thing to what we were just talking about, kundalini, except it‘s brought about by the practice of chi kung. Chi kung is a part of traditional Chinese medicine. If you went to see a Chinese medicine practitioner, many of them would actually prescribe chi kung exercises, because it is one of their many major healing modalities. But as I was saying with the yoga and with meditation, people sometimes practice these things very intensively and will end up with a kind of energy overload— which may be a simplistic way to label it. In other words, they‘re releasing all this energy through these practices but they‘re really not prepared to integrate them. So the chi kung phenomenon is fairly well known. It made it into the DSM IV, although they put it in as a cultural syndrome, implying that it only occurs in Asia, and actually people do experience that here if they engage in the practice of chi kung.

ALEXANDER: If we‘re talking about spiritual awakenings, how do you distinguish between, let‘s say, a healthy or normal spiritual awakening and a pathological spiritual awakening? Is there some way to differentiate between them?

LUKOFF: Even in the categories in the DSM, there are definitely some judgments calls to be made in this process. I think a therapist needs to be trained and prepared in order to recognize what is healthy spirituality. The vast majority of people who do spiritual practices and have spiritual experiences do not present differential diagnostic

32 issues because they never show up for any kind of mental health evaluation. Most people who have had these experiences are just fine and don‘t need any kind of help. But there is a minority of people--no one knows the exact percentage—who, for whatever reason, have some difficulty integrating their experiences in this area. And then it does become an issue for the therapist to look at the issue of what‘s functional and what‘s dysfunctional in what the patient is doing.

There‘s a case of somebody who went to a weeklong meditation retreat with Jack Kornfield. Jack Kornfield is both a psychologist and a very seasoned meditation teacher who has trained for many years in Thailand and other countries in Asia and has opened up a meditation center, the first one in Massachusetts and now one in Marin County. The person was attending mealtime in the middle of the retreat, and like the rest of the retreat, it was being conducted in silence. This person just, I guess you could say ―flipped out,‖ jumped up, started to do a bunch of karate chops in the air, talked about being able to see peoples‘ auras and so on.

Now that‘s the kind of behavior that could lead a person very easily into a psych emergency room, but Jack Kornfield--being a seasoned meditator and psychologist--got a few people to work with that person. They had him start working outside in the garden digging, doing manual labor. He was actually very athletic so they got him jogging and stopped his meditating. They had him eat more ―grounding food,‖ perhaps even some meat instead of the vegetarian diet there. Somebody stayed with him 24/7 during the next few days. They were able to bring him back with both feet planted on the ground after just a couple of days. Then they actually were able to get him back into meditating, not as intensely as maybe other people were doing there, but he was able to resume his meditating practice after just a couple of days. So sometimes it does take an adept spiritual teacher to work with these energies-- not just being able to differentiate them, but also to be able to know what to do with them.

I would think for a kundalini experience that I, as a psychologist, would want to consult with a yoga teacher and find out more about how to work with kundalini experiences. Some of the guidelines are very similar to what I just mentioned with meditation.

ALEXANDER: Because it sure sounds like a psychotic episode.

LUKOFF: That‘s exactly the point, and if you just look at it cross-sectionally, that‘s what it is. But if you know, for example, that the person has been functioning very well before this, if you know that person has been engaged in an intense spiritual practice that can induce altered states and so on, then it gives you the option of trying to work with this person as though they‘re having more like a spiritual emergency. No medication, no hospitalization, but they still need a lot of support. They need people with them 24/7 and so on, so it‘s still a crisis.

ALEXANDER: It reminds me a little bit of the syndrome that happens in Florence, Italy, that I‘ve heard about over the years. Young adults going to the Uffizi Museum in Florence for the first time and many other art galleries there get sort of an overload of all

33 this art, and they have what looks like a psychotic episode from all this. Then they have to unwind from all the over stimulation.

LUKOFF: I think that people can have these kinds of very spontaneous, overwhelming experiences. And if you just hit them right in that moment, they can be in a kind of psychotic state--if you define psychosis as an inability at the moment to live in consensual, agreed-upon, ordinary reality. The ideal in these spiritual traditions is to get to a point where you can do both--where you can have these altered states awareness and experience, but still have one foot on the ground. It takes practice to do that.

ALEXANDER: Right, well let‘s talk about religious and spiritual problems such as crises in faith. How would that present, and then how would you help with that?

LUKOFF: Interestingly, that was one of the ones we added when we decided to incorporate religious problems along with the spiritual problems. As I was doing my literature searches, ―lost the faith‖ was the most common clinical example that I was finding in the literature. It‘s certainly well recognized amongst denominational religions that people go through these kinds of crises of faith, but you don‘t find much literature on that in the mental health field. Yet a loss of faith will often present as something that looks very much like a depressive episode: a person thinks his life is meaningless, he has no direction, no motivation, trouble sleeping, and his affect is sadness, confusion and bewilderment.

One case, for example, was a person in his forties who had been a devout Roman Catholic and at a certain point had just lost that connection: stopped going to church, stopped viewing his religion as the foundation of his life. So at that point, a person is a kind of lost soul. I think a therapist needs to recognize that although a prescription of Prozac might improve that person‘s mood, that‘s not going to address the kind of loss of faith issue that is the major underlying cause of that difficulty. So that becomes an opportunity for a therapist to engage in some exploration with that client about what his prior religious beliefs were, what parts of them he still felt connected to, did he want to explore other religious options, and did he want to find a different variety of Catholicism? There might be a way he could in fact connect back to his Catholic roots, or maybe not. Maybe it would be time for this person to explore another Christian path that perhaps is less hierarchal and patriarchal but maybe still has a lot of the same beliefs about Jesus and about Mary. Or the person might want to explore something totally different, and to view it as an opportunity for the person to do some of that kind of work rather than a depressive episode that requires medication. Helping the patient see these options is exactly what this diagnostic category is intended to do. It is to show therapists that there are alternative ways to view some of the kinds of things that present when they have religious or spiritual foundations.

ALEXANDER: There were a few others that you mentioned as well, such as when a person is ostracized from their religious community.

LUKOFF: I mean we live in a very mobile society and of course people, as a result, are often faced with moving to an area that may not have the same denominational church that they were members of, or they might marry somebody who‘s of a different religion or denomination. And there are big differences between these kinds of groups, and there can be a real sense of loss and disruption in their lives as a result.

I found in the literature one example of being ostracized. It was a man who needed some surgery that would require a transfusion of blood. He was a lifelong Jehovah‘s Witness and he decided that he wanted the surgery, and as a result both his family and the Jehovah‘s Witness community disowned him because he opted to have the blood transfusion. So it‘s clearly a case where a person is cast into a religious kind of crisis and a therapist would need to know a lot about the specific issues involved in being a Jehovah‘s Witness in order to help this person be able to move on in his life after he made that choice. I don‘t think a therapist should tell a person that he should have this kind of surgery, but if the person makes this choice it certainly means that the therapist needs to support him in that.

ALEXANDER: That‘s a terrible thing to lose everybody, to have to choose between your life and everything that makes your life worthwhile would be a terrible choice, terrible. Going back to types of religious and spiritual problems, I just have to tell you that this was a tremendous list that you have, and I‘m wondering why, incidentally, this list itself is not part of the V Code? Why doesn‘t it get spelled out?

LUKOFF: When we submitted the proposal for the diagnostic category, we did include loss or questioning of faith and changes in membership. I think we did mention new religious movements and cults also as religious problems, and then we mentioned mystical experiences and near-death experiences as examples of spiritual problems. The literature on those is really excellent. There are also very good studies on people who‘ve had near death experiences and how afterwards, many of them experience a lot of distress around the profound experience they‘ve had. For example, they want to make changes in their lives as a result of that profound experience, and there can be real disruption in their marital and family relationships and so on. But if you look at them five years later, what that near-death experience triggered was a series of positive changes in their lives. There is a consistent finding that people feel their lives are better afterwards. So we thought that would be a perfect one to include in the definition, but the task force axed those from the definition. I mean, I understand why the definition should not include all eight types of spiritual problems and four types of religious problems that we identified. We have done that in our own publications to make people who want to pursue this in more depth aware of a useful typology.

ALEXANDER: There are a couple more religious and spiritual problems that you list that are so interesting. Particularly it‘s the one about the iatrogenic effect of culturally insensitive treatment, and I wondered if you could expand on that and give us some examples. That‘s a very interesting one.

LUKOFF: Well certainly one of the iatrogenic effects is in the area of misdiagnosis-- treating a loss of faith episode as a depressive episode. But there‘s even more, I guess horrific, kinds of examples. There‘s the one that was published in a statement of the American Psychiatric Association from that committee on religion and psychiatry. The committee was trying to make a case for why psychiatrists needed to be more sensitive to their clients‘ religion, religious choices and values and so on. So it was about a person who went to see a therapist who belittled the patient‘s orthodox religious practices. I just thought that was the classic psychoanalytic view that religion is neurosis. I mean, there is a quote from Freud that he even sometimes thought it was more towards the psychotic end of things. So this was obviously a very traditional psychoanalyst because psychoanalysis has also broadened its view quite a bit in the last ten years. Nevertheless, at this point the client was so upset, I guess adding to his depression, and he actually became suicidal and attempted suicide. It was definitely triggered, it seems, in this case by the specific input that he got from his psychiatrist.

There can be other situations like that: a very fundamentalist Christian mental health practitioner who believes that homosexuality is a sin should (I hope) refer a patient who was gay to a different therapist. But there are cases where in fact therapists have voiced their religious views to the client. So there are those types of conflicts that can occur and hopefully, therapists can become more informed about what it means to be sensitive to clients‘ religious and spiritual choices.

ALEXANDER: Our time is running short and I wanted to ask you for a couple of other thoughts. Do you have any predictions of how the study and inclusion of spirituality will go in the mental health world in the future?

LUKOFF: My sense is that the whole culture is becoming much more open to spiritual dimensions of life. We are seeing a much greater appreciation that religion and spirituality are important coping resources for the vast majority of people. So I would expect to see more of that incorporated into training. When continuing education programs, such as On Good Authority, take up this subject, I think that is a reflection of mental health professionals in the field increasingly recognizing the importance of these areas. It‘s likely that academic and training institutions will follow, but I know there was no training provided in my program when I went through it. When I look at curricula from mainstream schools, it seems that this subject is still not recognized as a core part of what the training should be. I would expect that in ten years you won‘t find a psychology, social work, nursing, or medical program that doesn‘t have courses on religion and spirituality. Already over half of medical schools have incorporated coursework on religion and spirituality.

ALEXANDER: This has really been very informative, and I am happy that we had this interview with you.

LUKOFF: Well, I enjoyed it as well.

ALEXANDER: Do you have any final thoughts you‘d like to add before we close?

LUKOFF: I view this also as an opportunity for people in the field to recognize and address the spiritual issues in their own lives. I think they‘ll find it a very satisfying process to do a spiritual inventory, perhaps look through all of the spiritual practice in their life and so on. I think it will make people feel better prepared to deal with these issues in others as well.

ALEXANDER: Well, thank you. Thank you very much for sharing your thoughts with us.

LUKOFF: Thank you for the opportunity to do that. I‘m excited to see other people focusing on this topic.

This concludes our interview with David Lukoff, Ph.D. We hope you learned from this interview and that you enjoyed it. Dr. Lukoff may be contacted at the Saybrook Graduate School in Petaluma, CA, telephone 707-763-3504. His website is www.internetguides.com.

I must say here that the views expressed by our speakers are theirs alone and do not necessarily reflect the views of On Good Authority. On behalf of On Good Authority, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #5: “Ways of Listening to Spiritual Content”

CONSTANCE GOLDBERG, LCSW

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Constance Goldberg, LCSW 844 Chalmers Place Chicago, IL 60614 (773) 348-3643 E-mail: [email protected]

Welcome to On Good Authority. I‘m Barbara Alexander. You are listening to or reading Interview #5 from On Good Authority‘s program, ―Spirituality in Clinical Practice.‖

In this interview, we begin our exploration of how spirituality plays out in the work of many dedicated practitioners out there, beginning with the first of three approaches to how we listen to religious material in the clinical setting.

Constance Goldberg is a graduate of the Columbia University School of Social Work. She is currently on the Board and Faculty of the Center for Religion and Psychotherapy of Chicago and on the Faculty of the Institute for Clinical Social Work, also in Chicago. She is in private practice and has written clinical papers using a self psychological framework as well as papers integrating religion and psychotherapy. The article on which this interview is based appeared in the Clinical Social Work Journal (Volume 24), entitled, ―The Privileged Position of Religion in the Clinical Dialogue.‖ which offers three approaches to understanding religious material in the clinical setting: the metaphorical, the functional and the foundational

ALEXANDER: Let‘s talk about the fundamental things that you wrote in this article in which you describe three approaches to understanding religious material in the clinical setting: how we listen and respond to religious material in the therapeutic session. I think that‘s such a wonderful concept, just to have noticed that we have to listen in certain ways.

GOLDBERG: Exactly. I explain this in some detail in the paper. One way to describe my over-arching position is to appreciate the fact that a very complex array of feelings surrounds religion in our culture. We are uneasy about the proposition that a therapist should be interested in the in-depth religious exploration of a client‘s life in the clinical setting.

We as therapists should understand what the subjective meaning of religious experience is. To me, that means that a therapist should leave the issue of the reality of God to others, namely to philosophers and theologians. I‘m proposing that we have a different task essentially in the clinical situation. We‘re not out there to say whether God exists or not and in what way. Rather we are attempting to understand what is the meaning of the concept of God and the patient‘s relationship to God. In another way I‘ve described this as having an attitude of inquiry toward religious or spiritual material, much as we have toward any other kind of material that comes our way in the clinical situation. So that‘s a kind of overview of the position that I take.

ALEXANDER: Let‘s talk about how you listen and respond to religious and spiritual material.

GOLDBERG: Essentially my understanding is that there are three ways of listening to a spiritual religious experience. The first of these I think of as the foundational approach, and I‘ll get to definitions in a minute. The second way is the metaphorical approach, and the third way is the functional approach. There‘s overlap, but I think for conceptual purposes it makes sense to make this kind of division.

The foundational approach, to my mind, occurs when the patient is an adherent or a follower of a particular set of religious ideas. This patient may even believe in the structuring of experience even though it may not be in accord with any established form of religion. Nevertheless, the experience is unquestioned by the patient as foundational or that which gives grounding to his life. Some of those clients who sense that religious beliefs are foundational to their experience and therefore should not be questioned for its psychological meaning may find their way to a center that is staffed primarily by pastoral psychotherapists. Because of the context in which he or she works, the pastoral psychotherapist is assumed by the patient to be unquestioningly accepting of the religious experience, although the pastoral therapist may indeed have some of the same struggles as a secular psychotherapist. That pastoral psychotherapist may be familiar with the religious language and imagery and may relate to the patients who present themselves as ―believers‖ in a way that the secular therapist may not.

Perhaps it would be helpful if I give a clinical example of a foundational approach--a foundational way of listening to a patient. A patient of mine remarked, after about two months of therapy, that she had a wonderful conversation with a friend about the grief that she, the client, was experiencing. The friend had told her that within this suffering, God would make his gift to her known, perhaps not now, but eventually. The patient had told me that she was extremely consoled by what she called, ―this generous statement.‖ My patient knew that God‘s plan was not for us to suffer for the sake of suffering, but

39 that some kind of meaning would emerge from the suffering. However, she felt that she herself had lost sight of this understanding, and that her friend had reminded her of the possibility of it occurring eventually. What had been adding to her distress and grief over the loss of her mother had been her sense that God had not been with her. Thus she was experiencing a double loss-- that of her mother and then of God Himself. Then what followed her telling me of the experience with the friend was that she told me that every morning she had said the following prayer by Thomas Merton, which she copied and handed to me to read. This is Thomas Merton‘s prayer:

My Lord God, I have no idea where I am going, I do not see the road ahead of me, I cannot know for certain where it will end, nor do I really know myself and the fact that I think I am following your will does not mean that I am actually doing so. But I believe that the desire to please you does in fact please you, and I hope that I have desire in all that I am doing. I hope that I will never do anything apart from that desire and I know that if I do, you will lead me by the right road though at this point I know nothing about it. Therefore I will trust you always though I may seem to be lost and may seem to be in the shadow of death. I will not fear for you are ever with me and you will never leave me to face my perils alone.

That‘s the end of the prayer. In the session I read the prayer in silence and when I was finished I said that I thought it was wonderfully expressive of what she had been telling me of her hope for connection with God, even though that connection was for her, at times hard to discern. So for this patient who was raised in an Italian Catholic home, the framing of life experience via the church was in part culturally determined. However one doesn‘t have to reach far to understand that in her life there was a tremendous yearning, a yearning for an omnipotent, all-caring parent that was expressed for her in these all powerful words of Thomas Merton.

Now, the issue is can this patient‘s faith be reduced simply to an elaborated expression of childhood longings? Do we interpret these causative hypotheses that are in our mind to the patient, and if we do, will the faith disappear for her? This is a frequent issue with such patients for whom God is a foundational concept. Do we want the loss of this faith for some patients because of our own uneasiness around such a foundational belief system?

ALEXANDER: If one views it that way, aren‘t we thinking of it in the metaphorical framework in which this as a defense that you can‘t interrupt?

GOLDBERG: Yes. I think the issue is always, ―Is this defensive?‖ If indeed it is defensive, do we have an obligation as clinicians to move with the patient toward a greater understanding of the function of this belief. Now we‘re always moving between acceptance of the framing of a patient‘s experience in terms of the meaning of this experience, and/or the meaning of religion, and/or toward accepting this faith -- this grounding in the concept of God -- as foundational to a person‘s experience and needing no further interpretation. This is really the crux of the argument here. Some of the work

40 that I have done includes writing about this issue and talking about it. I have used a quote of the philosopher Ludwig Wittgenstein-- a rather controversial quote in a certain sense--where he says, ―Of that which we do not know, we should be silent.‖

ALEXANDER: That sounds like it could have been written by Emily Post or Amy Vanderbilt!

(laughter)

GOLDBERG: It could have been if we are backing off from an interpretation of a more functional approach because we feel that it isn‘t good manners, or we don‘t want to shake up the person. What I‘m suggesting is that there are some patients whose beliefs we may interpret as defensive in our own psychological terms. Nevertheless we respect the use of this defense, and say that this is a healthy adaptation by the patient which we do not need to explore further.

ALEXANDER: With this patient, did you interpret her yearning let‘s say for an omnipotent parent? Did you say anything about it or did you let it alone?

GOLDBERG: What happened with this particular patient is that I did not interpret her relationship to God, her need in her life for an omnipotent other, so to speak. I didn‘t interpret it to her. It could be said that this was my own countertransference.

Another interpretation may have to do with the complexities of my own religious background, based on somewhat ambiguous notions about the reality of God. It‘s possible that my reticence to make this interpretation had to do with the very real possibility of shortchanging the patient with regard to furthering her understanding of the way in which religious faith functioned for her.

But it was my sense that what needed to happen was for her to realign her relationship with God as she understood it, more along the lines, interestingly, of what her friend had said to her (that I mentioned a few minutes ago). The friend had said to her, ―There is an understanding that is going to come about this. God has not departed from you and you will understand it further down the road.‖ In other words it‘s an acceptance of her world view and of the importance of God in it. My task then as a psychotherapist was helping her to reconnect with the sense of her own foundation. That is stopping short, in this instant, of a full interpretation of the functional role of religion within her.

Originally when I was thinking about this example, I was thinking of a metaphorical approach to understanding religious and spiritual matters as an entirely separate category. By the time I thought through this--and this is something that I still think is true in my own conceptualization-- I believe that the metaphorical is closely tied to the functional, and I‘ll explain about that. To my mind the metaphorical approach involves our realizing that the use of religious terminology is often poetic and descriptive, evocative for the patient, and really that is all.

Now, I think the best way to explain this is to give a brief clinical example. A patient told me once of waking in the morning and saying to me, ―I was filled with a sense of God moving in my life in ways that I did not understand. I know that I seem to be in one of betwixt and between times in my life.‖ Then she paused and she smiled and looked at me and said, ―Actually, I don‘t need to talk about God and His moving in mysterious ways. What it is actually is my own lack of certainty about things that I don‘t understand. It‘s within me, it really isn‘t something related to God.‖

I think most therapists, hearing a patient talk in this way, would feel reassured that we‘re not being required by her to accept in an unquestioning way, a belief that really isn‘t our own. Actually we‘re relieved that the patient is content to use the imagery of religious experience without placing herself within it in such a way that seems to require our unquestioning acceptance of it. So perhaps you hear the difference here. She herself is using religious language metaphorically so this is an example of what I think of as a metaphorical approach and I think it is a use of language that helps our patients, and helps us, to further elaborate and get closer to the third way of listening to and responding to spiritual matters and that‘s what I call the functional approach.

ALEXANDER: I would like to go back a second to the patient‘s wonderful insight and self-observation. I‘m just wondering what a mistake it would be for a more fundamentalist sort of therapist to say that maybe God is or is not with you.

GOLDBERG: Exactly. That is certainly implicit in my considering these matters. It can be a serious error to enter into what we might call ―the reality‖ of those concepts as put forth by the patient. She herself is either backing away from, or in her own life really does not experience God as foundational, but she is familiar with the language and is using it to talk about her emotional affective life. And in the clinical setting, that is what we are after all most familiar with. We are not theologians, we are not philosophers, and we have no special expertise in those areas. What we are most equipped to do--what I maintain we are most comfortable with--is to try to understand the emotional affective meaning of what it is that our patients are speaking to us about.

My own feeling about this is that because of the complicated feelings surrounding religion in our culture, we can be uneasy about the proposition of discussing religion in a therapy session. What we need to be focusing on as clinicians-- when we explore a person‘s life in depth--is understanding the subjective meaning of religious experience. What we really primarily have to do is leave the issue of the reality of God to the philosophers and the theologians.

ALEXANDER: Can you give us an example of listening in the functional way?

GOLDBERG: Yes. Tom was a Catholic priest in his forties whom I saw in therapy for severe clinical depression, for which he was on medication. He had a serious sleep disturbance, unpredictable weeping, social isolation, and crucially a sporadic relationship with a woman that was highly physical but did involve actual intercourse. He told me early in the therapy that when he was most depressed, he and his friends would perform

42 what he called, ―a private mass,‖ just for themselves. At these times there was for him a fusion of the sexual and the religious since they would follow the religious liturgy with episodes of fondling and caressing. He told me that he felt a sense of being exonerated for this sexual activity. More importantly the familiar religious structure of the liturgy seemed to offer for Tom a soothing sense of familiarity and calm in the face of what to him was often agitated and disturbing sexual activity. I haven‘t gone into that in this example, but frantic and driven masturbation had been a part of his history and was very disturbing to him.

The liturgy that he performed was frowned upon if not actually impermissible in the eyes of the church, but it had an aura of specialness for him that fed his grandiosity. He felt it was acceptable for him to hold the services because he knew how to walk the line between what was approved and what wasn‘t. Implicitly, he felt that he was special and that God would forgive him. Also his performing of the mass, he felt, would be so exquisitely done that he felt like it would be an honor to God.

The interesting theme here of God‘s response to him was, in terms of his own history, clearly a maternal transference. He experienced himself as special in God‘s eyes as he very much had been in his mother‘s eyes. However, that specialness had involved certain burdens to please and not to distress. The distressing part for him was that he lived with a mother who had what is sometimes referred to as a veiled psychosis, and Tom had taken it on. His responsibility early in childhood was not to upset her, not to distress her so that she wouldn‘t become overtly psychotic.

Now there are many more things about Tom, but for Tom at no time was there really an issue about the reality of God. God in Tom‘s life was a foundational reality, referring to the first way of listening to patients that I mentioned. However, while understanding the foundational meaning of God for Tom, his relationship to God as expressed in these masses was something that I understood on a functional basis. In other words, it was my understanding that the completion of the mass was first and foremost a way of Tom‘s trying to calm himself from a very agitated state, psychologically. It was his way of trying to express and then to modulate his grandiose self, to use a self-psychological term. Over time, this was something that Tom and I talked about and that he came understand about himself. So with Tom, this is a highly condensed vignette from a rather long treatment.

In my work with Tom there was both a foundational acceptance on my part of his relationship to God, and a functional interpretation of his relationship to the mass, certainly of his relationship to the woman with whom he was involved. That relationship was again another attempt to calm himself down at times and interestingly at other times to lift himself out of a very profound depression. This is an example of someone with whom I found myself using both conceptual frameworks.

ALEXANDER: What was the outcome with him?

GOLDBERG: There were other aspects to this treatment. After about a year and a

43 half of work together, Tom‘s depression was lifted significantly. I want to add parenthetically that he was also on an antidepressant, and that was part of the picture. Over time, interestingly he was able to give up the private masses as well as give up the sexual aspect of the relationship with his friend. This is a man who had to take a leave from his order because of the severity of his depression. Now he was integrated back into his professional and religious community, and it was a successful outcome. Therapy ended somewhat earlier than we both would have liked because he needed to be transferred to another diocese, but it was at a time that it was possible to do that.

ALEXANDER: What are the implications when the therapist‘s religious foundations, let‘s say, or beliefs are alike with the patient or different, does that make a difference?

GOLDBERG: I think that similarity and difference in terms of religious orientation raise important issues but I would like to offer one caveat about that, and that is that these reactions are what we in general might call countertransferences. I think that we don‘t want to make such a special case of the countertransferences in this area as differentiated from others. In other words, we may have patients who come from similar ethnic backgrounds or similar socioeconomic backgrounds, academic backgrounds, family size- -all sorts of things that may be similar or different. I think that in all instances of countertransference, and certainly in areas of similarity and difference with regards to religion, we want to do what we always need to do which is to monitor our own responses. We want to be careful when we feel we are drifting into a very comfortable place with any patient because of similarities, what in a self-psychological framework might be called our sense of ―twinship‖ with another person. It can be very comforting but it can cause us not to be on our toes about an attitude of inquiry. We can take certain things for granted that we shouldn‘t, and in terms of areas of difference we want to be careful also that we are not condemning, that we keep an open mind about areas of difference, much as we might if we are of a different political party than someone we are meeting with. In other words, we want always to have our own self-observing capacity well-engaged. That is one of the main points in this discussion. We want to include religious data and religious orientation in the clinical process in a way in which we include other things.

ALEXANDER: Those are perfect words to end the interview on, Mrs. Goldberg, and I want to thank you very, very much.

GOLDBERG: Thank you.

This concludes our interview with Constance Goldberg. We hope you learned from this interview and that you enjoyed it. You may contact Constance Goldberg at 773-348- 3643.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #6: “SPIRITUALITY GROUPS WITH HOSPITALIZED TEENS”

ABBY FYTEN, M.Div

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Abby Fyten, M.Div. c/o Alexian Brothers Behavioral Health Hospital Hoffman Estates, IL (847-755-8067) E-mail: [email protected] http://www.abbhh.org/

Welcome to On Good Authority. I‘m Barbara Alexander. You are listening to or reading Interview #6 from On Good Authority‘s program on ―Spirituality in Clinical Practice.‖ In this interview we continue our survey of the wide variety of spiritual activity being conducted within the context of psychotherapy and counseling. This speaker brings us an example of spiritual work in the Christian tradition.

None of these speakers in this program is a ―fundamental Christian counselor,‖ as we may typically think of that group. But I do want to talk about Fundamentalism for a moment. Why? Because one of the most disturbing questions of our time is why, in our supposedly secular age in which technology grows faster than a speeding bullet, has fundamentalism emerged as an overwhelming force in every major world religion. Karen Armstrong, in her book, The Battle for God, suggests that the more technologically advanced our world becomes, the more those who fear the advance of technology and don‘t understand it cause the pendulum to swing back in the other direction toward myth and religious dogma.

That said; let‘s look at some treatment approaches that have a tilt towards the directly religious as well as the spiritual. We‘ll talk first to an ordained minister who leads spirituality groups with psychiatrically hospitalized adolescents.

Reverend Abby Fyten serves as staff chaplain at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, IL. This 92-bed full-service psychiatric hospital has

45 extensive inpatient, partial and intensive outpatient programs for a wide variety of populations and ages. Before coming to Alexian Brothers, she was a resident chaplain in pediatrics and obstetrics at Rush Medical Center in Chicago. Rev. Fyten is an ordained minister in the Christian Church - Disciples of Christ.

ALEXANDER: Reverend Fyten, let‘s talk about your work.

FYTEN: I lead spirituality groups throughout the hospital including adolescents and children. They have spirituality as part of their programming.

ALEXANDER: Let‘s define our terms, how do you define spirituality now?

FYTEN: It‘s one of those terms that‘s being thrown around a lot lately in popular culture. I‘m upfront with patients about how I define it. I define spirituality as essentially the human quest for the experience and the understanding of the following: personal meaning, something greater than themselves. Many people refer to that as God, and the universality of humanity. There are three components to that: why are we here, why am I here, what‘s my purpose in life? God, higher powers, universe-- however you chose to define that-- and then the oneness of humanity-- how we relate to each other. So Self, God, and Other is part of that.

ALEXANDER: What is the difference between pastoral counseling and spiritual counseling?

FYTEN: Well the term ―pastor‖ is a Christian term. Pastor is a word that means somebody that is in the field with sheep, quite frankly, and that‘s how Jesus was imaged in some of the scriptures. So pastoral counseling is a Christian term, and it means somebody who understands Christianity, has some training in it and who can speak that language. It differs from a Christian counselor. These terms are a little confusing. A Christian counselor will specifically bring up the bible for specific problems.

Then you asked the difference between pastoral counseling and spiritual counseling?

ALEXANDER: Right, well let‘s say this—―spirituality in therapy.‖ That‘s what I mean.

FYTEN: Spirituality as I defined it earlier is much broader. It has to do with not just connection to God, but also connection to self and to others and existential concerns. When I say existential concerns I mean why are we all here, what is the meaning of life? So spirituality is just broader; pastoral is a Christian term.

ALEXANDER: So when the teenagers come to your groups, they know that they‘re coming to a spirituality group?

FYTEN: That‘s correct. The way that it works at our hospital is that the programming is standardized, and it‘s unlike on the adult units. For the adolescent programming, it‘s not optional so that‘s part of the reason that I don‘t lead church with them; I lead spirituality. Because church is Christian and spirituality is wider. They‘re all there in one room with me, the chaplain. I start off by explaining to them who I am and what a chaplain is. I do a real quick, ―Here‘s what we‘re not going to do; we‘re not going to talk about the bible; this isn‘t CCD class; you‘re not going to be asked to believe in anything you don‘t believe in.‖

I do that for a variety of reasons. First of all, as I‘m sure most people realize, individuals who are clergy receive a lot of instant projections. So folks have a lot of opinions about what a chaplain is or a what a clergy is, and of course it‘s tied in with their personal experience of God and/or their personal experience with religious, both negative and positive. So the second I walk in the room I often get a lot of reaction, both positive and negative, especially on the adolescent unit. Some of the kids will announce, ―I‘m not Catholic,‖ or ―I don‘t have to be here because I don‘t believe in God.‖ So I say these things in part to relax people and to let them know that they‘re not going to be preached at. That‘s how the group starts. . ALEXANDER: About how many teenagers would be in a group?

FYTEN: Anywhere from 10 to 18.

ALEXANDER: That‘s a large number.

FYTEN: It is a large number, and the age range is 12 to 18. Twelve-year-olds would be in there only because maybe they have chemical dependency issues, or they are not appropriate to be with younger children. Eighteen year olds attend, if they recently turned 18 or if they are still in high school, but usually it‘s 13 to 17, actually.

ALEXANDER: Boys and girls both?

FYTEN: Boys and girls 13 to17, but sometimes 12 to 18 years old.

ALEXANDER: What kind of diagnoses would they have? What would they have been hospitalized for, let‘s say?

FYTEN: On the adolescent unit we see all diagnoses essentially, because it‘s an age grouping, unlike in adult psychiatry where patients are acute and non-acute. So acute would be psychotic/schizophrenic; non-acute would be chemical dependency, for example. Adolescents are fewer in number are all together, so the diagnoses can be absolutely anything. We see a lot of are anger issues-- kids acting out at home or at school, kids that threaten teachers or become destructive in the home. We see a lot of anger issues in males and females, actually. Frequently kids come in for drug abuse, drug and alcohol abuse. Sometimes kids have psychotic breaks for whatever reason, so they‘re actually in for psychosis and then coming down from it. Depression, which is

47 also coupled with a suicide attempt; those would be the most common. Eating disorders often go off into their own program.

ALEXANDER: Would these be open-ended groups or closed groups? For instance, an open-ended group would be as anybody comes into the hospital program, they would just come to the next group meeting, versus closed where you‘d have the same 12 or 18 people every time.

FYTEN: No. Because of the way behavioral health care is managed in the United States in general, hospital stays are becoming shorter and shorter, and our hospital is no exception to that. The average stay is about eight days, so it is an open group simply because it has to be. So in any given group there might be someone who has been there for a couple of weeks and there might be someone who has been there a few hours.

ALEXANDER: How do you determine or how do you establish a goal for the people in the group? What is the purpose of the group?

FYTEN: The purpose of the group is to create a supportive and safe environment where adolescents in this case can connect with themselves and the other human beings in the room to explore the benefits of spirituality. Because it‘s an open group, there are some limitations to exploring the benefits of spirituality and that is quite appropriate. Patients often aren‘t willing to share really deep things in group because they just met each other and they don‘t have trust. I actually encourage that because it can almost be diagnostic if an individual is revealing tons of very deep personal painful things to people they haven‘t met before in a group setting. So the goal is always just to explore spirituality, to respect themselves and other human beings in the room-- just to make some sort of connection even if it‘s small.

ALEXANDER: What‘s the first thing you do after you have introduced yourself and explained what they don‘t have to do?

FYTEN: I find out their names and their ages, and then I introduce the topic. Through experience I have learned what topic works and what doesn‘t work. I still check in with the mental health counselor to determine the milieu. If the milieu is very hyper I won‘t do certain things, if it‘s mellow enough I‘ll do other things. So first of all I determine the milieu before I even go into the group.

ALEXANDER: Can you explain to us please what you mean by the milieu.

FYTEN: To speak in street language, the milieu is, ―What‘s the vibe on the unit?‖ Some days the unit is real low energy because you‘ve got several kids who are depressed, or it‘s rainy outside, or for some reason the group just isn‘t real high energy. So that would be a low, mellow milieu. A ―hyper‖ milieu would be created with more manic kids, more behavior disorder kids who are for whatever reason acting out that day. That‘s what I mean by milieu--the vibe on the unit or what‘s going on.

ALEXANDER: You find that out and then you make some decisions about where to go from there?

FYTEN: About my topic.

ALEXANDER: Let‘s say you have a low key day…

FYTEN: For a low key day, I have found that the adolescents love guided imagery. For those who may not be familiar with it, guided imagery is when I speak and lead them through an experience. I have them close their eyes. I say, ―You are on the beach, and now you go here; now you find this treasure chest; looks what‘s inside it; now you put it back.‖ Another imagery I would create is when I would say, ―You are walking in the woods and you see this person; it‘s a wise person. Ask them a question that you‘ve wondered about yourself. Now say goodbye to the wise person.‖ I am the guide speaking. The imagery is what they imagine in their minds. On a low key milieu day, I would do guided imagery, and the kids really love it, because it‘s so different from other things that they do at the hospital. It‘s not as cognitively based, and it‘s more imaginative, more free. And they often surprise themselves with what they imagined.

ALEXANDER: So you have them tell what they are imagining?

FYTEN: Yes. I need to describe some guidelines that I set up. First, I have made it very clear to staff that I‘m doing guided imagery for about five minutes long, and please don‘t walk in. I make it clear to the kids to please not speak during this even if you yourself can‘t experience it for whatever reason because you could ruin it for everybody else. Usually they are very respectful of that. In addition, I have turned down the lights, but you can still definitely see in the room. After I turn the lights back on, I have them share their experiences. What I say to them is, ―Sometimes we imagine private things or things that wouldn‘t be appropriate to share in our guided imagery so whatever you‘re comfortable sharing, please share.‖ And they‘ll share.

I do make it clear to them that if they were using drugs in their imagination or having some other private experience, please don‘t share that. It is an adolescent group after all, and the kids respect that, so sometimes they‘ll choose to pass. For the most part, they do well with it and they share what they were imagining. Many of them will present imagery that does relate to the reasons why they are in the hospital. For example, I have them ―go‖ in the woods and they see this wise person on a log, they sit down and they ask this wise person a question. Often the questions are, ―Will I ever get better; will I get back together with my girlfriend; will I ever connect with my birth mother?‖ They ask fairly significant questions of the wise person. Then the wise person answers them. Of course, the point of that is that the wisdom is inside of them already, because there is no wise person, it‘s a guided imagery experience.

ALEXANDER: Well, do they say what the wise person says?

FYTEN: Yes.

ALEXANDER: So then they have their own answer!

FYTEN: That‘s right. That‘s the goal of that guided imagery. I tell them it explicitly at the end that I am not here to interpret everyone‘s guided imagery because I don‘t know them well, and only they can say what it means to them. But there is a sense in which in reality there is no wise person and the answers are within them. I just encourage them to remember that they actually can trust their intuition on many levels.

ALEXANDER: This is very lovely.

FYTEN: Yes it is. They love that one in particular.

ALEXANDER: I‘m surprised. I‘m surprised they settle down and relax for it, but they must find that very helpful.

FYTEN: I think they like it too, because it‘s one of the few times during the day where things are truly mellow on the unit, not people talking. Now that‘s what I would do in a milieu that‘s at least somewhat mellow.

On a day were there has been a lot of activity I might choose to do something like “Belief,” which is, ―What do you believe?‖ I do that because one of the developmental tasks of adolescents is self-differentiation from mom and dad and their upbringing. So we would essentially have a conversation around what they believe about God, religion, humanity, and the world. This is basically a ―fill in the blank‖ thing. We discuss such topics as, ―What I value most in life is; what gives me hope; Do I believe in God?‖ I have them write out their answers because this helps them be structured. Then we go around, they say their answers, which we discuss.

ALEXANDER: So you distribute material? A questionnaire?

FYTEN: Exactly, it‘s about 10 questions and they just fill in the blanks. I tell them this isn‘t school. The point isn‘t for me to pick up the questionnaires. They do need to complete them, but the point is to think for a minute and then we‘ll have a conversation. This is the way it helps to structure them.

ALEXANDER: Are there kids who are not allowed to come to group, who are too wound up, or too acting up at that time? Do you know how they determine that on the unit?

FYTEN: When that happens, they are not going to any groups. So it wouldn‘t just be my group that a patient wouldn‘t be appropriate for. Sometimes patients are overwhelmed by groups. Then they are on what is called ―an individual treatment plan‖ and they‘re essentially out by the nurse‘s station alternating between doing work individually and working with a person one-on-one.

ALEXANDER: By the way, how often do the groups meet and how long is the session?

FYTEN: Spirituality groups with the adolescents are is twice a week and each session is 50 minutes long. I try to stick to that very clearly. I let them know this guideline when I say who I am and what we‘re going to be doing. I stick to that, because that is just simply their attention span.

ALEXANDER: Do you say, "We have five minutes left" or something like that, to give them a five minute warning or ten minute warning?

FYTEN: Yes. I‘ll say we have time for two more people, or I‘ll let them know. I may not say the exact number of minutes because they‘re not writing at that point, but I will let them know the group is coming to a close

ALEXANDER: So you would potentially have kids who are there a couple of times?

FYTEN: Yes.

ALEXANDER: So then there would be sort of a buzz on the unit about how these groups go?

FYTEN: There would be. I notice that if I‘ve done guided imagery in the previous session, they look forward to my coming.

ALEXANDER: How do they respond then to the belief program?

FYTEN: They respond pretty well. I think that the ones who don‘t believe in God or have extremely negative views towards religion, to some extent enjoy the group more than others because it‘s an opportunity for them to talk about it. And here I am, the clergy person and I‘m not disputing it or telling them they‘re going to go to hell or anything like that. So it‘s a sense in which I try to put, quite frankly, an appealing face on organized religion, in as much I‘m a representative of it.

ALEXANDER: Do you get kids being obnoxious at all?

FYTEN: Sure.

ALEXANDER: Give us some examples of that and how that‘s handled.

FYTEN: There are lots of examples. Most of the time it just looks like chitchatting and not listening to peers. So I‘ll just say, ―You know guys, it‘s just not respectful not to listen when someone else is speaking.‖ Most of them can hear that. Once in a while I‘m met with just outright hostility and the first couple of times I‘m met with that I just answer back in a very neutral tone of voice. But certainly if somebody is just out and out being extremely rude to me as a human being, I will ask them to leave. That‘s probably happened three times in the year that I‘ve been here. If you respect them, they‘ll respect you.

I also have the luxury of being the chaplain. I‘m not the one that tells them what time to go to bed, to pull their shirt down or anything like that. I have that luxury that I‘m not enforcing all sorts of rules. I do respect the rules of the program when I‘m leading the group in that they‘re not allowed to do things with me that they can‘t do on the unit. But they don‘t have as many issues with me, so I think there‘s a little bit less acting out. Sometimes a kid has been out of control off-and-on, and so they‘ll start to argue with another patient. Arguing with a peer is actually the most common form of acting out, and I‘ll just them to knock it off. That usually tends to work. Once in a while I‘ll have to ask them to leave.

ALEXANDER: Does the group itself ever jump in and tell the person to be quiet?

FYTEN: Yes. Sometimes a patient-- for whatever reason-- aggravates or annoys many other patients, or a group of patients. If someone is really acting out or being annoying-- unless they appear dangerous--other patients are likely to tell them to knock it off.

ALEXANDER: Do you get kids who are scapegoated and then what happens?

FYTEN: Yes. It would be the same situation. A kid would annoy the other kids and so anything they say is a problem, annoying, or stupid. My response is first to respect that patient who‘s being made a scapegoat. So I model respect for that person. I treat their answers with respect even if their comments are not very thought provoking. I try first to model it. I would say, ―That‘s rude,‖ to another kid who is mocking the patient who is being made a scapegoat or being mimicked right in front of them. Or I‘ll just tell the rude kid that he or she is not being helpful. Usually that‘s enough.

ALEXANDER: What about your own emotions. Are there ever times when you feel angry or you feel fear or sadness? What do you do?

FYTEN: Well as I mentioned earlier, my training earlier is in chaplaincy. A significant portion of chaplaincy training is to be aware of your feelings in the moment, to know when you‘re hooked or feeling a certain way. Next you need to have empathy for yourself, so I try and practice empathy for myself. I ask myself why am I feeling angry, have I been working too hard, or why does this particular kid hook me, what does it touch in me? So first of all I look at myself, and usually what I do is just acknowledge it in myself, tell myself that if I‘m feeling angry, the group will end, so you can look at this stuff later to figure out why this particular thing is hooking you. It‘s really about being self-aware and not letting it get the best of me, quite frankly. Again, I have the luxury of not having to be with them non-stop for eight hours; I get to go to a different group after that. Certainly, I get angry sometimes if someone is being really rude to me. I‘m a human being too and I know it‘s their sickness at times, or I know it‘s just the fact that they‘re an adolescent, but still I need to be treated a certain way too. Sure, I can have strong feelings in a group.

ALEXANDER: Has it ever happened that you have had to stop the group early because

52 of disruptive behavior or acting out?

FYTEN: It happened once, but there‘s a fair amount of staff on the unit, so what happens is that patient is removed.

ALEXANDER: How do you get to them? Do you have a pager on, or are there staff members in a group meeting?

FYTEN: Sometimes there is a staff person in there with me, and this is standard throughout the hospital. I sit near the door. I don‘t ever sit away from the door if I‘m alone. I can just open the door and say I need help. I say it in an insistent voice. If somebody were to end up needing to be sent to the quiet room, which definitely happens every once in a while throughout the unit, they would call what‘s called ―a code.‖ In psychiatric care, a code is not a code blue; it‘s a call for assistance so staff came from all different units to assist. Most of the time, just a bunch of people showing up is enough to get the kid to go to the quiet room. The quiet room has a bed with a blanket and that‘s it, so they can calm themselves down, quite frankly.

ALEXANDER: Has it ever happened that the group comes in and they are utterly silent, there‘s been a conspiracy ahead of time?

FYTEN: Right, that‘s never happened to me, so I‘ve never experienced that. I think that may be because it‘s an open group, not a closed group, conspiracy is harder to do.

ALEXANDER: That‘s right.

FYTEN: The patients don‘t know each other well enough; at least all of them don‘t know each other well enough. So that‘s never happened. I‘ve certainly had days where I felt like I was dragging the group, where it was really low energy. And that‘s part of the reason why I check in about the milieu ahead of time. If the milieu is super- low energy, there‘s no way I‘m going to do a group on ―What do you believe or what do you think.‖ That‘s just not going to work. Days like that are for guided imagery, I also do meditation with them.

ALEXANDER: Let‘s talk about that. How do you do that?

FYTEN: What I do with the adolescents is a guided meditation rather than free- form mediation. Free-form mediation involves focusing on one word to attempt to clear the mind. It is like asking someone with a broken foot to run a mile when you‘re talking about an inpatient psychiatric setting. Asking people to clear their mind is just almost impossible because part of the reason that they‘re there is because their minds are racing.

The guided imagery that I do with them was developed in the Middle Ages and is called, ―The Examine.‖ It‘s a way to get them to slow down and to reflect on all the interactions that they had during the day.

If I‘m doing a group with adolescents in the late afternoon, I‘ll have them be quiet and I‘ll explain the directions. We‘ll do some breathing, and then I‘ll ask some questions such as, ―At what point today did you give or receive the most love? Not necessarily romantic love, but at what point today did you have a positive interchange with another human being?‖ Next question will be, ―At what point today did you have a negative interchange with another human being?‖ This is followed by, ―At what point today were you good to yourself?‖ It‘s just a way for them to get in touch with their feelings. This isn‘t just important for hospitalized adolescents experiencing mental health issues, but also for a lot of us. We have all these interactions all day long, all these experiences, and we aren‘t even aware of what we‘re feeling in the moment. It‘s a way to get them in touch with what was going on for them and to get them to slow down and think about the day, think about their experience -- being hospitalized for a psychiatric condition as an adolescent is a very intense experience.

ALEXANDER: What do you hope they take away from the group?

FYTEN: My goal is always that they have some sort of connection with themselves and with others. In terms of taking away actual skills that they might use, I do leave them with the meditation skills that I just described that helps them connect to themselves and to others.

ALEXANDER: Just the knowledge that they‘ve had that experience is good, because if they can do it once they can do it again?

FYTEN: Yes, and that‘s something that I remind them of too. For example, I‘ll do a memory- based mediation with them in which I ask them to select a memory in which they felt loved and they felt gratitude in it. Then I remind them that even though the situation has changed and they may no longer be in a relationship with that person, they have the capacity to feel those feelings. This means they can feel them again at some point. So the sense for me is that I certainly feel a privileged connection because that‘s how I see spirituality. As I defined it earlier, this is a connection to self, to God or a higher power, and then to humans. That‘s just my personal preference and theology.

ALEXANDER: Are there any other kinds of meditations you might use? You‘ve talked about The Examine and the memory meditation. Are there others that you might use?

FYTEN: With the adolescents, no. I would do guided imagery, but that‘s not exactly meditation. It is somewhat similar in that it is an experience where they slow down and they are not speaking, but it‘s not traditional meditation. I do meditation with the adults, but I don‘t do centering prayer for example with the adolescents.

ALEXANDER: Is centering prayer a form of meditation?

FYTEN: Yes. It‘s basically a form that was developed by Jesuit priests. I‘ll do it with the adults. They‘re invited to be still, and then they should think of whatever word comes to them out of their desire to connect with something greater than

54 themselves. For example, the word love might come to somebody, or peace. They‘re asked to just repeat that word over and over again to themselves for five to ten minutes. Then we talk about whatever it is they experienced out of that. But that‘s too hard with adolescents who are not in the group voluntarily; the adult groups are voluntary. Not all people have a desire to connect with a power beyond themselves. With the adolescents, I can‘t assume that everyone wants God in their lives.

ALEXANDER: Do you ever actually use prayer to start the session or to end the sessions?

FYTEN: No. I certainly wouldn‘t do that in a spirituality group because that could be a serious turn off for somebody. We are a Catholic hospital but we privilege spirituality, not Catholicism or Christianity. So prayer wouldn‘t really be appropriate to start a spirituality group. I do lead church though on the three adult units we have, so I do of course pray then. Sometimes a little group of adolescents, or more commonly, children, will know me from the spirituality group and then they‘ll see me on Sunday and say, ―Hey are we going to have church?‖ And I‘ll say, ―Ok, if there‘s a few of you, let‘s go.‖ That doesn‘t happen every Sunday though.

ALEXANDER: Let‘s go back a minute and just explain what you mean when you say you ―privilege‖ spirituality? What does ―privilege‖ mean? What do you mean by that?

FYTEN: Privilege means that‘s my goal in all things. Some people might privilege affect so they might be trying to get the patients to feel their feelings. When I say, ―I privilege connection,‖ that means I favor it above all else.

ALEXANDER: You value it, in a sense.

FYTEN: Value it, yes.

ALEXANDER: Have you had kids in the hospital who are Jewish or Muslim, not Christian?

FYTEN: Yes.

ALEXANDER: How does it go with them?

FYTEN: That‘s part of the reason I start a group with my little speech that participants are not going to be asked to believe anything that they don‘t believe. It‘s a Catholic hospital, and we‘re in an extremely Christian area--the northwest suburbs of Chicago. I say the speech for the non-Christian patients to know that I‘m not here to pass out tracts or to tell them to accept Jesus Christ as their Lord and Savior. When people meet a chaplain or a clergy person, they are dealing with all of their prior experiences with religious people, not to mention any feelings they have towards God. When people are in pain in particular, their feelings toward God can be filled with hurt and they‘re wondering where God is.

ALEXANDER: Do you have an answer for that?

FYTEN: Well, I personally do, I try not to put it on the patients, and I try and let them be with whatever it is they‘re sorting out. Usually with a question like ―Why?‖ isn‘t a question, it‘s a lament.

ALEXANDER: That‘s right.

FYTEN: So to answer that question can be quite obnoxious. It‘s kind of like the stereotype of a woman who just wants to talk about her feelings and the man is giving her a bunch of answers, and fix-it‘s. It can be that way too with spiritual injury where people feel anger at God or confusion about it. There‘s a sense in which all of us must come to terms with our own spirituality and find the path that‘s right for our self. So I‘m happy to be a guide if patients are truly asking me the question why. Sometimes they are, but often I hear why as a lament.

ALEXANDER: Is there anything you‘d like to add that I haven‘t asked you?

FYTEN: Maybe just one more thing. I also do a unit for adolescents on Values where it‘s similar to the unit on Belief. In Values, I ask the adolescents where they get hope from and what they turn to when they‘re sad, other than drugs and alcohol or cutting. A lot of kids say music and people. So I just wanted to say that music is extremely meaningful for adolescents-- males and females-- particularly males though. Its effect and its meaning to them cannot be underestimated. I hear it over and over again: ―I get hope from music,‖ or ―When I‘m sad, I turn to music.‖

ALEXANDER: Do you use music at all in your groups?

FYTEN: I tried it in the beginning and because the tastes in the room are so varied, and because adolescents are so sensitive to music that they hate, it didn‘t go over as well. I don‘t actually incorporate music.

ALEXANDER: What would you say to therapists, mental health professionals, who wanted to run spirituality groups or to introduce spirituality in their regular group therapy? What words of advice would you say to them?

FYTEN: I would say get some materials from somebody who has run spirituality groups. Spirituality groups are often run in most psychiatric facilities, although not as frequently as we run them here. For example, on the adult unit we run them every day. But I would say to get some materials from someone that you trust, and really, let your patients be your guide. My training was traditional chaplaincy. It was one-on-one work, it was death and dying, it was families in crisis in a medical setting. So, when I got out of my training, I had to learn for myself how to run these groups. Even though I have theological training, the patients have really taught me a lot in terms of what works and what doesn‘t work. But I would say just listen to the patients. Anything that‘s a positive without being hokey I would say can‘t hurt.

ALEXANDER: I think that about wraps it up, Reverend Fyten. Thank you so much for your time and your thoughtfulness. It‘s just a pleasure to listen to you, I feel calm. FYTEN: Sure, thank you. Thanks a lot Barb, this was great.

This concludes our interview with Reverend Abby Fyten. We hope you learned from this interview and that you enjoyed it. You may email her at [email protected].

I must say here that the views expressed by our speakers are theirs alone and do not necessarily reflect the views of On Good Authority. Until next time, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #7: “Prayer/Spiritual Direction”

DWIGHT JUDY, Ph.D.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Dwight Judy, Ph.D. Oakwood Spiritual Christian Life Center 702 E. Lake View Road Syracuse, IN 46567 Phone: (574) 457-5600, ext. 423 E-mail: [email protected] www.oakwoodfoundation.org

Welcome to On Good Authority. I‘m Barbara Alexander. You are listening to or reading Interview #7 from On Good Authority‘s program on ―Spirituality in Clinical Practice.‖

This interview continues On Good Authority‘s survey of the wide variety of spiritual activity being conducted within the context of psychotherapy and counseling. Here, Dr. Dwight Judy, a Transpersonal Psychologist and theologian describes how he uses the psalms and prayer in his clinical practice.

Currently Dr. Dwight Judy serves as Associate Professor of Spiritual Formation and Director of Doctor of Ministry and Spiritual Formation Programs for Garrett-Evangelical Theological Seminary in Evanston, IL. He also serves as Director of Spiritual Formation for Oakwood Christian Spiritual Life Center. Both a licensed psychologist and an ordained United Methodist minister, he is a member of the American Association of Pastoral Counselors and of Spiritual Directors, International and he provides training for the United Methodist Certification in Spiritual Formation. Previously, he was on the faculty of the Institute of Transpersonal Psychology in Palo Alto, CA. He was president of the Association for Transpersonal Psychology from 1994 to 2000 and is the author of four books, including Christian Meditation and Inner healing and Embracing God: Praying with Teresa of Avila.

ALEXANDER: Dr. Judy, with your years of study and practice in the ministry and in psychology, how are you working these days?

JUDY: My primary mode is actually what I would call, ―Group Spiritual Direction.‖ This consists of working with a small group, preferably no more than a dozen, and we do shared meditating prayer practice which moves people‘s own process. I think the simplest description is this: ten years ago I was doing a retreat in a little town in Arkansas and at the end of the day a woman spoke up and said, ―Gee, I feel like I‘ve had a whole day of psychotherapy.‖ These groups use both psychological processes and Christian thought to guide people into a depth encounter with themselves and out of that, wonderful movement happens.

The undergirding question here is ―How am I being invited by God now at this stage of my life to use my life energy in a creative way, and a meaningful way?‖ So whether it‘s with individuals or in this group spiritual process, the major assumption is that our lives are constantly in change, God is constantly in change, and the social structures in which we live are constantly in change. Thus we need to catch up with that movement which often seems to proceed ahead of one‘s mind. So that‘s the deep question that we‘re always wrestling with is this: things have moved and changed; how do I catch up and understand and see exactly where all that comes together?

I‘ve been rereading The Seasons of a Man’s Life, that came out many years ago and in that there‘s a wonderful notion which is the concept of ―life structure.‖ This is the sense that we live within a life structure and then something happens: there‘s a critical illness, there‘s a disruption of relationship, there‘s a disruption of work, or perhaps there is creative energy and there is the summons to something new and fresh. I hold all that theologically as a part of my understanding that the dynamic nature of the universe is held by a dynamic god, pointed to by Jesus‘ teachings and the language in the New Testament about seeking new life. Then the invitation that I offer to people is to work at multiple levels to try to understand, ―What is this changing, shifting thing of life in which I‘m involved right now and how is it an invitation to a fuller more creative life?‖

ALEXANDER: One of the things that therapists struggle with has to do with the theodicy question: why do bad things happen to good people? How can there be a god, how can God exist when there is evil, when there is sickness, when there is suffering, when there‘s injustice? It‘s felt sort of like a copout to say, ―Well, I think you should talk to your minister, rabbi, whoever your counsel is.‖ So how do you deal with that?

JUDY: Well, you get right to the heart of one of the real challenges, both of life and also of any clinical practice. It seems to me that that question cuts across anyone‘s religious foundation. All the religions try to answer this question in some fashion or another. Is the heart of the universe benevolent even when it doesn‘t look like it all the time? Basically this is the way I think Christianity tries to answer it, to say, ―Yes it is,‖ to say that God is foundationally love, but we are given freedom and therein lies the juggernaut. We‘re also in a world that is transitory, and dependent on the fact of our biological existence. We live in a world in which there are microbes that are out to get

59 us; that‘s their job and we‘re going to die.

The question for my work is do we go with people into that what we might call, ―Faith construction/ reconstruction place in our clinical practice?‖ Is that a place we feel equipped to go?

With people struggling with that question, I can do my best job within a Christian framework because then we can talk about the varieties of ways Christianity historically has dealt with the problem. In terms of practice and exploring with our clients, this is a personal decision as to where we are both competent and comfortable and where are we not. And where is it highly appropriate to do what you suggest, which may be to engage some others into the conversation at that point, the rabbi, or priest, or clergy as well?

ALEXANDER: How do you use the Bible or how can one use the Bible to reinforce healthy growth? Let‘s say somebody comes to you with a marital problem or they‘re complaining about their angry husband or their wife, or they find themselves to be angry all the time. How do you use the Bible in that process?

JUDY: I wouldn‘t necessarily recommend the Bible. In terms of my practice it would depend on where that person is in their faith journey, and if they‘re asking those questions and looking to Biblical references, there are plenty of places to go. One of the reasons the church historically has used the Psalms -- and I‘m not sure of how much people are aware of this, but the Psalms in the monasteries are prayed on a weekly basis all the way through the Psalms, or in settings where there are fewer services per day than in the monasteries, maybe the cycle is in the monthly basis. It really is the place where every human emotion is just up front and it is a very significant way for people to get a sense, first, of validation, to say, ―It‘s ok to be angry.‖ It‘s a necessary part of our human existence. It‘s necessary to doubt, it‘s necessary to struggle with faith issues, and all of those are really laid out pretty powerfully in the Psalms. So that‘s one place I certainly would go.

I have a little quote for you here: ―I cry aloud to God that I may be heard in the day of my trouble. I seek the Lord in the night and my hand is stretched out without wearying. My soul refuses to be comforted. I think of God and I moan, I meditate and my spirit faints. [Editor‘s note—this is a condensation by Dr. Judy of a number of lines from Psalm 77.]

That‘s from Psalm 77. There‘s so often a sense of Victorian religious propriety that is laid over our emotions and people don‘t realize that in the heart of the Bible are places with pretty straight forward raw emotions. So it‘s a good place to look first of all, simply to validate the basic core psychological notion that we‘ve got to attend to our feelings and be present to them as one of our primary ways of understanding life and reality and what‘s before us.

Another way I use the Bible is through the lens of Joseph Campbell‘s Hero/Heroine

Journey model. This is the call to adventure and awakening to kind of a new story. Our life is lived in a series of stories. For the couple you suggested coming for counseling, the marital crisis is a call to adventure. In the next five to ten years of that couple‘s life journey, will they be able to navigate to a new depth of comfort and rapport and support within their relationship or not?

In the background, in the terms of my own thinking, is the biblical story of Abraham who is 75 years old and God gives him message to get up and leave the place that he‘s lived in all these years. Abraham asks, ―How am I going to know what to do?‖ God says, ―I‘ll show you where to go.‖ That‘s it, that‘s the message: leave, I‘ll show you where to go. So the question is can we find the kind of personal courage and sustenance and life affirmation to move forward into new and different place? That‘s where the personal faith part jumps in: can we find the faith to take those step and risks that may be summoning us into a new arena of life?

I‘m very conservative when it comes to marital crisis. I want people to work very hard at uncovering and being present to one another as a process of growth, but I do know certainly that there are times when couples must part ways.

ALEXANDER: It seems to me that you don‘t approach this from a pathology base at all, is that right?

JUDY: Right. I approach crisis not necessarily as a challenge to be resolved, but as an invitation to look at what areas of creative life are emerging. Now it doesn‘t mean that there aren‘t pathologies to be addressed, but I think you‘re correct.

ALEXANDER: How is this different from what a more fundamentalist Christian counselor would be doing?

JUDY: Yes, I want to share a couple of definitions. I think when we hear the term, ―Christian counselor,‖ usually, although not exclusively and I want to be careful about that, we are talking about a person who is working within a particular Christian framework, usually of a more conservative nature. So, when a person is seeking a Christian counselor, they may be saying, ―I want to work with someone whose faith stance I know and is compatible with mine.‖ Fairly often that will be someone with a fairly straight forward Biblical orientation.

When you see the terms ―pastoral counselor,‖ or ―spiritual director,‖ that is closer to describing what I do -- someone who‘s open to faith issues, but who is also recognizing that one of the major things to be dealt with in the client interaction may well be a crisis of faith. This may be a kind of turning of faith, it may be a questioning of faith, and this would be different than what one would ordinarily have in the setting of Christian counselor.

The other thing I would want to say about all of this is the whole concern, which is a bit different topic, of what I would call ―healing of religious abuse.‖ We live in a culture in

61 which a person may have been taught a fairly punitive God image, sometimes a punitive family environment reinforced by the punitive God image, often couched in ―Christian‖ language. I know many counselors come across this kind of material. It often surfaces in working with abuse victims, survivors, to some degree. So, one questions, ―Is that something that‘s best handled within the religious framework in which one grew up and has the struggle going on, or is it best handled outside of that, in the counselors office which is a more open ended or kind of secular environment.‖

ALEXANDER: Is this more a theological problem or a therapeutic problem? Does the person need to talk with someone with a collar? A therapist can tell you that something is not right from a psychological point of view, but maybe it would take a spiritual or clergy person to say, ―No, God‘s not like that.‖

JUDY: The issue then kind of gets back almost to your theodicy question: can someone really help that individual struggle with their fundamental core faith issues that have arisen out of this problem.

ALEXANDER: To what extent does a client have a right to know the basic spiritual orientation of a therapist?

JUDY: I‘m going to give you an individual answer first. Because of all of this background I have, I needed people to know about some of that. It seemed to me that it was only fair disclosure to say, ―Here are the fair arenas in which I am comfortable working.‖ That involves some of the theological as well as some of the counseling role. The frame of reference I would encourage all of us to be thinking about is this: in the last ten to twenty years, spiritual issues are on the horizon in a way they weren‘t and are in the clinical practice in a way they didn‘t use to be. Does the counselor/therapist need to disclosure something about one‘s basic spiritual religious orientation, just as we would name of areas of practice that we have training in. Ethically we wouldn‘t practice outside of our realm, our domain of training, and since this is now on the horizon, should one make that declaration clear? If it is critical to one‘s own self-understanding as a counselor, then I would say, ―Maybe so.‖ If not, then perhaps not.

ALEXANDER: You‘re saying it should almost be a field of specialty within the psychology/ counseling/ social work practice sphere?

JUDY: That‘s what I‘m beginning to ponder. As this is beginning to be in the public arena, do we not have an ethical right to disclosure to the client just as we do in other areas of practice?

ALEXANDER: As a clinical example of this, let‘s say that somebody has come from a punitive family, they have found themselves in a punitive counseling situation, and they come to you, they come to me, or they come to any of us who is, let‘s say, ―secular‖ in their practice. Let‘s say they‘re straight psychodynamic or let‘s say they‘re straight cognitive behavioral. Then part two, let‘s say that this stirs up a particular countertransference in the therapist who thinks, ―I‘ve got to undo this,‖ or ―I‘ve got to

62 rescue this person from this horrible indoctrination that they‘ve experienced.‖ Now can‘t that be problematic also?

JUDY: What I‘m a little reluctant about these days is the popular notion that all of this blends really gracefully together, and I don‘t think it does. There are areas of expertise that we all bring to this and we need to be honest and upfront about those and practice within our domain, and then we need to refer beyond it. But we‘ve got a new fuzzy area in the whole arena of spiritual area now. As the counselor, with the same grace and good intentions, wouldn‘t you allow that discovery to emerge from within the client as you would other situations?

ALEXANDER: If the person‘s religious issues were so primary, can you stay out of them then?

JUDY: I don‘t think so, no. Do you?

ALEXANDER: No.

JUDY: No, I don‘t think so. Are we open and available and aware of our own biases, as the therapist? We would have expected to done our family of origin work and similarly, in order to be as clean and clear as we can be for the client, we would be expected to have done our religion of origin work.

ALEXANDER: How do you use prayer in your work?

JUDY: I work with a model of guided meditation often based on scripture on the healing of Jesus stories. This is a very old, old and foundational pattern of prayer based in imagery and articulated by Ignatius in the sixteenth century One goes into a scripture story, images one‘s self into the story, allowing the inner senses to awaken to that process.

In one of my favorite of Jesus‘ healing stories, this man has been infirm for 38 years, and Jesus asks him, ―Do you want to be healed?‖ This is one of my favorites because it enables us to address issues and depth challenges that have been with us a long time. One reads oneself metaphorically into these stories and then one is left to ponder the Jesus‘ question, ―Do you want to be healed?‖ I‘ll guide people into this and give it about an hour, hour and a half for people really to ponder, pray, reflect, journal with this kind of material. Wonderful things happen. It gets people to a depth of presence and quiet and letting the mental clutter fall away so that the deeper themes emerge. Then I invite people to use the group for some sharing and processing as they are comfortable with that deep material. So that‘s one way.

Sometimes in the one on one encounter, we will have extended quiet together; sometimes it will be unpacking some of those kinds of prayer experiences. Sometimes it‘s not that deep at all; sometimes it‘s simply reflecting with people about their own, what we call in Christian framework, ―spiritual disciplines.‖ By this I mean how is their life of worship

63 and of scripture reflection, their own journal material etc. working? How‘s it going on an ongoing basis to support their emerging discovery of God and self?

ALEXANDER: Dr. Judy, I‘ll ask you this question two ways: what advice would you have for the secular therapist about including spirituality in their work, and then what would you have for the Christian counselor?

JUDY: I was helped many years ago in my early training in the eighties by Frances Vaughan, who‘s been very instrumental in the theoretical development of transpersonal psychology. Vaughan wrote an article in that was in a collection of articles called, Beyond Ego, and she talked about context, content, and process of psychotherapy. It made a great impact on me because I had never had put all these things together this way. She said in this 1980‘s article that the context for psychotherapy is entirely set by the therapist. That knocked me on my ear. Wow!

So the question to the so-called secular therapist is to ask, ―Are you open to the spiritual domain as your clients might be describing it?‖ It gets very basic. Do we feel comfortable opening those areas up, or by our very demeanor, are we giving the message that those areas are not to be brought into the counseling room? Do we feel comfortable? Is that an area where we have enough training? Do we need to get some training? Do we need, perhaps, to engage more consciously in some of our own theological reflection or struggling with that theodicy question that you raised?

Then to just carry that a little further, Frances Vaughn said that the context is set by the therapists, the content is presented by the client, and then mutually, the process is derived at between client and therapist. We want to be aware of that interplay between the content being presented by the client and our own readiness, willingness, openness to go where the client is presenting. Then we need to back up to ask ourselves if we really have the training and skill to go into some of these areas? Can we recognize our own areas of limitation, recognize that this is a new area of training and understanding and perhaps refer to another person?

One thing I would say is that as the area of spiritual direction has become more common, it is not unusual to have a very happy situation in which there is both a counselor doing depth work with an individual and a spiritual director with whom one is probing more the theological and spiritual kinds of questions. That can work. Of course everybody has to be mindful of the interactions and protect each relationship, but it is a new model that can be effective.

To the Christian counselor, first of all I‘d ask if I have described their work accurately and I may not have because it‘s a term that has arisen in a different part of the practicing Christian arena than I‘ve been a part of. But I would say the question is, again, ―Are you open to your own evolution of faith and the constructs of Christianity? Are we letting the life circumstances of the client keep us moving, opening and unfolding? Are we being mindful of Christianity of a life-giving process, not as one that quite honestly and historically has been used in a very destructive way, holding people away from their full

64 potential? How do we hold our Christian framework? I think is an ongoing question that all of us have to ask.

ALEXANDER: Dr. Judy, I think that might be very good advice. Is there anything else you would like to say?

JUDY: I would like to say that we‘re at a time where if your counseling audience, the primary folks that these interviews are for, have not visited their bookstores in a while and looked at the areas of Christian spirituality and prayer, there has been a renaissance in the last twenty years. There are large numbers of very usable books devoted to meditating on scripture, recovering the basic understanding of contemplative Christianity and there‘s a really a wonderful point of interface and dialogue between the drive to individuation and this particular strand of historical Christianity. That‘s the world that I‘m very happy to somehow have landed in the middle of.

ALEXANDER: That‘s good. Thank you.

JUDY: Good to talk with you.

This concludes On Good Authority‘s interview with Dr. Dwight Judy. We hope you learned from it and that you enjoyed it. You may reach Dr. Judy at the Oakwood Christian Spiritual Life Center in Syracuse, Indiana, 574-457-5600, and his books are available at amazon.com.

I need to say here that the views expressed by our speakers are theirs alone and do not necessarily express the views of On Good Authority. Until next time, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #8: “Integrating Spirituality and Psychodynamic Psychotherapy”

MARK BAKER, Ph.D.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Mark Baker, Ph.D. LaVie Counseling Center 650 Sierra Madre Villa, Suite 110 Pasadena, CA 91107 Phone: (626) 351-9616 E-mail: [email protected] http://www.laviecounseling.org/

Welcome to ON GOOD AUTHORITY. I‘m Barbara Alexander. You are listening to or reading Interview #8 from On Good Authority‘s program on ―Spirituality in Clinical Practice.‖

This interview continues On Good Authority‘s survey of the wide variety of spiritual activity being conducted within the context of psychotherapy and counseling. Here we speak with a psychologist and ordained minister who founded a behavioral health center with a spiritual focus, where all the therapists are Christian, and where his own area of specialization is Intersubjectivity. This offshoot of self-psychology was developed by Robert Stolorow, whom I interviewed in On Good Authority‘s program entitled ―Today‘s Psychoanalysis.‖

Dr Michael Baker has received a Ph.D. in Clinical Psychology, a Masters degree in Theology, and a certificate in Psychodynamic Psychotherapy. He is licensed as a Clinical Psychologist as well as a Marriage Family and Child Counselor. Dr. Baker is the Executive Director of the La Vie Counseling Centers with offices in Pasadena and Santa Monica, CA. In addition to his public appearances, Dr. Baker has made numerous presentations to professional psychological organizations and published articles in professional psychological journals such as Psychoanalytic Psychology, and the Journal of Psychology and Theology. Dr. Baker‘s latest book, The Greatest Psychologist who Ever Lived: Jesus and the Wisdom of the Soul was published in 2001.

ALEXANDER: Dr. Baker, my understanding is that you do Christian counseling and in fact your center is a place that trains therapists and counselors to do Christian counseling, is that right?

BAKER: We are Christians in the practice of professional psychotherapy. We like to phrase it that we are Christians for professional therapists. We studied this for years, and most of our therapists, myself included, have degrees in theology as well as psychology. We‘ve come to the conclusion that there isn‘t really a specific ―Christian counseling,‖ but there are Christians who can address spiritual issues in counseling better if they receive specialized training. So we address spiritual issues as the client brings them up, because our therapists are trained to do that.

ALEXANDER: Are they all denominations of Christian?

BAKER: All denominations--Catholic, Protestant, pretty much across the board of denominations.

ALEXANDER: What makes the counseling specifically Christian?

BAKER: I think there is a common misunderstanding. There are therapists who have specific training in particular approaches to counseling that might be called ―Biblical Counseling,‖ let‘s say. There are therapists who might go through programs that when people would come to them, they have a programmed approach to treatment. They might pray at the beginning and end of every session, they might use scripture verses to address each problem as they come up, and that‘s called ―Biblical Counseling.‖ We consider that to be a form of pastoral counseling and not what we do. There are people who do that and they would say what they do is Christian counseling. We would put that under the rubric of really more pastoral counseling. So what we do is we apply the standard psychological theories that you would learn in any counseling program to our cases, and we also have therapists who are trained to discuss and deal with spiritual issues as well, if it should come up. So you might say there‘s an integrated approach to treatment that we use.

ALEXANDER: And does it help?

BAKER: Well I would say that the clients who come to us who are spiritual people come to us because they know that we have therapists who are spiritual people, and they‘ll often ask the therapist in the first session whether he or she is a Christian. They‘ll ask that question because they know we‘re a Christian counseling center. And once our therapists are able to say yes to that, it opens up the door for them to talk about that area of their life that they would not talk about if the therapist said no to that question. So I look at it this way--we open up the door to areas of our patients‘ lives that get closed when spiritual people come to therapy and when their therapist is not a spiritual person. They just don‘t go into that area is what we find. When they come to us, they know they‘re free to talk about their despair with God, and their anger towards

God, and their frustration towards their church, and their disappointment with the religious people in their lives. There are people who might agree with certain values, but their behavior seems incongruent with that and so we‘re able to wrestle with them about those things.

ALEXANDER: Why would a person go to therapy for that, I‘m really trying to be –

BAKER: Playing the devil‘s advocate? Let‘s see if we can clarify it for you. They are coming to professional therapy because many of them have already gone to a pastor, and our training is that pastoral counseling or Biblical counseling that I referred to earlier does a certain thing in people‘s lives. It sort of helps put them back together, and get them back out on the road quickly. It helps shore up their defenses in a functional way and gets them on about their lives.

There are a great number of people who are--in essence--spiritual people, who want something more than that. They want to peel back the layers of their lives and understand the deeper issues, not just get functioning, but understand themselves better. Shoring up their defenses is not what they‘re looking for. They‘re looking for something deeper, but they want to do it within a context that will understand and support their spirituality. And what they have found is that therapists who are not Christian can be very devaluing and misunderstanding of their spiritual lives, and they don‘t want to be criticized for being religious.

You see Freud‘s original view of religion was that it is a defense and a crutch for people who could not deal with helplessness. So what we do in defense of the pain of the feeling of helplessness is artificially create the concept of God--that God is our defense against our inability to tolerate helplessness. There are certain therapists who have that same attitude today about people who believe in God. That‘s been a very judgmental and a very non-accepting attitude towards spirituality. Our patients find those kinds of therapists unable to help them then in the spiritual areas of their lives. They need to come to a therapist who does not take that attitude in order to open up with them, and that‘s what‘s helpful about the therapists that we have. They have a particular approach towards God that‘s out on the table; it‘s right there in the beginning out on the table.

ALEXANDER: There are a lot of therapists who are Christian by denomination; I mean if they were to fill out the census form or something, they would put Christian. Is that how you mean ―Christian‖ or do you mean a more avowedly Christian person who‘s the therapist?

BAKER: Our therapists are people who profess to be Christian, yes, our therapists.

ALEXANDER: Are they Born-Again?

BAKER: Some of them would probably describe themselves that way, and some would not. They‘re people who are professing to be Christians interested in working

68 alongside other Christians, interested in dealing with spirituality as it comes up in therapy. They believe in God and they believe that God helps people in their lives. These are the kinds of things we deal with.

ALEXANDER: Would the therapist bring this up if the patient didn‘t?

BAKER: Never. That‘s the difference between pastoral counseling and what we do. We only deal with issues that the patient brings up, and our therapists have specialized training to deal with the issue of spirituality should it come up. Many therapists are just not interested in doing that; they don‘t believe in God, they think that it is a defense, and that area is not helpful to go into. So they would not apply to work on our staff.

ALEXANDER: Let‘s turn to a clinical example if we could because I think that would really help explain not just what you do and how you work, but what some of the competencies and the skills are. There are so many ethical issues in spiritual counseling and most codes of ethics say that you must have the training and competency, and your center does do this training in a clinical format as opposed to, let‘s say didactic, is that right?

BAKER: Primarily, we do both, but primarily it‘s clinical. We do have in-service training which is didactic but that‘s only one hour a week.

ALEXANDER: What things do you cover in that? Do you cover psychotherapy and psychological issues, or…

BAKER: Everything, we cover a wide variety of topics. We‘ll deal with medication and have a psychiatrist come in and talk about medications in dealing with spiritual issues. We‘ve had pastors come in and talk about spirituality and the crises they see. We deal with marriage counseling, we deal with the latest analytic theories, how to deal with personality disorders. I‘ve published a couple of articles on how to deal with religion when it‘s used as a defense: what do you do with someone who uses their religion in a way that is actually inhibiting his or her growth-- both spiritually and emotionally. That becomes quite tricky.

ALEXANDER: Let‘s go into the case example.

BAKER: Probably a case that might be helpful to talk about is the one that I published in The Journal of Psychology and Theology; I have two articles in that journal. The first article is on religious fundamentalism, which I believe came out in 1999, called, ―The Loss of the Self-Object Tie and Religious Fundamentalism.‖ This is written for therapists primarily. In that article, I outline the concept of fundamentalism and try to help therapists understand why it is that Freud and others had such a negative view of religion. I think they were looking at one aspect of religion that I call ―fundamentalism,‖ which actually is problematic in people‘s lives. But I do not believe all aspects of religion to be pathological or defensive, just certain ways in which religion is applied.

Then my second article is called, ―The Psychodynamic Treatment of Resistance with a Patient from the Perspective of Intersubjectivity Theory.‖ Here I deal with a particular case of a man who was a pastor who came to treatment at our center. This particular man had a number of problems in his life: his wife was frustrated with him; he worked part time as a pastor, and part time doing lots of other things. He had a gambling problem, and when the therapist--who was also a minister--would attempt to talk to him about his life, he would gloss over the emotionally painful aspects of his life with religious references. He would quote the Bible; he would say things like, ―That‘s just the will of God.‖ It‘s very difficult talking with patients like this--trying to deal with the emotional aspect of their lives when they feel like they‘ve got the sanction of God for them to be about a higher calling. So he would excuse his difficult behavior like the gambling and the irresponsibility that his wife experienced with things like, ―Well, I‘m about a higher calling.‖ He‘d make those kinds of statements.

Now the traditional approach to dealing with patients who use Biblical references or religion in ways such as this is to try to confront them about the misuse of scripture and principles and try to get them to see that they are not interpreting the Bible correctly. The man was neglecting his responsibilities at home because he believes he‘s following a higher calling. This is in contradiction to other verses in the Bible.

Now our approach is that this is not that helpful. Patients like this just become more defensive, they refer to God even more, and they likely even drop out of therapy because they feel that something that they hold very precious is being devalued and denigrated by the therapist.

So this is what we ran into: the therapist was a minister and he was offended by this man‘s behavior, feeling that he was not a very good representative of Christianity in the community. I mean he actually gambled away his mortgage payment at one point. So the therapist was trying to counter the religious references by this patient with other religious references and scripture verses. The therapist tried to get him to change his behavior but it wasn‘t working very well. The patient was actually becoming more religious as a result of these interventions. This is what we call a ―disjunction‖ -- a psychological disjunction. The therapist and the patient had competing agendas and the disjunction was causing the patient to be actively resistant.

So for us to work more accurately with this patient, we had the therapist shift his stance in this treatment. Rather than trying to disabuse the patient of his religious distortions, we had the therapist try to understand the meaning of the religious references from the perspective of the patient.

The patient felt like he needed to leave his wife here in California and go to the Midwest to take a call at a church. The therapist started to be very interested in why the patient thought he needed to do that. Instead of fighting him, he sort of wanted to get on his side and understand the meaning that he was attaching to this calling, this calling of God. And once he did that, the patient was more able to open up and talk about the doubts that he had about himself and providing for his family. Ultimately he did not go, he did not

70 leave his wife, and he stayed and tried to look at many other things in his life that had deeper meaning that he was trying to escape with this religious defense. So that‘s the kind of work that we‘re able to do because we‘re able to understand a patient‘s religious perspective on a much deeper level.

When patients bring up Biblical references, our therapists have a good understanding of what they mean and don‘t have to always view it as defensive. The therapists are able to grasp it as defensive if it impedes other areas of the patient‘s life. So we don‘t always take it at face value when a patient says, ―Well this is the will of God for me to do this.‖ What we do is take an approach of trying to understand, ―Well what does that mean? How is it benefiting your life, how is it not benefiting your life? What are the emotional areas of your life that you‘re avoiding because of that? What areas of your life are being opened up because of that?‖ That helps us deal with patients who come to us sometimes in great pain.

ALEXANDER: Let me give you another little vignette. One of the things that I do is Critical Incident Stress Debriefings, and there was a terrible accident and the person who was killed worked very closely with a lot of people. So I did this debriefing with 15 or 20 of her co-workers, and as a couple of them were crying and trying to console themselves, they said, ―Well she‘s in a better place now.‖ And I really didn‘t want to touch that, in the one or two hours that we had. I didn‘t really know these people and I didn‘t want to touch that. But how do you handle that in an individual session let‘s say, or a couple‘s session, with a therapist and client who‘d been working together for a while? How does the therapist respond when the client experiences a terrible sadness surrounding the loss of someone close and the client says, ―She‘s in a better place now?‖ Do you train your staff to do that?

BAKER: Well, it depends on what point of the grieving process they are. Now if it‘s in the very beginning stages like critical incidents debriefing, what we would do is be supportive of the patient‘s perspective that the departed person is not suffering or perhaps is even beyond where we are now and in an even better place. I think in the initial stages of trauma and grief, we‘re trying to get oriented, often in shock, often in denial at the reality of what‘s happening. So in the very first stages, we don‘t unpack the varieties of meanings that might be behind that.

Now let‘s say six months or a year later, if a person comes to us for treatment, and we haven‘t seen any evidence of grief, sadness, any anger, and they‘re saying, ―She‘s in a better place,‖ we might start wanting to look at that as perhaps a defense against a grieving process, much later. So it depends on where they‘re at in the grieving process as how we would understand the meaning of that phrase. Early on like you, I definitely would not want to unpack that because it serves a supportive function in dealing with the shock and the trauma that the patient is initially experiencing. As you know, the process of grieving follows and unfolds overtime, so it depends on where they‘re at in the grieving process as to whether we would want to try to unpack that or leave it alone.

ALEXANDER: The word ―unpacked,‖ is that a more pastoral word than a

71 psychotherapeutic word?

BAKER: It‘s more of an analytic word; it‘s a word that‘s more typical in psychoanalytic approaches to the treatment and that we find to be compatible with spirituality. For us both as spiritual people as well as psychologists, we look at layers of meaning and so for us to ―unpack‖ means to peel back the layers of meaning. This is a good example: someone who‘s in trauma--has just been traumatized by having someone taken from them prematurely—and the superficial layer of meaning would be to hold oneself together. We don‘t want them to decompensate, we don‘t want them to have psychotic episodes, so the superficial layer of meaning is, ―Ok they‘re in a better place and that brings me comfort.‖ I‘m not going to unpack that. A year from now if they haven‘t grieved, I‘m going to start looking at, what‘s another layer of meaning below that? So we would say that psychological experience is multidimensional and it just depends on which dimension of experience you want to look at and for us, that‘s the meaning of the term ―unpack.‖

Another way to look at the multidimensional aspect of experience would be if someone is going through a trauma we can look at the grieving process, we can look at his or her need to defend again pain, to hold him or herself together; those are dimensions. Or we can look at the spiritual dimensions. Then we have questions of how God could allow this to happen; that‘s another dimension. You can focus on any, or all, or none of those. Our therapists are trained to look at things from this multidimensional approach. We‘re equipped to talk about any of those dimensions, but don‘t have to talk about all of them. Spirituality is one of those dimensions.

ALEXANDER: So in one way it seems to be an attitude or openness. And the other way seems to be a content matter. Am I right in this?

BAKER: Right. As I said earlier there are some therapists who approach spiritual or Christian counseling very much from a content perspective. They believe there is a certain programmatic approach to treatment that is considered Christian counseling. As I said, prayer might be non-negotiable, the use of scripture in every session might be non- negotiable, and so they‘re very content driven.

Our therapists are not content driven, we‘re more of a process orientation, and it is a lot about an attitude of openness to spiritual issues if they‘re brought up. But I would say we‘re somewhere in-between because our therapists also have their own personal spirituality to draw upon as well as the training and the theology and integration that we‘ve provided and that they‘ve received in their graduate training. This gives them analogues to draw upon. This is always true in doing therapy.

When a patient says something to us as a therapist, I look at my own life and say, ―What do I know about that, what do I feel about that, what is my experience about that?‖ And we use that to inform our interventions. If our therapists have specific training in the area of spirituality and religion, then they‘ve got more material to draw upon when a patient makes a religious reference. We can look inside our own selves and say, ―Well what do I

72 know about that and how do I feel about that?‖ That informs then what I‘m going to say next.

ALEXANDER: What kind of questions do you get asked most? What do other professionals ask you the most?

BAKER: There is, of course, a division of The American Psychological Association, Division 36, of psychologists who are interested in religious studies, the psychological study of religion, who have a common understanding of what we mean. So within that group, the questions are maybe more technical. There‘s a kind of an understanding that there‘s a wide range of therapists who are interested in religion.

Now outside of that group I‘m also a member of Division 39 made up of psychologists interested in psychoanalysis. The questions there might be much more suspicious because they don‘t know what I mean when I talk about religion. My book with Harper Collins is titled The Greatest Psychologist Who Ever Lived, and the subtitle is, Jesus and the Wisdom of the Soul. Some of my colleagues in Division 39 wouldn‘t know what to ask me about that because they have Freud‘s basic understanding of religion, that it‘s a defense. So they find themselves maybe not even wanting to go into those areas with me because they find it awkward. And I would say then that with their religious patients, they are going to have the same experience. There are certain areas they are going to find awkward to explore.

ALEXANDER: I was talking to a psychoanalyst and I said that my next program was going to be on spirituality and he said, ―Why?‖

BAKER: Exactly. Don‘t you find that an odd statement given that ninety percent of Americans believe in God, and eight percent of those people identify themselves as Christian in one form or another, and his perspective is why do you even want to talk about it? So ninety percent of the people who come to him think in terms of God, and he‘s not even interested in exploring it. Don‘t you think that‘s interesting?

ALEXANDER: Yes, I do.

BAKER: I do too. So those people are free to come to us, because they know that we can talk about that if we want to.

ALEXANDER: Within the training programs that you do, is there any one thing that therapists who are in training have to work on the most?

BAKER: Well, most of our therapists come to us with previous training in religion. Most of them have at least masters degrees in theology, so they come to us pretty educated. Now some of them don‘t. We have therapists from other schools who have no previous formal training. So the questions usually have been answered by the time they get to us because we do the clinical training. So graduate programs send their therapists to us, and they have a wide a range of questions.

Probably in the beginning, most of the therapists who come to us want to know, ―Are you doing Biblical counseling? Are you doing professional psychotherapy?‖ So they‘d want to answer that question themselves: ―Am I required to follow a particular program and use verses and pray with every patient?‖ Most therapists who come to us don‘t want to do that; they want to be free to let the patient decide where they want to go. So I would say that‘s probably the most frequent question.

Then there are the same questions you‘re asking: how do you guys do that, what does that mean, do we have to do it a certain way, and at LaVie, we don‘t. We‘re not programmatic in that way because we also get patients who come to us who are not religious at all and we‘re able to work with them as well, which we couldn‘t do if we required every patient to follow a particular program.

ALEXANDER: Is there anything else you‘d like to add, any final thoughts that you‘d like our listeners to understand about your work?

BAKER: Well in the beginning in my book I say this, which I think is the reason I wrote the book. For me there‘s been an antipathy between psychology and religion since the beginning of psychology because of Freud‘s attitudes and it still exists today. I think then there are people in the Christian church who fear psychology and there are psychologists who dismiss religion as you have experienced yourself, and I think that is based on fear. It‘s unfortunate that religious people fear psychology and psychologists, I think, fear religion because it is such a powerful force in people‘s lives. I think fear is often based on ignorance, and if we became more sophisticated and more educated about both psychology and religion, we would find that there are a lot of helpful overlaps between the two. Psychologists can learn from religion, and the religious people can learn from psychology. That‘s been our experience. People should feel free to integrate those two areas that are important and powerful areas in their lives. That‘s the work that we do, that‘s the reason I wrote my book. I think Jesus in fact had brilliant insights into the psychological understanding of people, and we as spiritual people should feel free to explore ourselves psychologically and spiritually to find wholeness in life. So that‘s our perspective.

ALEXANDER: Dr. Baker, thank you very much.

BAKER: Certainly.

This concludes On Good Authority‘s interview with Dr. Mark Baker. We hope that you learned from it and that you have enjoyed it. Listeners interested in contacting Dr. Mark Baker can reach him at the LaVie Counseling Center, (626) 351-9616.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #6: “A Relational Approach”

CAROLYN JACOBS, Ph.D.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Carolyn Jacobs, Ph.D. Dean and Elizabeth Marting Treuhaft Professor Smith College School for Social Work 207 Lilly Hall Northampton, MA 01063 (413) 585-7977 E-mail: [email protected]

Welcome to On Good Authority. I‘m Barbara Alexander. You are reading or listening to interview #4 from On Good Authority‘s program on the Spirituality in Clinical Practice.

In this interview, we continue looking how spirituality gets incorporated into traditional practice. Before utilizing any spiritual interventions, many researchers and clinicians, as well as many professional codes of ethics, insist that at a minimum, a brief spiritual assessment should be performed on all clients to assess their religious and spiritual concerns. One of the main benefits of this is determining whether the clients‘ spiritual beliefs and spiritual communities can be used as healing and coping resources. Our first speaker addresses the subject of the spiritual assessment, as well as other spiritual experiences that arise in the treatment process. I think you will find her treatment of prayer in the therapy session to be a very kind and helpful answer to a very troubling question.

Carolyn Jacobs, Ph.D., is the Dean and the Elizabeth Marting Treuhaft Professor at the Smith College School for Social Work. She has written and presented extensively on the topic of spirituality in social work and she is the co-editor of Ethnicity and Race: Critical Concepts in Social Work. Among her publications on the subject of Spirituality in Clinical Practice are ―Spirituality and End of Life Care Practice for Social workers,‖ and

―Spiritually-centered Therapy.‖ In addition to her teaching and research, Dr. Jacobs is a Spiritual Director, trained at the Shalem Institute for Spiritual Formation.

ALEXANDER: Dr. Jacobs, it seems that everybody has a different definition of spirituality and using spirituality in clinical practice. So I wanted to start by asking you first, what do you mean when you speak of including spirituality in our practices?

JACOBS: Well, I really like the definition that Jim and Melissa Griffith provide in Encountering the Sacred in Psychotherapy. They speak of spirituality as a relationship. I think for those of us who are deeply committed to dynamically oriented therapy it works best as we think about it. They define spirituality as the sense of relatedness with oneself and other people, the physical environment, one‘s heritage and tradition, one‘s body, one‘s ancestry, and one‘s faith in the higher power. Spirituality is a commitment to choose as the primary context for understanding and acting one‘s relatedness. It is all of nature, all of a higher power, all of God (if that is a part of the way that you see the world), and all of creativity.

For those of us who are concerned about understanding the relational base of practice, this really fits well with Winnecott‘s thinking about how you work with people in the context of the relationships that have meaning in their lives. Religion really represents that kind of cultural codification of the spiritual metaphors. It finds a way to be present in rituals, formal dogma and community as to however God is personified or is defined in relationship for the individual. So I find that‘s the way that I look at spirituality.

ALEXANDER: Did Winnecott actually say anything about spirituality?

JACOBS: Winnecott says you look at the transitional space and phenomena, and in that transitional space art, creativity, and religion occur, which is absolutely wonderful for us. So if you think about working with people around transitional objects, the notion of God as an object, or religious beliefs as a part of that is very important because then you can enter with them into that space and see how they work at transforming that over time to make those objects more relevant in their life at particular stages.

ALEXANDER: Let‘s get specific. How does a therapist broach the subject of spirituality? Does a therapist broach the subject of spirituality?

JACOBS: I think so. I think if you approach the work from a strength perspective, then what you‘re asking is: what are those sources or resources in people‘s lives that help them cope with difficult times or crisis? What has given meaning to identity and the definition of self over time? Just as you look at taking a family history, you can weave into that taking a spiritual or religious history just to have a sense of what resources are available. Specifically in regard to people who are in health care crisis or at end of life, one of the things that you might want to know is whether there is a spiritual connection or a religious connection that is meaningful for them as they face the crisis of death or dying. So I think it‘s a natural weaving-in as we look at what are the supports and

76 resources available for the individual, the family, and the elderly person at various stages of people‘s coping or crisis.

ALEXANDER: As you talk about the life cycle, you bring another question to mind, and that is whether there are stages of spirituality across a person‘s life span?

JACOBS: I think what happens is that we revisit various objects, if you will, or meanings that have occurred earlier on. For example, a lot of times with adults if you do a spiritual history with them and ask what their images of God as a child? They will answer with an image of God as judging or Santa Claus: if I‘m good, everything works out well. At adulthood what happens with people, if they have not reworked that image from childhood, is that this interpretation becomes worthless at a point of crisis because things don‘t work out well even if you‘re good. Things happen in people‘s lives that are very difficult for them to find ways to explain. The sense of God becomes different if that image is important to them or the spirituality is important to them. It becomes an image often of an anchor or a way of holding on during very difficult times. The image gives them the strength to go on and make meaning of life when things seem impossible. So you can revisit that image over time of who God is and it moves from the limited focus of a child to the mature image of an adult. That is a sense of the growth in the relationship and the complexity of life, as well as the uncertainty of life and the inability to find simple answers to life.

ALEXANDER: How do you help adults who do not have that more complex or abstract concept about it?

JACOBS: What I do is spend time with them understanding where they find a sense of connection in their lives--whether it‘s people, nature, or writing. People are extraordinarily creative with the ways in which they have attempted to grasp meaning. I‘ve worked with someone who really struggled with whether he had a relationship or connection with God. He was a carpenter and I found that what he would do was sing to the new wood when he was working on a house early in the morning. I was very moved by his whole affect and presence of talking about what music meant to him and how the intimacy and the connection early in the morning just moved him outside of himself in a very powerful way. That to me is spirituality, and that was the strength that got him through other crises in his life. It was the ability to use the music to connect it with the work that he did and to find some sense of ―holding‖ as he moved through other transitions.

ALEXANDER: So specifically with this man, you would have him recall in the bad times what he did in the past? Is that it?

JACOBS: That‘s right. This was a way to get him anchored in the internal strengths that he had for coping with or dealing with difficult situations. And I honored that as the presence of the spiritual in his life. It was not to feel that the spiritual was connected someplace that he needed to run off to, but that it was very much connected with his own gifts of music, his own gifts of wanting to be connected with the wood and

77 the work that he did in the morning.

ALEXANDER: So this is not something you would need to refer to a pastoral or clergy person in this case. This is something that not only non-medical but non-religious therapists and counselors can do?

JACOBS: Very much so. Where you wind up needing to refer is when people have very strong religious practices or beliefs and when those beliefs may have not been helpful for them in terms of dealing with a particular situation. For example, I worked with a young woman who had an abortion and who was a practicing Catholic. She was deeply concerned about being able to fully participate in the sacramental life of the church. Well, we spent time talking about this and she had a real good sense of herself and the decision that she‘d made. She had a sense of forgiveness of herself for what she had done that was a ―sin,‖ as defined by the church. She was able to say to me that she really wanted to participate in the sacrament of reconciliation, the sacrament of penance as a way of moving back into the Eucharist and the life of the church. I spent time with her and found a priest who would understand her journey in a very forgiving and healing way. Because she wanted that connection, I referred her. If she had not wanted that connection and not wanted to return to the life of the sacramental church as a part of who she is, I would not have referred her. So it depends on how the beliefs, as Joseph Campbell talks about it: the concern is not with religion per se, but that impacts the psyche of the individual.

ALEXANDER: How important is it that the therapist or the clinician understand their own spiritual beliefs?

JACOBS: I think that‘s critical because there is a whole issue around countertransference. It‘s how does my ―stuff‖ get in the way of my work with the other? If I have not done the work on my own spiritual journey, I may find myself getting stuck with issues that come up out of my own experience and block my ability to really hear what the client or person that I am engaged with in this work is really saying. So I need to have done some of my spiritual work. The journey is an ongoing part of life for all of us. Just as psychological work is an ongoing part of life, so I need to be aware of and look at ways to continue that work for myself.

ALEXANDER: How does one personally embark on a spiritual journey? Let‘s say that the therapist or clinician is not themselves at all spiritual. How would they go about beginning?

JACOBS: Well, if you remember the definition that I gave, [spirituality] is the hunger for a connection and relatedness with the world around oneself and relationships. People often will sit by the ocean and realize that there is something very powerful in the waves crashing against the shoreline that connects them in a way that they can‘t explain. That to me is the beginning or the ongoing part of a spiritual journey. By being out in nature and watching birds, or animals, or young children at play, a person will sense that there is something about that that connects us to something beyond ourselves. Often

78 people will begin to do that by keeping journals, by doing artwork, by beginning to struggle with a hunger or a longing to make meaning of the work that I do. How do I make meaning about this world that I‘m in that is not beyond me but is a part of me and a part of all that‘s around me.

Often what will happen is those conversations start with other friends who pick up the vibrations of the hunger for that kind of journey. And people will find themselves moving into finding a way to meditate, or do Buddhist sitting, or experiences of prayer, or experiences of sharing what one‘s deepest longing is with others.

ALEXANDER: That‘s very good; those are things you can recommend, of course, to clients too.

JACOBS: That‘s right.

ALEXANDER: The same things you would suggest and try to help yourself.

JACOBS: That‘s right.

ALEXANDER: I sent out an email to all the people on my mailing list and I asked them to submit questions for this program, questions about use of spirituality in clinical practice. One listener said that she uses spirituality even though her clients are not aware of it. I wondered if you had any guesses of what that might mean. Is it possible to be spiritual without your clients knowing you‘re being spiritual?

JACOBS: Oh yes. For example, before a client comes into the office, you may take a few moments of just centering yourself, of becoming grounded, or whatever meditative practice or contemplative practice you use. You may be in the midst of listening to what the client is saying find yourself using a mantra or word to center yourself so that you stay focused and don‘t get distracted.

After a client leaves, there may be that moment of just collecting yourself in a very centering way. By that I mean trying to move to your meditative or contemplative practice--however the individual does it--to allow yourself as a therapist to just be mindful of what has transpired during the clinical hour and being able to record notes or process notes out of the experience of having come to stillness, again within yourself. So, yes, you can do that without the client knowing it because at points before, during, and after, you may find yourself moving to a moment of stillness--not for your sake, but for the sake of being open to what you‘re hearing and the relationship.

ALEXANDER: That‘s just excellent. Many therapists, I think, have the experience of feeling like they‘re just a revolving door at times. You just go from one person to the next person without taking the time, and I think that that‘s just a lovely thought.

I‘m going to bring up a couple of other questions that some of the people in my email list raised, and here‘s one from Elisa Dale. She asks, ―How do you respond to clients who on

79 one hand blame God for their trouble or on the other hand, fatalistically except poor treatment as a manifestation of divine will?‖

JACOBS: Part of what I would want to know is where they got that image of God? Is this grounded in their own religious beliefs and practices or is this based on their own understanding of their personal history? If it‘s grounded in a particular church or religious belief or practice, I would want to consult with the religious authority, be it a priest, rabbi, imam or clergyman. I would want to just to get a sense of whether this is the truth of that teaching and refer the person there so that he or she has a better theology or a better understanding of what they believe. Often what will happen is that people just have either not heard or it‘s just not been clear to them exactly what their particular denomination or tradition teaches. So I want people who are very much committed to their religious practices to deal with providing the best referral for them for information. Then if that‘s not the case, or even if it is at some point, I want to understand with them how their image of God limits who they are and their potential. And I want to get a sense of if this is an image or an experience of God that really will get in the way of their full development as a person, because the work in therapy is about maximizing one‘s human potential. So how does the belief block that? Have they internalized that? What messages have they gotten, and how do we need to help them develop insight into other ways of seeing their God or their sense of creation and their energy?

So it‘s on two counts: one is this bad religious understanding on their part or is this something that really needs to be dealt with in a way that helps them let go of that particular experience? I think that‘s true, especially where you have people who have been in cults and where you‘ve got to be very aware of how negative that image and experience may have been in their development as individuals. How much fatalism is there: ―This is what I‘m doomed to be because (according to whatever tradition or experiences) this is what I know. I just am not capable of becoming anything else.‖

ALEXANDER: Elisa Dale also asks about praying with clients: if you do that, how and when do you do that?

JACOBS: It depends. If the client asks me directly to pray with them, I would encourage them to pray while I sit silently. I do this mainly because I don‘t want to create a set of images that come out of my prayer and experience that may not be the client‘s prayer and experience. And what they‘re asking for is reflection back on what they are feeling, experiencing or saying. If they don‘t have the words to do it, what I suggest is that we sit silently for a few moments.

ALEXANDER: That is a wonderful way of making the person feel like you‘re with him or her while still being true to yourself. Now here‘s another question, from Michelle Farrabough. She asks about forgiveness and she wonders if the therapist has trouble forgiving, will that impact their ability to help people themselves who need to forgive, and how important is forgiveness in helping people come to a better spiritual place?

JACOBS: Well for one, I think if therapists have trouble forgiving, that will

80 impact their work as does anything they do in their own lives. The therapist‘s own perspective impacts their own work, and it‘s a piece of work that we all have to do. As to the other part of the question, ―How important is forgiveness?‖-- I think it‘s critical because part of forgiveness is letting go of the self-anger and frustration and disappointment, as much as it is forgiving the other. So most of what forgiveness is about, from my perspective, is the forgiveness of self--for having gotten into the situation, for being vulnerable, as well as forgiving the other for having done whatever they did.

Now part of the work with forgiveness is to really be able to claim that there was a bad act against you. That doesn‘t mean that you accept the negativity or the impact of that act. But the issue of forgiving the other becomes very important because of the sense of us all being connected in relationship. The fine line of forgiving the other is not accepting the act that caused the need for forgiveness. One needs to recognize that forgiveness of the other doesn‘t mean that you necessarily have to take them back into your life. Part of forgiveness is helping the person to not be vulnerable again but to be free of what that act of violence or betrayal has meant for them, how they‘ve internalized it and what it has meant for how they see others in their world around them.

ALEXANDER: Now here‘s another question. Deborah Wiley asks, ―How can you work with clients who have no spiritual base or no religious experience and in fact are anti- spiritual?‖ Can you work with them?

JACOBS: Oh yes, because if they‘re coming to see you, they‘re coming to see you about, I would assume, some crisis of meaning in their lives in a very broad way, and you just stay focused there. It isn‘t necessary to try to include or develop a perspective on the spiritual in that work. You deal with wherever the client is coming from. If the spiritual is there for them as a resource fine, if not--fine.

ALEXANDER: As an educator, what kind of training do you think is necessary to work in this spiritual dimension?

JACOBS: I think people should get training in spiritual guidance, direction or formation in some ways because you need to not only understand your journey, but also understand the faith traditions and experience of others. As I was saying earlier, if someone doesn‘t have a faith tradition or a spiritual tradition, it is not the role of the therapist to help them gain one, unless they are asking for that. So it‘s important for the therapist who is working in the area--or who may want to look at the issues of spirituality--to really understand where spirituality or religious practices can be an asset or a strength for a person. On the other hand, the therapist should also understand where spirituality or religious practices can be limiting or cause increased dysfunction for the person.

Part of the work in spiritual guidance formation or spiritual direction in terms of that training helps you to understand how spiritual life should or should not be looked at or worked with within the context of therapy. For example, where someone may have had

81 very negative experiences in terms of clergy abuse or other kinds of negative experiences, you want to look carefully at how you introduce, support, or suggest to the person a return to that particular religious tradition or church setting. The work in spiritual direction or guidance helps you to think about and to reflect in a different way on those issues for individuals.

ALEXANDER: Have you found a bias against religion and spirituality in post-graduate education?

JACOBS: Well I think historically there has been a bias. I think in the beginning of professional education we all hungered for the scientific basis of psychology and human growth and change so the origins of the helping professions under religious auspices was just put aside and denied. At best we said that it was important ―to serve others,‖ which is--in most of the religious traditions--one of the maxims that you learn. The maxim is the sense of charity and caring for others.

I think what has literally happened now is that the research from both the medical side of the helping professions as well as other places, has really tapped into the fact that the way people make meaning out of their lives (such as their ways of prayer) can help them heal faster and use supports in a better way. What we‘re hearing now about mind/body work and spirituality in medical schools and elsewhere is that it is important to know that people in crisis have a faith dimension in their lives. That will allow healing to take place; that will allow them to move back to as healthy a state as possible and faster than those who don‘t have those connections.

So I think we‘re coming full circle to a much more holistic integration and understanding that the social sciences like psychology and others only can explain a very limited amount of what happens in the relationships that move people towards health. I think that the bias has been there, but I think it‘s shifting as we begin to see the whole person versus the person as split in two: ―This is the area for the therapist, this is the area for the physician, this is the area for the theologian or the politician or the economist.‖ There‘s something about us understanding the integral nature of the human being that moves us to say we can‘t separate this out, we have to respect the interaction of the spiritual as well as the psychological, the physical, and the larger social systems.

ALEXANDER: What if the spirituality of the client doesn‘t seem ―healthy,‖ to the clinician, or when the client comes off as sort of grandiose or narcissistic--or is that too value loaded?

JACOBS: No, if it‘s not healthy then I would treat it as something that needs to be dealt with. Depending on where you would see the person developmentally and where you see that rooted, I would really work on trying to get the person to develop some insight on how this has fed into the dysfunction or the crisis in his or her life.

In one situation I had, a woman really kept getting herself into church situations where she would give over the power of her own beliefs and her own sense of who she was to

82 the priest or the clergy person. She would always find herself in a situation where there was psychological spiritual abuse, i.e. someone constantly putting her down. She kept doing this from church group to church group. I finally said, ―Maybe you should take a look at not continuing to go to these churches because look at what‘s happening to you at each step along the way.‖

In our work together, she stopped going and found herself spending Sunday mornings either with friends, or horseback riding, or just doing things that connected her with nature and others in a very healthy way. She came back from those experiences and could begin to talk about how she had chosen to allow someone else to demean her, and she how had internalized that. Finally, we were able to deal with the earlier experiences that had developmentally allowed her to move into this very negative space. So in that situation, she kept telling me about the experiences, and I kept asking, ―What are these choices that you‘re making to do this, and what are the other possibilities for you for community?‖ Part of what she was longing for was to be in a space for community, and she began to create different community space for herself.

ALEXANDER: Dr. Jacobs, you have a great framework to put this in--of thinking outside of the box. How does a person get that or is it just a matter of being born with it? How do you learn to be more open?

JACOBS: When I introduce this workshop at Smith--since I‘ve been at Smith for twenty-three years and talk with people about it--I talk about how could this happen here? I say one of the things that I discovered here with one of the other social work educators is that those of us who began to teach courses on spirituality about 10 years ago, were all researchers. And I decided to do that on two counts--one is that we taught the content that people often didn‘t want to take in social work, i.e. the research courses.

As Einstein said, there‘s so much you can pose based on the variable you pull together, examine, and look at. At some point we always talk about being able to explain 95 or 99 percent of a relationship or an interaction based on that, and Einstein says that finally at the extremes of that, it‘s all mystery. So if you come to a sense of the curiosity about what really makes the relationship work (I mean the research on clinical relationships), we can talk about transference, counter-transference, and theory that informs our practice, when you get in the clinical setting, in the room with the other, there is something that really works with one client that won‘t work with another one. You can look at the process recordings, the time of day, the room, etc, etc, and sometimes all you know is that the experience is one of extraordinary connection and mystery, if you will, because of what the relationship has offered up.

I think that‘s a part of that sense of how one comes to that. It‘s a curiosity about what makes a difference in terms of the work that we do, and I think there is something about it with the relationship that is beyond our explanation. We know when it works well, we‘re not sure when it doesn‘t, what we can do to change it, although there are probably some extremes that we can deal with that.

I think that there‘s a profound mystery of the human spirit that comes together. One of the things that has happened with the physicists of this world is that they moved to saying that we can no longer isolate elements and really be very clear that this variable or this element will discretely impact the other. What we find is that you can get two or more of the smallest elements, atoms, quarks together and all of a sudden you have a new relationship or configuration. There is an energy in relationships that is often beyond our capacity to explain, except that we know when we sit and when we listen carefully, there is a powerful way of reflecting back with the other what that experience is, and I think that‘s what brought me to this work.

We just don‘t enough that we can isolate. What we know is if we explore who we are, and if we are open to the others exploring who they are (even though they may not be able to articulate it), we will find some way to hold theory lightly, to be able to understand what causes, what enables, what empowers the change and the insight.

ALEXANDER: Dr. Jacobs, thank you very much. This has been very insightful.

JACOBS: Oh, I‘m glad, I‘m glad. Good conversation.

ALEXANDER: Thank you.

This concludes On Good Authority‘s interview with Dr. Carolyn Jacobs. We hope you learned from this interview and that you enjoyed it. Dr. Jacobs can be reached at the Smith College School for Social Work in Northampton, Massachusetts, 413-585-7977.

I need to say here that the views expressed by our speakers are theirs alone and do not necessarily reflect the views of On Good Authority. Until next time, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY IN CLINICAL PRACTICE

Interview #10: “Spirituality and Brief Therapy”

WILLIAM O’HANLON, M.S.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

William O’Hanlon, MS O‘Hanlon and O‘Hanlon, Inc. 551 W. Cordova #715 Santa Fe, NM 85705 (505) 983-2843 E-mail: [email protected] www.brieftherapy.com

Welcome to ON GOOD AUTHORITY. I‘m Barbara Alexander. You are listening to or reading Interview #10 from our program on ―Spirituality in Clinical Practice.‖

It may come as a surprise to you to learn that Spirituality and Brief, Solution Focused treatment have much in common. It certainly surprised me, and I think you will enjoy this speaker.

Bill O‘Hanlon, M.S., is the founder of Possibility and Inclusive therapies and one of the pioneers of brief solution-oriented therapy. He has made prolific contributions to the field of therapy and has authored or co-authored 20 books, the latest being A Guide to Inclusive Therapy, Try and Make Me! He has appeared on the Oprah Winfrey show featuring his book, Do One Thing Different, and since 1977 has taught over 1000 therapy seminars around the world. A top-rated presenter at many national conferences, Mr. O‘Hanlon was awarded the ―Outstanding Mental Health Educator of the Year‖ in 2001 by the New England Educational Institute.

ALEXANDER: Mr. O‘Hanlon, the brief treatment that you‘re doing now, is it still solution focused work?

O‘HANLON: Well, I always use the word ―solution oriented.‖ The ―Solution- focused model‖ is a slightly different one. It is basically why I‘ve been talking about brief therapy and spirituality. One of the missing elements to me in that solution-focused model addresses is that the therapist has a deep and respectful listening approach and acknowledges people‘s pain and this seems to me more integrated with the spiritual approach. It offers much more than the classic brief therapy approach, which is ―let‘s get in there, fix the problem and move on.‖

To me brief therapy has always been a spiritual approach and the solution-oriented approach seems to me always had a spiritual basis to it but it wasn‘t obvious to most people. It was obvious to me because I created it, but it wasn‘t obvious to most people. Sometimes people come up to me at workshops and say that there‘s some spirituality in this, even though I haven‘t mentioned it. Nevertheless, they say that they just got it ―between the lines.‖ So now, I‘ve made it not so ―between the lines‖ and more explicit.

ALEXANDER: Can you define for us what you mean by spirituality?

O‘HANLON: I think that‘s the key, isn‘t it? There are so many definitions of religion and spirituality and is that the same thing? I think for many people they‘re exactly the same, for many people they‘re antithetical almost, and they don‘t have much to do with one another.

So I define spirituality very practically and very simply with three C‘s. The first C is Connection, and it‘s connection to something bigger, within, or beyond you. The second C is Compassion--instead of judgmental self-criticism or criticism of other people, it‘s a softening towards oneself and others. The third C then is Contribution. I think when you‘re connected to something bigger you‘re compassionate; the next thing that occurs to most people is you want to be of service to people. So I define spirituality as those three C‘s. Some parts of the three C‘s sound like religion, some parts don‘t. So if you‘re a religious person you can relate to them but if you‘re non-religious, or a person who has been shamed or traumatized by religion, who has an antipathy towards religion, you can still relate to those three C‘s I think.

ALEXANDER: Aren‘t those three C‘s what a good therapist would be doing anyway?

O‘HANLON: Those are what a good therapist would be doing, and I think somehow we‘ve left some of that spiritual stuff out of therapy because we‘ve been a little influenced by Freud, who saw being religious as neurosis and a defense mechanism and was very down on it. In addition, our training says ―don‘t impose your values on people,‖ and people took that a little too far. In fact they left out a pretty important part of human beings lives—spirituality--connecting to something bigger, and having that sense of contribution and compassion.

So I think it‘s always been there but it hasn‘t been recognized or made so explicit and that‘s part of the work that I‘m doing in my recent writing. I‘ve written a book called A Guide to Inclusive Therapy. The book now expands the idea of brief therapy so it

86 doesn‘t have to be so narrowly focused. It also includes more spiritual sensibilities, because when people have them, you might as well use them as a resource.

ALEXANDER: Do you think you could give us some kind of a clinical example?

O‘HANLON: I have a friend in Australia who‘s written a book called Nature Guided Therapy. His name is George Burns (like the comedian but he‘s a therapist). When I was down in Australia teaching workshops, there was an article about his work in the paper. He had a very simple idea, which I thought was great, and which most people might not relate to spirituality. He described that when he has a couple in therapy who are really stuck and can‘t soften towards one another or solve their problem, he sends them to walk in the woods and talk about the same problem they can‘t otherwise solve. He reports that they find different resources and solutions when they‘re in that different setting. That‘s what I‘m pointing as it pertains to with spirituality. We get stuck in sort of a small place when we have problems--individual problems, family problems, couples problems, work problems, and whatever kind of problems, including physical problems. Going someplace different can help you feel connected to something bigger than yourself, whether it‘s a mountaintop, ocean, or a church, or whether it‘s connecting to another person in a new way, whether it‘s connecting to your sense of the divine--whatever it may be. If you can get out of that small narrow confined place, I think that‘s one way to use spirituality.

Another quick clinical example occurred some years ago when I was still feeling restrained about bringing up spirituality or religion into my treatment approach, because you would be imposing your ideas on people. I had a client who was in the middle of a hypnosis session, really frightened and I said, ―Well is there anything that would help you feel less frightened right now?‖ And she said, ―Yes, if I imagine Jesus coming in and putting his hand on my shoulder,‖ and I thought, ―Well ok, imagine Jesus coming in and putting his hand on your shoulder.‖ I thought my supervisor probably wouldn‘t like that because I‘d be bringing religion in, but it was this client‘s resource, and I think sometimes because we‘ve been trained not to bring up spirituality and religion because people obviously have different values and different beliefs, we‘ve sometimes been restrained from bringing in some of the obvious resources that people have.

There was a research study and survey published in the American Journal of Family Therapy by a guy named Thomas Carlson. He asked American family therapists, ―Do you think there‘s a relationship between spiritual therapy and mental health?‖ And 96% answered yes. When he was asked, ―Do you think spiritual issues should be in clinical work?‖ only 62% of the therapists said yes. So almost everybody thinks it‘s relevant but only two-third of the marriage and family therapists surveyed actually brought these issues in because somehow we‘ve been restrained from finding a way to do that in a respectful and non-impositional way. So that‘s what some of the training I‘ve been doing recently is. I think there‘s a way to bring it in and not impose it on people.

ALEXANDER: Ok so how do you do that? How do you bring spirituality into a session where it hasn‘t been the focus or the topic?

O‘HANLON: I think the first thing is to broaden your definition of spirituality. It isn‘t just organized religion. Some people connect with spirituality through art, and they have a sense of connecting with something bigger.

I live in Santa Fe, New Mexico, and it‘s a very artistic place. Sometimes I go and look at some of the art and it doesn‘t really move me, but I see it moves other people. But I can listen to a piece of music and be moved to feel connected to something bigger. I can read a book and feel moved. So what moves people? It doesn‘t sound classically or traditionally religious, but what art really moves you? Do you go to a theatre and really get moved by the play? Do you read a book and really get moved by that? Do you paint or write music? Where do you get connected to something bigger? It‘s not just creativity, but I think it‘s what connects you to something bigger. So first of all we can expand our definition of what spirituality is. It‘s not just religion, although for some people religion is where they connect to something bigger. So I‘m not leaving that out.

Years ago, when I first started doing therapy, I worked as a drug and alcohol counselor. Then when I moved more to the mental health side, I noticed my colleagues in mental health were not asking about drug and alcohol issues very much. They just weren‘t trained to deal with those issues, and they weren‘t aware of how pervasive drug and alcohol issues were. That was in the mid-seventies. Now many years later, most therapists are pretty aware of the pervasiveness of drug and alcohol issues and how much they influence mental health problems, couples and relationships problems, family problems, or domestic violence, or sexual abuse. So I think over the years we‘ve had our awareness raised about domestic violence, sexual abuse, and we ask a few questions that might open up those areas at every intake. I think most of us do, we‘ve been trained to be more sensitive to these issues, and I think the same is true with spirituality.

If you ask a few questions such as: do you have religious or spiritual practices, are those important to you, have you had them in the past and gone away from them, do you miss them -- if we just ask a few questions and start to open up this area, we find that most of our clients have resources that are quite profound in this area that we‘re not tapping into. We‘re relying on the regular behavior, or emotional or interpersonal resources, which are fine. But there are some resources that are beyond that which we‘re not even asking about. I don‘t think you need to focus on them and say, ―We‘re going to spend all the fifty minutes of our assessment together on spirituality‖-- it might just be one or two questions, but if there‘s a mother-load of resources there, we‘ll dig deeper into it.

ALEXANDER: So let‘s say somebody comes in with a problem like they‘re phobic or their child is acting out, or something like that. As part of discussing the issue, do you ask these questions?

O‘HANLON: Obviously if they‘re phobic, or anxious, or whatever it may be, you might ask about what medications they‘re using or non-medication drugs that they‘re using. You might ask about this in brief therapy in a solution-based way: what‘s been helpful to you? How have you been able to move out of those fears? What about a time when you expected to be phobic and you weren‘t, or you were less phobic?

You would ask all those kinds of things and the only other thing you would throw in is, ―Has there been a time you were feeling in a place that didn‘t have fear?‖

And the answer could be, ―Yeah, one time when I was first in love. For some reason I could do a lot of stuff before my phobia stopped me.‖

I would answer, ―Oh well, that‘s interesting, tell me about that experience.‖

The patient said, ―Well, I was on vacation once and for some reason I wasn‘t as tense as usual and I rode an elevator and I was really surprised that I could ride an elevator.‖

You find out about those moments that were exceptions to the problem, which is a typical brief therapy ploy, and you might steer it a little more towards finding out if there ever were moments in your life where you feel that flow or that sense of connection to something bigger, or a sense of compassion for yourself or other people, or you made a contribution to someone else?

I have a colleague that I heard give a presentation at a large conference and it struck me that I‘ve been doing something similar. He called what he did ―Mitzvah Therapy.‖

ALEXANDER: Mitzvah, by the way, is Hebrew for a good dead or an act of kindness.

O‘HANLON: He had a woman who‘d come in who was severely abused when she was younger, and now she was on disability. She been in years of therapy, the typical story, post traumatic stress and trauma and things like that, and she just couldn‘t get over it and was vastly overweight because she ate to comfort herself, really isolated from other people. She came to him for therapy and he said ―I don‘t think therapy works for you, so I‘m not going to give you regular therapy. I‘m going to give you Mitzvah therapy.‖

She said, ―What‘s Mitzvah therapy?‖ and he said, ―I want you to go out and volunteer at a residential treatment center where they treat kids who have been abused. They always are understaffed and overwhelmed and they probably need some volunteers.‖

So she goes out and finds a place like that. She comes back in a month and said, ―It‘s the first time in my life I‘ve felt valued and needed, because those kids need me. They are understaffed and they love it when I come. The staff loves it when I come and the kids love when I come.‖

So she comes back in a month really shifted for the first time in the years she‘s been coming to therapy because she‘s tapped into something bigger than herself, something beyond herself. She doesn‘t just sit in the therapy room focused on, ―What‘s going on with me, what‘s my post traumatic stress, how have I been abused, how can I work through that?‖ He invited her out into the world to make a contribution and because of

89 that invitation, she moved beyond where she was.

To me that is how the brief therapy that I‘ve been doing connects to spirituality. Sometimes we tap into resources that are beyond people--they‘re not within them. Sometimes that‘s a classic brief therapy thing, namely what solutions do you have internally? But also what personal, interpersonal, and transpersonal connections or resources do you have?

ALEXANDER: Tell us about what else is in your book?

O‘HANLON: Well, I actually have several books out that deal with pieces of what I‘m talking about. One was, Do One Thing Different, which is a book for the general public that I wrote a few years ago. I was on Oprah for that book, and it has one chapter on solution-oriented spirituality. So it really combines the brief therapy model that I‘ve been teaching for the last 20 years with spirituality. It describes how solution oriented therapy taps into people‘s resources, and, in the same way, a therapist can also tap into people‘s spiritual resources--the resources that are beyond the everyday resources and that are more beyond the person. So there is a chapter on that, but I haven‘t written a definitive book on brief therapy and spirituality yet.

And then I wrote another piece, which is what I call ―inclusive therapy,” in a recent book called A Guide to Inclusive Therapy. That‘s sort of when people become too small within themselves. This method is what I call inclusive therapy, which has three parts, and it really helps people reclaim their souls if you will--reclaim aspects of themselves where they‘ve gotten too small and left behind. Usually that‘s from trauma or shame or just the socialization process that we go through. Sometimes people leave aspects of themselves. A simple example is that a male grows up and he got teased because he‘s a sensitive male or vulnerable or something--big boys don‘t cry--and they leave all that vulnerability sort of to the side. I had a guy come in to see me and he said, ―What‘s wrong with me? My father died and I love my father, but I can‘t seem to cry. Typical issue for a male; they can‘t seem to let the emotions go.

So I think inclusive therapy says: first thing is that it‘s ok not to cry, and you don‘t judge them or criticize them because they haven‘t been able to experience something because that‘s just antithetical to the experience. The second thing is that it‘s ok to cry. So for me that‘s a direction that my brief therapy has been taking: that it is ok to include more experience rather than just focusing on action and solution: ―Here‘s where you are now. It‘s ok to be where you are. It‘s ok not to have cried. Everyone grieves in their own way at their own rate and their own pace. Maybe you‘ll never cry, maybe you‘ll cry in two years.‖ And then on the other side, ―It‘s ok to cry, it‘s ok to be a man and be vulnerable.‖ Inclusive therapy gives various permissions and inclusions, to sort of bring back in what he had left behind. Those ―pieces of himself and pieces of his soul,‖ are what I‘d like to think that he left behind probably because of the socialization process. So that‘s what the recent book is.

Then I have another book that‘s coming out next year -- it‘s on how to have a good breakdown basically. Sometimes the only way to grow spiritually for people is to bring back those missing pieces as we go through a major crisis. That gets you to question everything, and although crises can be traumatizing, they can also be growth experiences. So this is a book called Thriving Through Crisis, and it‘s just how to use a crisis experience as a spiritual breakthrough rather than as just a traumatizing event as it often is obviously.

So if you say to people, ―Where do you connect to something bigger, something more than yourself? How do you connect with other people? What artistic activities do you enjoy doing or watching? Where do you go or what do you do to recharge your battery?‖ all of those can tap into spirituality sensibilities and they don‘t sound like religious or spiritual questions.

I also think there‘s another way to use spirituality in that I always thought that solution- oriented brief therapy had a spiritual basis because I never believed other people were as small as they seemed to be when they come to your office or when they first come to the hospital, wherever you do your treatment. They show up the smallest that they ever show up, the most resource-less, the most stuck, and I think there‘s always more to the story. The ―more to the story‖ is that people have souls and spiritual resources. Sometimes I see people that have been massively traumatized but somehow they kept going. I don‘t know if you‘ve ever had this experience but sometimes when I‘m listening to these stories of massive trauma, I think, ―I don‘t know if I would have made it through that. That sounds too devastating, too overwhelming,‖ but somehow these people did make it through those experiences. Often when you ask them, how they made it through was to get some meaning from it, or to have a sense of spirituality. They think that there‘s a reason for being alive and that they think there‘s something more.

Viktor Frankl, a Viennese psychiatrist, used to do crisis and suicidal crisis counseling in the concentration camps. I can‘t imagine how you could do suicidal crisis counseling in the concentration camps. He said that what he would say to people is something very simple. He‘d say: ―Something else awaits you after this traumatic experience, there‘s something in the future that awaits you.‖ He said for a lot of people that if they believed there was something on the other side of this experience, that belief would relieve their desire to commit suicide. That was a spiritual sensibility for them. There‘s no rational reason to believe there‘s anything on the other side of it. If you‘re just dealing with the trauma, it seems too terrible and too overwhelming.

So there‘s another element of spirituality that I think has always been a part of brief therapy and that‘s a future-orientation. That is the sense that there is some future waiting for you--maybe some destiny, some purpose--but there is something waiting for you in the future. And there‘s some reason that you can make some sense of the terrible things in the present from that future perspective, looking back to the present. Having gone through these terrible experiences, you find when you make it through that somehow you do make sense of them.

ALEXANDER: What if the person says to you, ―Well how do you know that?‖

O‘HANLON: Well I don‘t know that I just have that sense of it, and I wouldn‘t have said that actually. Frankl said that during the concentration camp. He actually thought to himself that maybe he was lying to these people and maybe there was no future for them. He said that for himself, he thought there was no future because his father had died during the concentration camp and later he learned that his mother and his wife had died in the concentration camp. When he came out he said, ―I really did lie to those people. There was no future. I have nothing that waits for me out here.‖ Then within a year he had fallen in love again, he married and he stayed married from 1946 to 1995 at his death. She was the love of his life and Frankl had an amazing life. So he was right, a future did await, but it only waits if you can go through the terrible experience and come out the other side and somehow keep going. I think his was more a motivational technique, but my sense is that everyone has future aspirations, even when they‘re really depressed.

I don‘t know if you‘ve ever had this experience as a therapist, but I‘ve sometimes had people come into my office and say, ―I have to kill myself, I can‘t go on.‖ And in the back of my mind I‘m thinking, ―If that were really absolutely one hundred percent true, why would they bother to come into my office and tell me that ‗I have to kill myself?‘ There must be some seed of a future hope that they have. They must hope that I‘ll talk them out of it or there must be something inside them that believes there‘s a future other than suicide or else they wouldn‘t bother to roll out of bed, get dressed, come into a therapists office, and tell me that they have to kill themselves.‖

So I think even when we don‘t talk about it, when people don‘t think I‘m using spirituality or they don‘t know, I think one of the things I have is this faith that people do have a future. As long as they‘re willing to stay alive and make it through whatever they make it through, I think there is a future that waits for them. And I try and help them connect with that future, because I think that‘s a good thing to do without being impositional or being just Pollyanna: ―Everything is going to work out.‖ Everything might not work out. But you have some dreams and some hopes for the future so what are those?

ALEXANDER: So that‘s what you would say to that person?

O‘HANLON: Yes. I mean, ―What do you imagine?‖ Sometimes they‘ll say, ―I‘ve got to kill myself.‖ Then a few minutes into the conversation they‘ll say, ―But I have this vacation planned in the summer and I really don‘t know how I‘m going to be able to make it on that vacation because I‘m so depressed.‖ They‘re already thinking about the future. They‘re telling me they‘ve got to kill themselves and they‘re already talking about three months in the future so there must be another aspect to them.

And I‘ll say, ―Ok. What would you like to have happen in the future if you weren‘t so depressed? If you could go on that vacation, tell me about that future. What would you like to have happen once this depression lifts, and you can get through this time? When

92 you get over this trauma, what kind of life would you like to have?‖

So I orient them to a future with possibilities, not saying that future is true or not. It‘s just saying that is one of the things that human beings use to make meaning. It‘s like asking, ―Why am I going through all this terribleness? There must be something that makes it worthwhile in the future.‖ I mean, how did you or I get through graduate school? Every minute wasn‘t great but we had a vision of what we wanted to do after we got through graduate school and that kept us going through the difficult parts, I think. Human beings are naturally future oriented, I think, unless they lose that connection to the future, and that‘s one of the things we rehabilitate in a spiritually- oriented therapy or a spiritually-oriented brief therapy.

ALEXANDER: What if you as the therapist when you hear their story, you think, ―Well maybe suicide is the only thing they should do? Why should they be trying to live?‖

O‘HANLON: I think that‘s when you‘ve gotten hooked in a certain way. There are a lot of those stories for me in therapy. It occurs when I get to that place then I know I‘m resource-less. Where do you go to get yourself renewed? Where do you get your hope from?‖ Because if you get hooked in like that and think, ―Yep, given that life, and given what they have, maybe it makes sense for them to kill themselves.‖ Well, everybody obviously always has a right to kill themselves as a human being, but we as therapists are supposed to try and stop that, that‘s part of our mandate.

Also, I think, having been suicidal myself in the past when I was depressed, that‘s usually a narrowing of your focus of attention where all you can see is the past misery, the present misery, and the potential future misery. So our job as therapists is to remind them there is the possibility of something more. Now maybe they‘ll be depressed the rest of their lives and it will be a miserable life--that‘s always a possibility. But when I get hooked like that I think, ―Oh that just means I‘m a little depressed in this situation and I need to go back to where I get hope, and where I get possibility, and where I get a sense that there is something more than what I actually see in front of me.‖ Because if all I focus on is what I see in front of me, it looks hopeless and lost. How do I bring a spiritual sensibility in and a sense of faith when everything looks the darkest and when everything looks like there‘s no possibility here? How do I keep myself hopeful and how do I tap into my inner or outer resources so I don‘t get so discouraged like they‘re discouraged now.

ALEXANDER: There was just something in the paper in the small town that I live in. There was a man who killed his two small children because he was angry at his wife, and there was a picture of him on the front page as he‘s sentenced to a life sentence. I was thinking, ―How could this man want to live? Does this man want to live?‖ And I remembered something another person I had interviewed a long time ago said. That was: even though he will be in prison for the rest of his life there may be good things that he can do and accomplish to gain a sense of worth for himself in the future.

O‘HANLON: Yeah, I can‘t imagine that either, I mean you know your family‘s dead, you had a hand in that, and you‘re going to prison. Your life is over, but obviously people do. We know that from example, after example, after example. Malcolm X and other people go to prison and find for the first time their sense of meaning and their sense of what they‘re here for and what their contribution is supposed to be. Chuck Colson in the Nixon administration goes into prison, comes out and wants to be a minister to people in prison. So people do find their meaning through these terrible experiences; that‘s sort of what the book on Thriving Through Crisis is about.

The other thing that we haven‘t focused on too much is this idea of compassion and contribution. There was a study that was published in Psychological Science by Stephanie Brown, and she found that when she studied 423 older couples in five year studies, couples who reported helping someone, even as little as once a year, were 40- to 60- percent less likely to die than those who reported not helping anyone in the previous year. As I was saying before in this Mitzvah therapy, giving to other people seems to be helpful for our physical health and our mental health. People seem to be healthier and feel better when they‘re able to give, and I think most of the clients and patients that we see are so beleaguered. They can‘t imagine giving to anyone. It‘s like, ―Ugh, it‘s too much; I‘m overwhelmed with my symptoms and my problems.‖ But somehow if we can get them out of that stuck place, that small place, and connecting to other people and being compassionate and making a contribution, I think sometimes we can do very powerful things to move them out of their symptoms.

ALEXANDER: And in a very short time.

O‘HANLON: Yeah, well that‘s the connection to brief therapy; it doesn‘t have to take a long time. One of the things about brief therapy I always liked was this idea that you can get people moving. It may not solve all the problems in their life or their deep personality problems, but you can get people moving in a fairly short time. It‘s not that difficult to get people moving but what it seems to require often is a connection to resources and taking action. Both of those seem to be pretty crucial in getting people moving quickly.

Meanwhile a lot of traditional therapy involves sitting in an office and trying to figure out what the problem was, what the cause of the problem was. I think the newer and briefer therapies say that we‘re not so focused on that, but rather we‘re focused on getting people moving by doing something. We‘re also focused on connecting to them and having them connect to their resources as quickly as possible and out of those resources start to make some changes. So that for me is how brief therapy has always been spiritually based because we‘re always thinking, ―They‘re not so small as they look, they‘re not so stuck as they look, there‘s always other possibilities.‖

ALEXANDER: What about dreams, do you work with dreams at all?

O‘HANLON: Years ago, I was trained to work in a Gestalt way with dreams. It‘s not that relevant to me. I think there‘s a confusion of anything that sounds psychic, or dream

94 work, or anything like that with spirituality. Dreams can be an opening to spiritual endeavors but I don‘t think dreams necessarily are spiritual. Some people do and if that‘s their spiritual connection, great, use that, but I don‘t think generically they are. I also don‘t think that an intuition or psychic phenomenon is spiritual. I don‘t think those are necessarily spiritual, although they can be opening spirituality. Because again I go back to, ―In spirituality, do you feel connected to something bigger and if you do, is it so through dreams?‖ Some people really do. For some people it‘s just a dream - doesn‘t mean anything to them. If you feel connected to compassion and contribution or service through psychic experiences, then great. If you just have psychic experiences and don‘t connect them to anything bigger or compassion or contribution, to me it‘s not spiritual. It‘s just an experience you have that might be a heightened perception of some sense that most people don‘t have. So I think dreams, psychic stuff, often get confused with spirituality and for me, what matters is, ―Does this connect you to something bigger within or beyond you, does it lead to compassion or does it lead to contribution or service?‖ That‘s what I keep going back to as my touchstones for spirituality.

ALEXANDER: I‘m so glad you‘re saying these things because I think people tend to think of spirituality as a twilight zone, weird, way out there…

O‘HANLON: I did want to make if very practical… Viktor Frankl broke with Alfred Adler on this issue of spirituality. Frankl said that spirituality is central to mental health and Adler said it had nothing to do with it, it was peripheral. Then other people brought it in. Gordon Allport brought it in, Maslow brought it in in sort of a way, and Jung brought it in in sort of a way as well. But I think there‘s a renaissance of interest in spirituality in our culture, in the world, and also in psychotherapy. People have been coming up to me saying ―I‘ve been doing this for years,‖ or ―I‘ve really had an antipathy towards religion and I couldn‘t figure out how to bring any spiritual stuff into my practice but now you‘ve given me practical tools to bring it in.‖

I think it is very practical and I just have these simple questions that I ask people every once in a while: Can you remember a time when you felt compassionate towards yourself and towards another person? How did you do that? Think of a time when you felt more compassionate because you felt akin to someone who you‘ve previously been judgmental of someone or alienated from. How do you give of yourself, where do you give of yourself? If you had to name your most spiritual contribution or significant contribution to helping other people, what would you say? If you had to name the cause that you believe is the most worthy on the planet, what would that be and are you doing anything about that? Whether it‘s hunger or ending hunger, adopting a child, being a foster parent, whatever it is that you think is really important to do in the world, are you doing anything towards that or have you been so focused on your own problems that you‘ve been caught up in that. Again I don‘t do that in a judgmental way, I‘m just searching for the bigger story in the person‘s life. When they‘ve gotten small and disconnected and without resources, where are the bigger stories and resources?

ALEXANDER: This is just wonderful. I tell you, it‘s really helping me personally right now as we‘re talking. In the time that we have left is there anything that you would like

95 to add that I haven‘t asked you or are there final closing points that you‘d like to make?

O‘HANLON: Two things I guess. When you said it‘s helping you personally, it‘s interesting to me because obviously the work that you‘ve chosen to do -- you could stay in your office and do therapy and that‘s one thing, but you‘ve chosen to do something that makes a contribution to the field. You‘ve created this business and this service for people, and I read some of the things on your website of people saying, ―Thank you for this!‖ For people who are ill and can‘t get out to conferences -- ―This is really helpful.‖ ―I really like this way.‖ ―I have a two year old at home and it‘s really hard to get through my CEUs‖ -- you‘ve figured out a way to make a contribution and what was that impulse? I mean sometimes you think whether all this work is worth it? Yes, I went in to do this for a specific reason: not just for a career, not just for money, but there‘s something bigger. If it was just for money it wouldn‘t be worth it.

Same thing. I think most therapists have gone into this career for a specific reason. If they went into it for money, they need antipsychotic medication. Most of us don‘t make that much money as therapists. But most had that impulse: ―I think I can make a contribution to people; I think I can help them.‖ So I think one of the things I notice about therapists these days is that they seem really discouraged a lot because of the financial issues in therapy, managed care, and all these financial restrictions and all the legal worries that people have, and ethical worries that people have. I would say that on the other side of the coin, remember why you went into this field. There was something that pulled you. You may have thought, ―I think I could be helpful to people and I think I could make a contribution.‖ If you can remember that, if you don‘t get so burned out or so small or so narrow in your work, then that‘s really powerful. So that‘s one thing.

Second thing is I think there‘s a great deal of research, very clear research that says there‘s a big correlation between spiritual and religious practices and beliefs in mental health. It‘s very clear that most people having spiritual or religious sensibilities or practices make them less vulnerable to depression, and if they get depressed they recover more quickly. There‘s a lot of evidence of the same thing with anxiety disorders, alcohol and drug abuse, and marital stability. So there‘s a great deal of evidence. There are a few exceptions I will say, if you‘re of Eastern European Jewish background, you‘re more likely to be depressed -- we don‘t know exactly why but that‘s been found. If you‘re a Pentecostal baby boomer, you‘re more likely to be depressed and anxious and have drug and alcohol problems, but those are small exceptions to what is a pretty good generalization: spiritual beliefs and practices seem to be preventive of mental health problems and behavioral health problems, and they seem to help you recover more quickly if you develop mental health or behavioral problems. So I think that‘s a powerful incentive for us to know a little more about this and get more interested.

We‘re just at the beginning of that research. This really only started in the late eighties/ early nineties and it‘s mostly correlational research rather than causal research. But I think more and more, we‘re going to find out spirituality is a cornerstone to mental health and can be really helpful if we can find a way to bring it out without imposing it on people.

ALEXANDER: Mr. O‘Hanlon, I want to thank you both for the interview and for the personal inspiration that you have given me.

O‘HANLON: Thank you.

This concludes On Good Authority‘s interview with Bill O‘Hanlon. We hope you learned from it and that you enjoyed it. To contact Mr. O‘Hanlon, call 505-983-2843. His books may be ordered through amazon.com.

I need to say here that the views expressed by our speakers are theirs alone and do not necessarily reflect the views of On Good Authority. On behalf of On Good Authority, this is Barbara Alexander. Thank you for listening.

SPIRITUALITY in CLINICAL PRACTICE

Interview #11: “Jung and Dreams”

PRISCILLA MURR, Ph.D., LPC

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Priscilla Murr, Ph.D., LPC 1500 W. Sixth Street Austin, TX 78703 (512) 482-0074 E-mail: [email protected]

Welcome to On Good Authority. I‘m Barbara Alexander. You are reading or listening to Interview #11 in On Good Authority‘s program on the clinical aspects of Spirituality in Clinical Practice.

As we have seen in our previous interviews, there are a number of different approaches and sets of intervention strategies for incorporating the spiritual dimensions into our counseling and therapy practices. In this interview we will explore a less well known perspective: Jungian dream work. Central to Jung‘s approach to psychotherapy is the value and importance of the spiritual dimension of human existence. To become a whole human includes the re-integration of the spiritual as well as the psychic. In his work with patients, Dr. Jung witnessed the natural healing mechanism of the dream, and thus for Jung, the dream is a teacher and guide on the road towards wholeness.

Priscilla Murr is a Jungian analyst who has been in practice in Austin for 18 years. She graduated from the Jung Institute in Zürich, Switzerland where she lived for 14 years and also has a Ph.D. in English from Universitat Zurich. From 1985 to the present, Dr. Murr has taught at the C.G. Jung Society of Austin. She leads dream workshops and often takes groups to West Texas to visit rock art sites. She is a Licensed Professional Counselor in Texas and maintains a Private Psychoanalytic/Psychotherapeutic Practice in Austin. Priscilla has a lifelong interest in archaeology. She often takes groups of people to archaeological sites.

ALEXANDER: Dr. Murr, we are going to talk to you now about dreams and spirituality. I would venture to say that most of the people that listen to these programs know almost nothing about Jung, so maybe you could talk about the basic structure of dreams as you work with them in a Jungian format.

MURR: Throughout the history of mankind, and certainly as long as there‘s been homo-sapiens, people have been working with their dreams. We have an Old and a New Testament which is replete with dreams. One of my favorite dreams in the New Testament was when Joseph was very upset that his new fiancée, Mary. She was pregnant and he knew he hadn‘t done it so he was going to get rid of her and he wanted to do it nicely. However, he had a dream in which an angel of the Lord appeared to him and said ―Mary is pregnant, but not by a human man.‖ The Lord said ―she is a virtuous woman, and you must care for her because she‘s about to give birth to a wonderful person.‖ Joseph accepted that dream and changed his attitude towards Mary entirely.

Now 2,000 years ago people lived like that. Sometime in the last 2,000 years, we‘ve absolutely put away that knowledge. With enlightenment and the scientific revolution, we‘ve gotten beyond this inner voice that is constantly talking to us, because we know better. It was toward the end of the nineteenth century that Freud became very interested in dreams. Freud published a wonderful book called An Introduction to the Interpretation of Dreams, where he analyzes his own dreams. Jung became interested in Freud and connected with him partly because of this book. Jung himself had grown up in the country among people who were still listening to their dreams--sort of medieval people. Even though it was late nineteenth century Switzerland, people were still listening to their dreams so he was always very interested in the inner-life and that was the beginning of his interest with Freud.

Eventually the two men split and they split on an issue of spirituality. Freud called everything that was from the soul ―occultism‖ and felt that we should protect ourselves against it. On the other hand, Jung didn‘t like the word ―occult,‖ and he felt that we needed to be listening to this inner source in a different way than the way Freud did. The split is very famous and if anybody is interested in reading about it, then read Jung‘s autobiography, Memory, Dreams, and Reflections, Chapter Five, entitled ―Confrontation with the Unconscious‖. He describes his own tremendous experience when he first really realizes the power of the unconscious, how it‘s completely separate from ego consciousness, and that it has such a wealth of information to teach us. He went through a long experimental period and at the end of that, he came up with a structure that is more or less applicable to dreams. Like any structure, it doesn‘t apply 100%, but it‘s a place to begin.

Particularly when I‘m confused by a dream, I like to go back to this structure and see what I can get out of the dream by following the structure. Basically Jung felt that a dream is the unconscious holding a mirror to your life and saying to you: this is what your life looks like to you today from the standpoint of an energy that is much broader, has a bigger vision, and knows more about your life, and about life in general.

To be very practical, Jung came up with a fairly simple structure that begins with the setting -- that is, people, place, and time. Not all dreams have all those things, but usually the dream begins with some sort of setting, such as: ―I was in my mother‘s house,‖ or, ―It was midnight, and maybe it‘s midnight and I don‘t know where I am (and that is not relevant),‖ or ―I‘m with my sister.‖ This setting gives some kind of a context for the dream itself.

Within that setting, usually is what Jung called the ―statement of the problem.‖ So I might dream that it‘s nighttime and I‘m being chased down a hallway by an unknown man. So that would be the problem--someplace in my life I‘m being chased by this energy that I‘m unconscious about. This problem may develop in the dream until it reaches a crisis or a turning point. Jung used the word out of Greek Tragedy, peripeteia to say the turning point of the dream, and then it follows with the lysis or the conclusion of the dream.

Basically the dream starts with this initial problem that the dream is addressing. If you continue dealing with this problem in the way that you have been dealing with it, this is what the conclusion of the problem is going to lead you to. Or the dream could be saying that there‘s the initial problem and here‘s an idea of what you might be doing, and then it could lead to a further conclusion.

ALEXANDER: Could you explain how Freud‘s view of dreams and Jung‘s view of dreams were different?

MURR: Well, Freud had this very strong definition of libido and it was that psychological libido is sexual energy. He believed that what motivates human beings are instinctual energies-- aggression and sexuality—but primarily sexuality. There is a tendency, as I understand Freudian dream interpretation, to view all dream imagery as somehow dealing with one of these basic instincts.

Jung defined psychological libido as simply energy, and that human beings require all sorts of different forms of energy. Jung talked about an instinct for religion, and if you understand nineteenth century instinctual theory, that‘s a pretty powerful statement. Jung said there‘s no such thing as a human being without religion, or without community, or relationships. He said that in our psychological energy, there are drives and needs for all of these different aspects of humankind. He said man is not driven only by sexuality. In fact, sexuality--or the pleasure principle--is really not what drives people most.

People want to make jokes about Mohammad Atta, who was involved in September 11, and that he did this because he was going to get virgins in heaven. I don‘t believe that for a minute. I think what pushed him is that he honestly believed that he was fulfilling the role of Allah. Now Jung would say that Atta made the mistake of giving up his human standpoint and didn‘t question what was flooding into him. But people are not motivated to give up their lives so that they can have more sex; they are motivated to give up their lives for something transcendental.

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This kind of thinking was an anathema to Freud. It was fairly basic to Jung, who felt this was really important. So there‘s a tendency in Freudian psychology to focus on the dream interpretation, to focus it on sexuality and instinctual drives, whereas we try to approach the dream openly: ―I don‘t know what this is about and it could be about anything.‖ I must say I am constantly being presented with dreams that just make me go: ―Oh my goodness, I have never heard anything like that before.‖

We look at the dream as coming out of the fabric of the individual‘s life; and everybody‘s life is as different as their fingerprints. There are overlaps in similarities and we can learn some general theories about dreams. We put a lot of energy into dream symbolism and working dream symbolism, learning about what different symbols have meant in different cultures around the world. But as you approach every dream, you have to remember that even though there‘s a lion in this dream, and I know that in Africa the lion is the symbol of the sun god, I have to ask this dreamer, ―What do lions mean to you?‖ because she or he may have had an experience with a lion and as a result a very different meaning becomes attached to that image than what has been collectively applied to that image.

ALEXANDER: Also, wasn‘t there some thought that to Freud, dreams were revealing things that the dreamer would rather keep hidden, and to Jung the meaning of the dream was something to celebrate?

MURR: That‘s a very good point that you bring that up, that‘s real basic and real important. Freud believed that the dream was often there dealing with the individual repressions, the things that the individual didn‘t want to think about, and that the dream imagery was often trying to help maintain the repression for the person. Jung of course believed in the theory of repression, but Jung felt that the dream itself was the best explanation for its meaning and that the dream wasn‘t trying to hide its meaning in the same way that the Freudian dream would be trying to hide. So from Freud‘s point of view if somebody dreams of a cigar, it is because the person is embarrassed to dream about a penis. Jung said that if you look at your own dreams. you‘ll realize that you‘ve dreamt of very much more embarrassing things than penises in your life. The dreams in fact are not hiding anything but they are trying to communicate to you. With the language that they have at their disposal, they communicate as directly as possible.

One of the big differences also is in our use of the word association as opposed to Freud‘s use of the word association. Freud wants dreamers to ―free associate‖ and just allow their mind to wonder and follow the path. He says that will always lead to the complex, to the emotional core of what is bothering the individual. In Jung‘s way of approaching dreams, when we ask dreamers for association, we want them to be very conscious about what this symbol or image means to them. We don‘t want them to go into this free floating state but rather to find what the dream image means to them so we can try to understand the language that the dream is using to communicate.

I had a client who presented a dream to me recently where she was being chased and attacked by a mountain lion, and mountain lions here in Texas are very similar to Jaguars.

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Jaguars used to come up into Texas and there‘s a huge mythology connected with Jaguars. But in her case I asked her what had been going on in her life the day before. That‘s an important thing that we do with our dreams. We always want the real life context for the dream. She said that she had been at home with her family and that the family was in this huge conflict, just terrible things were going on and she was very frustrated not being able to deal with the family. So knowing this client I said to her, ―How angry did you get?‖ She said that of course she didn‘t get angry. Now because she has difficulty with getting angry, I said, ―Well I think that you‘re really very, very angry and you‘re terrified of the anger. And the dream comes and presents you with this mountain lion as an image, a symbol of your anger.‖ And in the dream she finally is attacked by the mountain lion and gives in to the attack and at that point the mountain lion turns into a golden retriever.

I said, ―I think that if you would allow yourself to really get into your anger over this stupid family situation that you‘re caught in and that deserves your anger, it would turn out not to be as destructive as you think it is.‖ I think she fears that her anger is going to be as destructive as a mountain lion could be. In fact when she gets into it, she‘s going to find it very human related -- a golden retriever. No one‘s afraid of golden retrievers; they‘re wonderful dogs. So that would be one of the ways that we would interpret that dream. We wouldn‘t see the dream as trying to hide her anger from her in the form of the mountain lion. We would say that she views her anger as being as dangerous as a mountain lion and that it‘s that fear that‘s preventing her from getting angry with the family. But the family needs her anger; the family needs somebody to respond to what‘s going on. Sometimes anger is a great gift and of course, we don‘t want it to get out of control and we certainly don‘t want it to be a mountain lion, but in her situation if she would give into it she would find that it‘s quite manageable.

There are two words that come to mind once I‘ve given the basic pattern of the dream: one is the word compensation, and the other is the word association. Dreams are very often compensatory to our conscious attitude. So a dream I actually had once occurred years and years ago in Zurich. I was a new teacher, and I supported myself teaching English. I had been told that this class was just a wonderful English class and that they were going to be doing this incredibly difficult exam and I might find it really difficult to cope with the class. I was working myself crazy to prepare for this class and terrified of the students. Finally after a couple weeks of teaching, I dreamt of the class, and they were all making jokes in class, and they were just laughing and talking and not doing their homework. I woke up and I realized that this was a compensatory dream, it was saying, ―You‘re exaggerating the importance you‘re attributing to these people. You can bring it down a little bit; you don‘t have to be so nervous. They aren‘t so perfect and they aren‘t so incredible. The dream is saying they‘re playing around,‖ not that in real life, the class was playing around, but rather, I could be less serious in dealing with them.

ALEXANDER: So that really helped you gain the confidence to keep at it, is that right?

MURR: Yes, exactly. It made it a whole lot easier for me to keep going into that classroom, and I stopped going in with a stomach ache after that.

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ALEXANDER: That‘s wonderful.

MURR: It was wonderful, and you often see that in compensatory dreams. Now this dream with the mountain lion is compensatory, and hopefully it will help her to find a way to get angry with the family so that some change can be brought about in this stupid family situation that she‘s caught in.

ALEXANDER: What I don‘t understand is the use of the word, ―compensatory.‖ How was the lion compensatory?

MURR: No, the lion isn‘t compensatory, the golden retriever is compensatory. The dream is saying to her, ―You look at your anger as if it were a mountain lion but in fact, it‘s a golden retriever.

ALEXANDER: And for you with the class, you were looking at them as ogres, and they were just people.

MURR: Yeah, I was looking at them as ready to go teach at Oxford. In fact they were just normal people, and they were good, but I didn‘t need to be that terrified of them. Now the other word is ―association,‖ and I mentioned that earlier when I talked about Freud‘s theory of association and ours.

The first thing we do when we hear a dream is we begin to go step by step through the dream, asking the dreamer for his or her associations. So with this client I asked, ―What are your associations to mountain lions?‖ Her brother was in the dream, so ―Tell me what your brother has been doing;‖ her brother had been the one standing up to the family. ―What are your associations to running in the house; is there someplace you feel like you‘ve been running away from? Is there a problem that you are shutting yourself in?‖ She talked about that a little bit--that she did feel she was keeping her mouth shut about this problem rather than talking about it.

Now I haven‘t given you the full dream. She was out jogging and she saw a mountain lion and it frightened her so she ran back to the house and finally got in the house. She threw the doors shut just as the mountain lion hit the front porch. And as she turned and looked out the window, she saw her brother standing in the yard. She was really terrified because he didn‘t see the mountain lion. So she opens the door to go help her brother and at that moment the mountain lion came and is about to bite her throat when it turned into a golden retriever. So when I ask for associations, I want to know ―mountain lion‖--she didn‘t have much to say about mountain lion; it‘s a scary animal. Golden retrievers--she loved them--she didn‘t have a whole lot to say about golden retrievers. But talking about her brother opened up this issue about what was going on in her family because the brother had been standing up to the family and she felt that she was running from it and hiding herself from it. Then by turning and looking, she realized that she was leaving her brother alone to deal with it, and that she had to get back and start dealing with it also.

ALEXANDER: Did she wake up from this dream? In other words, was it a nightmare?

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Did she wake up?

MURR: No.

ALEXANDER: Does Jung have the concept of ―anxiety dreams?‖

MURR: Oh sure. There are anxiety dreams, there are nightmares. Anxiety dreams are different from nightmares. I would say our attitude towards nightmares is that when having a nightmare, you wake up terrified. You wake up, and that it is presenting you with a life situation that you need to be terrified of. Something in your life is going on that‘s terrifying and you need to wake up to it. With a nightmare the conclusion to the dream—the lysis that I mentioned in the structure of the dream earlier-- is that you need to wake up. You are asleep on a problem; you‘re not paying attention to something.

ALEXANDER: So Jung would not view a nightmare or dream that wakes you up as a failed dream?

MURR: You mean in contrast to Freud‘s idea that the dream is protecting sleep?

ALEXANDER: Yes.

MURR: Well I find it interesting that Freud mentioned dreams where we have to go to the bathroom. We start dreaming it so that it doesn‘t wake you up; now it always wakes me up, I always end up waking up from those dreams. So I don‘t quite understand what Freud meant about that.

Jung does not have the theory that dreams are there to protect sleep. I think the REM studies also would not say that dreams are there to protect sleep, but rather that dreams are there because that‘s why we sleep. What REM studies are showing is that our deep sleep--our non-dream-state sleep--can be interrupted fairly frequently without causing any harm in our health or our psychological attitude. But if the REM sleep is interrupted, if we‘re not allowed to dream, then we wake up in the morning tired and irritated. In fact, they had to call off their first experiment because people were beginning to show psychotic symptoms when they interrupted people in their dream sleep--every time they entered into REM sleep.

ALEXANDER: How can we learn not to be afraid of nightmares?

MURR: We can‘t learn not to be afraid of nightmares. You have to be afraid of nightmares. The nightmare is there to frighten you. There is something in your life that‘s frightening, and you should be paying attention to it. You‘re involved with a man who‘s destructive and you need to get away from him; or you‘re about to do something that‘s going to be dangerous for you and you need to start paying attention to it, or your attitude. I mean some people lead pretty frightening lives. Men who refuse to give love to their family and are cold and distant and have nightmares that wake them up--that nightmare will continue until they change their attitude. And some people lead very

104 frightening lives, people who have never forgiven people, carry resentments and grievances against other people for years; it‘s like killing their lives. So the goal is not to stop being afraid of nightmares. That‘s like saying I should stop being afraid of rattlesnakes. If I know a rattlesnake is dangerous, then being afraid of it is a realistic reaction to it.

ALEXANDER: Years back I was in an automobile accident where I was the passenger and the driver was hurt pretty badly and I just walked away with a scratch. For weeks I did not want to go to sleep because I was having nightmares, but finally of course, I got so exhausted that I had to sleep and I managed to get through it.

MURR: Well those are post-traumatic stress dreams, whether they‘re nightmares or not. That is actually the way the psyche is trying to help you process this event. This is a horrible experience to be in an automobile accident, not be hurt yourself, and the other person is very seriously hurt. You get into some serious survivor guilt. Of course you‘re not guilty, you haven‘t done anything wrong, but nonetheless, humanly it‘s a very difficult situation. It must have made you feel helpless; there was nothing you could do about this situation.

Actually, now I‘m thinking of the dream series of a Vietnam vet that I heard. He was pretty crippled by his experiences in Vietnam and he kept dreaming this particularly horrific trauma over and over and over again. Each time was an attempt to help the ego grasp it.

I think sometimes things can happen to us that are beyond our human grasping. I don‘t know how you go through Auschwitz and come out with an ego that‘s still intact. I actually read a book by a rabbi who had been in a concentration camp and the rest of his life was pretty much a struggle to keep his faith and a struggle with God: what have you done, how could you let this happen, how did this happen, where are you in this process? That may also be a difference between Freud and Jung; that is, for Jung, happiness was not the goal. The goal is more that you‘re in touch with meaning and purpose.

Somebody who has been in Vietnam and had gone through all these horrific experiences that some of our young men faced is just going to have to pay for it. And he or she pays for it through bad dreams and other post-traumatic stress reactions. All of these things, the reliving and all, are attempts on the part of the unconscious to get the ego to be able to integrate it into the ego structure; something that really is beyond ego comprehension. We send these people out to face raw evil and then are shocked when they can‘t incorporate it when most of humanity has never seen evil in quite that negative form.

ALEXANDER: How does your dream work influence, impact or enhance a person‘s spirituality? Where do these things interface?

MURR: First of all, I always like to have a dream, especially if a person is working on a very particular problem. For instance, it can become an ethical problem. If we look at this dream of the mountain lion, it‘s an ethical issue about how my client

105 handles this family problem. There‘s money involved, it‘s partly her money, and so what should she morally be doing? That‘s part of her question: morally should she be going in and getting angry because it feels selfish because she wants to protect her own money? Or should she allow the family to do with the money what they‘re doing, which is going to perhaps hurt her financially in the future. What is the role she ought to be taking, is there some sort of guideline? And the unconscious has come up with an answer. It‘s making a judgment on the potential behavior. It‘s saying if you give into this anger which you think looks like a mountain lion, it‘s actually going to be a golden retriever and it‘s probably going to help your family because it‘s not dangerous, like a golden retriever. What also then happens is that instead of the ego being always in charge of life, we give room for this objective psyche.

Jung basically would say if there‘s any place that we can listen to God‘s will, it is through our dream life and through our inner world. Just as in the Old and New Testament, people always believed that God was speaking to them through their dreams. Jungians don‘t necessarily use ―God‖ language, but we would say that the self is talking to us all the time, correcting our limited ego view. We also say that the self has been projected onto all of the God images that cultures have. So when a culture comes out with the figure of Christ, that‘s the archetypal image, the image of the archetype of the self which is the central moving force.

In another culture instead of Christ they‘ve produced Buddha as the central, archetypal image. This is a projected form of this inner motivating force which is the source of our existence. You can call it ―God‖ if you want, or you can just call it, with non-God language, ―the self.‖ But it really doesn‘t matter because it doesn‘t change this incredible power that the self has.

It‘s a really humbling experience to move the ego aside and to allow the unconscious to have a say in what you‘re deciding. Very often we‘re making decisions that we think, ―Oh yeah this is really wise,‖ and then the dream comes along and says you should look at it a little differently and you may change your mind. Usually people do when the dream comes. People usually do change their attitudes, then change their minds, and then make different changes in their decisions.

Now, this is kind of a tricky thing, if I can go back to Mohamed Atta. I believe that this man felt high the morning he got into that 747. He felt like: ―I am filled to my fingertips with the will of the Lord and I am about to do something wonderful.‖ I don‘t see otherwise how somebody can kill himself and many other people without being motivated like that. But for a Jungian, the most important thing is the struggle to maintain your human position against these unconscious energies. Just as we don‘t listen to the unconscious often when we make human decisions, we also very often hand our ego over to the unconscious and let it just sweep us along.

This happens most commonly when we fall madly in love with somebody. We have this tremendous experience of—―oh my God, I‘m in love, I‘ve met the perfect person, my life is going to be perfect from now on.‖ I call that euphoria the ―champagne phase.‖ It lasts

106 for a while, until one morning you wake up and you go—―Oh my God he‘s just like everybody else, in fact maybe worse, I hate him, what am I doing?‖ That moment is when the humanness can enter back in and you decide what you want to do about this relationship.

I don‘t think Mohamed Atta ever allowed the human position to come in and realize, ―Do I really want to give up my life, do I really want to take the life of these other humans, what is going to happen to my wife and children?‖ Asking these really boring, ordinary, little everyday questions that would have made the difference between whether or not he flew that 747 into that building. He didn‘t ask those questions; he just let what he believed was ―God‖ push him into doing it. And of course how are we to know whether what was motivating him was God or not? I mean our human viewpoint is limited and maybe a thousand years from now we‘ll look back and say, ―Yes it was God‘s will, and it really was for the best.‖ But for me to make that kind of decision is pure, rank arrogance. So part of the spiritual path is to become more human, not less, and to become more aware of what is motivating us and pushing us.

So on one level we need to be throwing the ego position into question by saying that maybe we don‘t have all the answers in life, and I need to listen to what is being offered to me. Or on the other hand, maybe I have given up my ego position way too much, and I need to remember what my ego position is before I start acting on this. You know, we don‘t have to jump off of every cliff that‘s offered to us just because it‘s there to jump off. We also don‘t have to climb every mountain that‘s there, just because it‘s there.

I think also that people who have worked for a long time with their dreams like I have-- for 40 years now-- get a really strong sense of your life being connected to a flow which transcends the limitations of your ego. As you listen to the dreams and struggle with them, you begin to realize that there‘s a purpose and direction in your life that you really had not anticipated and you feel more grounded in your own reality. If you‘re a very insecure feeling person, it‘s a great comfort to feel that you‘re making your life decisions in conjunction with a greater energy. Dreams really do know more about life than we do, and when you work with dreams over a long period of time you really see that they are giving you information that you could not have possibly known without that dream information.

ALEXANDER: Dr. Murr, is there anything that you would like to add? We can take a few minutes and have some closing thoughts if you have something that you‘d like to sum up or add to what you‘ve already said.

MURR: I think what I haven‘t talked much about is the symbolic nature of dreams. Jung very much believed that every dream was a symbolic statement, and a symbol is something that represents a part of life which is ultimately unknowable. It‘s different from a stop sign for instance—that is a sign that instructs you to stop when you see this sign. If you hold up a cross in front of people they‘ll have all sorts of ideas of what it means, but ultimately for that cross to be still a living symbol for people, it should be touching in to psychological energies that they can‘t put words to. And every dream is

107 basically a symbolic statement because it‘s coming from this world of your unconscious that looks at the world just quite differently from the way our ego looks at it.

One of the reasons we put so much emphasis on the study of symbolism is so that when we see a dream image, we can have a sense of what it possibly would be referring to. For instance, if people dream of sexuality we usually don‘t interpret it sexually, we usually interpret it as getting to know something better. If you‘re having sex with somebody in a dream, we would suggest that you‘re getting to know this person at a deeper level rather than saying, ―You really do want to sleep with your grandfather.‖ Because you know that most people don‘t…

ALEXANDER: The moral of the story is ―Don‘t sleep with your grandfather!‖

(laughter)

MURR: No, the moral of the story is don‘t be horrified if you do have a dream that you are sleeping with your grandfather.

ALEXANDER: I like that. Dr. Murr, you are very knowledgeable. This has been a wonderful and informative interview…

MURR: Great.

ALEXANDER: and I want to thank you very much.

MURR: Thank you, it was fun to do.

This concludes On Good Authority‘s interview with Dr. Priscilla Murr. We hope you learned from this interview and that you enjoyed it. You may contact Dr. Murr at 512- 482-0074.

I need to say here that the views of our speakers are theirs alone and do not necessarily reflect the views of On Good Authority. On behalf of On Good Authority, this is Barbara Alexander. Thank you for listening.

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SPIRITUALITY IN CLINICAL PRACTICE

Interview #12: “ZEN and PSYCHOTHERAPY”

BARRY MAGID, M.D.

Interviewed by Barbara Alexander, LCSW, BCD

(Edited slightly for readability)

Barry Magid, MD c/o Ordinary Mind Zendo 272 W. 86th Street #8 New York, NY 10024 (212) 749-3430 Email: [email protected] http://www.ordinarymind.com/

Welcome to On Good Authority. I‘m Barbara Alexander. You are listening to or reading interview #12 of On Good Authority‘s program, ―Spirituality in Clinical Practice,‖ continuing education program from On Good Authority covering diagnostic and treatment aspects of this controversial and important subject.

There are a number of different approaches and sets of intervention strategies for incorporating the spiritual dimensions into our counseling and psychotherapy practices. In this interview we will explore one of the lesser known practices: Zen and how the worlds of Zen and psychotherapy can operate in harmony with each other. Both of these systems of thought address the problems of the human mind and human suffering. Ideally, by being able to transcend and overcome unwelcome thoughts, desires and beliefs, the Zen-oriented therapist is able to be deeply empathic with clients, without countertransference distortions, and has a greater capacity for tolerating disturbing affects and tensions.

Barry Magid, MD, is a psychiatrist and psychoanalyst practicing in New York City. He completed his medical studies at the New Jersey College of Medicine and currently serves as a faculty member and supervisor at the Institute for Contemporary Psychotherapy, and the Postgraduate Center for Mental Health, where he completed his psychoanalytic training. He is a Dharma heir of Charlotte Joko Beck and the founding teacher of The Ordinary Mind Zendo in New York City. Dr. Magid has published numerous articles within the psychoanalytic field of self psychology and is the editor of

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Freud‘s Case Studies: Self Psychological Perspectives, and author of Ordinary Mind: Exploring the Common Ground of Zen and Psychotherapy.

ALEXANDER: Dr. Magid, you are an unusual combination of having an overall psychoanalytic psychodynamic orientation plus being a Zen master. That is unusual, isn‘t it?

MAGID: It still quite unusual. I think more and more people have some experience in both areas, but it‘s still pretty rare to be fully trained in both disciplines.

ALEXANDER: Well, let‘s begin by talking about meditation and how is it that meditation would connect or not connect with various psychodynamic orientations?

MAGID: I think the difficulty is always in specifying which therapy and which mediations. There are as many different flavors of meditations out there as there are therapies. So you have to begin to specify what kind of meditation you‘re talking about, how it‘s organized and practiced and try to make some basis of comparison with different ways of conducting therapy as well, some of which will be very compatible and some will seem like they‘re very different indeed.

ALEXANDER: Why Zen as opposed to, let‘s say, transcendental meditation?

MAGID: The way I begin to organize thinking about different types of meditation is a broad distinction I call, ―Top Down‖ versus ―Bottom Up.‖ A Top Down meditation is one in which the meditation is an attempt to induce a particular state of mind or feeling, however that‘s conceptualized. It may be thought of very simply as becoming calmer or more peaceful, or may be thought about in ―high falutin‖ spiritual or metaphysical terms, inducing states of oneness or higher consciousness or anything like that. But what they all have in common is the idea that we‘re doing a technique or practice geared to creating a certain outcome.

The other way of approaching mediation, what I call, ―Bottom Up,‖ has to do with staying with momentary experience as it is, regardless of its content. In that practice, which, in Zen terms is called, ―just sitting,‖ we keep our attention focused in the present, but without attempting to steer that present moment‘s experience any one way or another. We‘re aware of thought but try not to obliterate thought. We may be sitting with restlessness, pain, anger, a whole emotional range, and we‘re not trying to directly get that into some desired peaceful or spiritual state at all.

That basic distinction I think corresponds to a basic distinction between a broadly defined psychoanalytic stance and a psychotherapeutic stance that is goal-oriented. I think of psychoanalysis in general as being an open-ended, non-goal directed inquiry into moment to moment stream of consciousness. Other kinds of short-term problem-oriented therapies tend to try to focus in on a problem and have techniques to deal with it. So one thing I‘ve said is about the difference between psychoanalysis and psychotherapy is that

110 psychoanalysis doesn‘t help anybody. It‘s not geared towards a particular helpful outcome, and I think that for me, then, a psychoanalytic approach that is open-ended and non goal-oriented meshes very well with a Zen approach based on Just Sitting. It has similarly has no particular outcome, but which is a practice of staying with whatever our mind is doing.

ALEXANDER: It seems to me that this sort of meditation could be quite uncomfortable. Is that so?

MAGID: Well it can be comfortable or uncomfortable. Lots of different things can happen, but what it involves is a willingness to pretty much let anything happen, including discomfort. In Zen, we do sit very still and for a long time so as to allow ourselves to have uncomfortable experience that we then bring into the practice.

I would say in general something like transcendental meditation, to the extent that I understand that, is geared toward sitting for shorter periods of time, bringing about sort of more calm or peaceful states, and being able to stay with those.

In general, those Top-Down practices I think of as ―trickle down meditations.‖ You want to get into a certain place during the meditation and then hope somehow that the effect of it trickles down into the rest of your life. The problem is this: what does that meditation do for you in the middle of your daily life where you‘re feeling frustrated or angry or upset with somebody. I guess you can say, ―Well, you just have to go meditate more until you don‘t feel that anymore,‖ but the Bottom-Up kind of approach gives you much more practice in sitting still and not reacting in the face of discomfort, whether it‘s physical or emotional.

ALEXANDER: Do you try to clear your mind, in other words: all the lists; all the to-dos. Do you try to get rid of that?

MAGID: No. I think the way we practice is to try to get aware of ―thought as thought,‖ to see that as recurrent repetitive things that just go on in mind. We might have a simple practice of labeling a thought, which simply means that if you are sitting and start thinking about lunch, just say to yourself, ―thinking about lunch.‖ It‘s drawing yourself back a step and seeing thought as ―process.‖ You don‘t try to make it go away; you just note that that is what your mind is doing and now it‘s just done it for the fourteenth time in the last twenty minutes. You just see how over and over again, the same few generic preoccupations may recur, and you don‘t try to make them go away; you let them pretty much go away, if they will, on their own. But the more you see them as something repetitive, the less you‘re drawn into the content and the more they get to be some kind of background noise that you don‘t pay attention to, very much like what it‘s like to sit in New York City. It‘s not completely silent. Wherever you‘re sitting, there‘s going to be some ambient street noise that creeps in and pretty soon, you don‘t make that go away but it stays on the shelf. It stays in the background and the more you watch the recurrent nature of thought, the more that doesn‘t go away but it sits on the shelf in the background. The difference between the street noise and the thinking noise becomes less

111 and less. They‘re just two things that are going on that you don‘t necessarily give much attention to.

ALEXANDER: How do you instruct people to begin this?

MAGID: Well, first I give people some instruction in a sitting posture. We try to find a reasonably stable, comfortable position, either cross-legged or kneeling -- this is a mediation tradition that comes out of Japan and we do keep some of those forms. I will help them find a position they can get in and stay in for, say, at least a half hour at a time,

Then the first thing I tell people to do is just sit completely still. That will be the one rule: don‘t scratch an itch; if something hurts don‘t shift to make it go away; if your foot falls asleep just let it fall asleep. Nothing terrible is going to happen to you in the course of a half hour, so the one rule will be to sit absolutely still, and the first time, I tell people, ―Don‘t meditate. Don‘t do anything at all except just sit there for a half an hour and see what happens, see what that feels like, see what it feels like to just go through the ordinary restlessness or distraction or racing mind of sitting there. This is because as soon as people begin to think about meditating they think, ―Oh, I shouldn‘t be thinking‖ or ―I ought be calmer,‖ or something; it immediately conjures up a mental state of mind they think they ought to be in. So I tell them to start, just sit, still concentrate just on that, that‘s our one instruction, and see what it‘s like. See what your mind does, see what your body feels like and leave it all alone, and most people survive that, although there‘s an initial fear of going stir crazy.

ALEXANDER: That‘s right. There is. There would be. Why do we all feel that way?

MAGID: I think it‘s very analogous to what happens when people try to lie on the couch in analysis at the beginning. They get unplugged from the ordinary cues and sometimes they can get very anxious about what it‘s like to be in this odd position.

ALEXANDER: For people who keep compulsively busy, that‘s a characterological stance, right?

MAGID: Yes.

ALEXANDER: Well, how do our characterological stances in life such as avoidance and this kind of busyness, how does that become a part of how we practice meditation and that parallels, of course, how we are in treatment as patients.

MAGID: That‘s right. I think that your characterological stance, your transference will show up fairly quickly in how you approach meditation or how you approach a meditation teacher, just as it does show up in a relationship to a therapist or analyst. People will immediately try to fuse on a technique to master. There are people who try to get good at it, whatever it is, as fast as possible. There are people who easily feel frightened or overwhelmed and think, ―Oh, I can‘t handle this, this is beyond me.‖ There are people who think that by doing it a certain way, they‘re going to get the

112 attention or approval of the teacher and that that‘s the important thing. There are people who feel as if they are sitting with some terrible flaw or problem in themselves and that this is going to make that go away, this is going to cure it once and for all. They get caught up in a fantasy of transformation whether they call it, ―Enlightenment,‖ or ―cure‖ and endlessly pursue that; they make a project out of it. So I think all the ways you can imagine a transference unfolding in a therapy session, unfold in a Zendo as well.

ALEXANDER: What about for the therapist? As therapists we pretty much sit still. How would this benefit a therapist per se?

MAGID: Well, I had a supervisee come in the other day and complain that he was feeling very helpless with one of his patients and I suggested that whenever we feel helpless, there‘s clearly some ―agenda to help‖ that we‘re not coming to terms with yet. The hard part of being a therapist is often the need to just sit still with someone‘s experience as it is and not be able to fix it, not be able to change it.

Often we get caught up in an explicit or implicit agenda. We think we‘re supposed to be able to get somebody from a to b, but often I think the deepest function we have is to simply stay with a person and allow them to go through what they otherwise would avoid going through, to just stay with it, not to change it or fix it, but to just let the person feel the vulnerability or the anger or the uncertainty that they spend most of their time trying to ward off. So we have to develop that capacity to just stay still with things as they are and watch out for our own agendas and our own self-image about helping.

ALEXANDER: That is really an important point I think.

MAGID: Let me read a brief case for you.

Some years ago I had a student who initially came to me for psychotherapy. She was a young woman in her twenties who came to treatment because of chronic depression. Her symptoms had become quite severe in her last year of college when she was working in relative isolation on an independent research project, and at around the same time, she broke up with her boyfriend. She had been doing better with the help of anti-depressants until recently when she lost her job and was once again on her own without any outside support or close relationships. Her parents were divorced and each lived in distance cities. Her father was a recovered alcoholic and she had recently become worried about the extent of her own drinking. She drank daily, especially in the evening by herself and drank to the point of passing out each night as a way of getting to sleep and escaping her loneliness. Her break-up with her college boyfriend fueled her view of her parents‘ marriage as a legacy of failure she was doomed to repeat. Likewise, she felt afraid she had inherited her father‘s disease of alcoholism. To go to AA would be a confirmation of her predetermined fate as a basically damaged human being doomed to repeat the worst of her parents‘ lives.

We struggled to find a way to address her drinking that did not feed into her sense of underlying damage. We talked about whether problem drinking was a disease or not, and

113 what other ways of thinking about it there could be. At one point she said with some resignation in her voice, ―At least I suppose it‘s better than being all moralistic about it.‖ I replied that actually I thought her drinking was a moral problem and that was the alternative to a disease model. I said, ―Morality was a matter of how we live our lives, what our values and ideals were, and what we did or didn‘t do to try to live up to them.‖

This discussion turned a corner in the treatment, from then on she began to think in terms of her own choices and agency, rather than picturing herself as the passive, resigned recipient of a flawed genetic and familial legacy. We talked about the feelings she kept at bay through her drinking and what it might be like to regularly face them sober. At some point, I raised the possibility that she try a daily meditation practice as a way to simply sit still with her feelings. Over the next couple of years she became a regular meditator and quit drinking without ever attending A.A.

However a new problem surfaced in her meditation. Once she began attending group sittings and especially during long retreats, she found herself subject to repeated bouts of intense sleepiness. At first we tried looking at is as another sign of avoidance, but that approach didn‘t seem to lead anywhere. Gradually she found herself slipping back into her old frame of mind: there was something basically wrong with her that was interfering with her attempts to be a good Zen student. After a while she consulted a neurologist and underwent sleep studies, which determined she had a form of narcolepsy. While her mind was actively thinking that she could stay awake, but any period in which her thoughts quieted down seemed to lead inevitably to her falling asleep. Medication helped somewhat but once again she was confronted with a diagnosis that seemed to undermine everything good she had come to believe about herself and her practice. The E.E.G. seemed to be telling her she would never enter into those special states of thought-free sumati that everything she read about said was the goal of Zen.

One way or another she just kept sitting. We talked about sitting as sitting with our bodies and minds just as they are, without any goal other than an honest acknowledgment of what each moment brought. She was forced to sit with a true attitude of ―no gain.‖ All her hopes for her practice had been thoroughly undermined by her neurological diagnosis. Yet she kept sitting, not knowing what else to do, somehow devoted to the practice even though she thought herself forever barred from what others around her would be accomplishing.

Then one day, after a weekend retreat, she went to a museum show of Calligraphy by old Japanese masters. Suddenly all her sense of damage dropped away. She was who she was, and in a strange way, that was nobody at all. All the old stories by which she had defined herself all those years suddenly seemed empty; just stories she no longer believed in.

After that, nothing changed. She still fell asleep sitting, but also everything changed and her problems were just problems, no longer evidence that proved there was something wrong with her. She found a new boyfriend, they fell in love and then a year later he left her. She cried but didn‘t feel it was her fault. It was a terribly painful experience, but she

114 was easily able to resist casting is as a chapter in the story of how she was doomed to repeat her parent‘s divorce. Clearly telling herself that old story would always be an option, but why go there?

I think it‘s an interesting case about what changes and what doesn‘t change, both in therapy and meditation. I‘ve often said that as a result of practice, problems don‘t disappear from our life, they disappear into our life. They become seamlessly part of who we are and what life is, and we don‘t get caught up in these stories of damage or blame. We just deal with them one thing after another. She both changed profoundly and, as I said, didn‘t change at all. All the outward things were much the same, but her whole orientation to them, the whole story she told, changed quite dramatically.

ALEXANDER: That‘s a very remarkable and interesting example, I think, of, in a sense, not making a production of a problem.

MAGID: That‘s right. We get very confused about what‘s supposed to happen and not happen and how to think about our problems, whether they‘re all supposed to go away or not, and whether their presence is a sign that something isn‘t working right.

There‘s a wonderful story I‘d like to tell about two contemporary Zen teachers in Japan. This was told by Uchiyama Roshi when he himself was an old man and teacher, and he spoke about his early days as a monk when he was in training with his teacher, Kodo Sawaki. Sawaki Roshi was one of the great charismatic Zen masters of post war Japan, a very powerful influential figure, and Uchiyama describes himself as a young monk, as a very shy, anxious, retiring person, but after he had been a monk for a few years with Sawaki, he got up the nerve to go ask his teacher whether he was really cut out for this and what he could expect. He asked, ―Master, if I practice really hard, really diligently for years, do you think I could someday become of strong a person as you?‖ and Sawaki said, ―Absolutely not. ―I was this way before I started practicing Zen. Zazen had nothing to do with it. Zazen is useless.‖ And Uchiyama said, as an old man, ―You know, he was right. Thirty years later I‘m still a wimp.‖

(laughter)

So there‘s a whole change in our notion of what changes and what doesn‘t, what‘s a problem and what isn‘t as we go along. But this notion that Zazen is useless, I think, is very profound and a very deep teaching that we have trouble really integrating into our ordinarily therapeutic model.

Sometimes I say that practice is giving up the pursuit of happiness or that enlightenment is thoroughly abandoning any notion of enlightenment. We have to get away from any sense of trying to get from here to there, and if we really do that, we profoundly change. That‘s the paradox of this business.

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ALEXANDER: It is a paradox and I can imagine that there are people now listening to this interview saying, ―Well, if it‘s useless, why should I bother with it? Why should anybody bother with it?‖

MAGID: A former Abbot of the San Francisco Zen Center said, ―We sit simply because we‘re devoted to sitting, there‘s no goal or end that doesn‘t make us one way or another.‖

In part, I‘m reminded of a story. My mother had a pet theory, as a music lover, that conductors lived a long life because they were always standing up waving their arms and got all this wonderful aerobic exercise as conductors. I think she was thinking of Toscanini and Bernstein -- that generation. Whether it‘s true or not, we would think it very peculiar if a conductor said he went into conducting because of all the cardiovascular benefits! We expect someone to do something like that out of devotion for the practice itself.

There‘s a lot of work going on now where we people are taking monks into labs and hooking them up to E.E.G. machines and blood pressure cuffs and all this and trying to demonstrate what is the effect on the brain or on physiology and all of this. Well, it may or may not have those effects. I suspect if you found people who listen to Bach an hour a day, it would probably do something to their E.E.G and their blood pressure, but we would think it very strange if someone said, ―Oh I love Bach for how calm it makes me,‖ or ―what it‘s done for my blood pressure.‖ Would we think of that person as a real music lover? Would you keep doing it if it didn‘t have that effect?

It‘s very strange in a way to turn these things into techniques and I suppose I think what, at the bottom, makes meditation a religious practice is precisely the extent to which we don‘t turn it into a technology; we don‘t turn it into a technique. We do it simply because we‘re devoted to doing it and that it reveals or expresses something about what it is to be a human being the same way music does, or art does. They don‘t have any function or use outside themselves, but it‘s a very human thing to do and somehow, it‘s also a very human thing to meditate.

ALEXANDER: In your book, you give an example of two analysts beginning and learning to meditate, beginning to practice meditation, and the difference between them, which I think is very important for therapists to understand, not precisely because of the meditation but because of the awareness of things that we bring to our own work as therapists. So could you just review that briefly?

MAGID: Why don‘t I read it for you?

ALEXANDER: That‘d be great.

MAGID: ―Let us imagine two young analysts who have taken up meditation. Analyst A has been sitting at the local Zendo for a few years. One day while counting his breath, he gradually feels like he‘s no longer ‗doing‘ the breathing but is ‗being

116 breathed,‘ and suddenly he has the sense that he and everyone are one body. The world is a living unified whole. Everything is perfect just as it is. Though this realization lasts for only a few minutes, when he gets home at the end of the day, he‘s convinced he‘s had a great mystical experience, the kind he‘s always hoped to achieve as the result of his sitting. He feels different now and special. He feels a certain condescension, even pity, which he calls ‗compassion‘ for his fellow meditators and analysts who have never had such an experience. Because of his new insight, he‘s now more convinced than ever of the rightness of his clinical interpretations, and begins to believe that his patients partake, in some subtle way, of his newfound openness and perfection, just by being in the same room with him. Convinced of his own essential goodness, he increasingly has trouble imagining that anything he does could have a negative impact on them, and blames their failure to improve on their own entrenched dualism. From now on when he meditates, he puts all his effort into trying to recapture the feeling of oneness he experienced on that momentous day.

Analyst B has been meditating for some years as well, but never had a dramatic experience like the one analyst A rushed to tell him about. His own sitting, instead of giving him any blissful sense of oneness, has only made him more aware of his own anger and anxiety. He has seen how much he tries to do everything perfectly in the Zendo and how frustrated he can get by his limitation. He notices how his shoulders always seem to tense up when he sits rigidly, trying to be the model student and to impress the teacher. Gradually he comes to realize that everyone in the Zendo is struggling with the same problems and the same pain. Instead of feeling special, he begins to feel more like part of the group, supporting and supported by everything that takes place around him. With his patients, he finds he no longer divides them into two groups: good analyzable prospects; and difficult if not impossible borderlines. Now he empathically resonates with a greater range of human suffering. He‘s more inclined to see everyone who walks through the consulting room door simply as a fellow human being. The differences between himself and his patients no longer seem so profound and relevant. It‘s not that he‘s become oblivious to their difficulties, just the opposite. He‘s more willing to engage with whatever arises in himself and others without pejorative labels or judgments. Differences have stopped making a difference.

In a way, it doesn‘t matter what you call analyst A‘s experience of oneness, whether you say it‘s regressive or not. What does matter is that he immediately incorporated it into his own self-centered view of things, his special experience confirmed him as a special sort of person. Paradoxically, his realization of oneness only increased his sense of his own difference and his separation from everybody around him. Whatever sort of oneness this was, it didn‘t diminish his dualistic thinking in his day-to-day life.

Analyst B, on the other hand, progressively became aware of the barriers he habitually set up between himself and others, and as a result, these barriers gradually and un- dramatically began to come down. He never had a mystical experience, and in his life, on the surface wasn‘t so different from that of his colleagues who never meditated, but he began to function less and less from a self-centered, dualistic perspective.

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So I probably should confess that both of those analysts are me at different stages of things! I tried to draw them apart to illustrate different things that could happen and how you could use these different kinds of these experiences well and badly. ALEXANDER: I just want to highlight this for our listeners because, as therapists, boy, can we fall into the trap of thinking that we have all the knowledge, and that that does separate us from our clients as opposed to seeing us as working together with our clients.

MAGID: That‘s right. I mean, I think you hear so much about oneness in mystical and spiritual literature, but if it becomes an experience that is uniquely yours that separates you out as a special person, what kind of oneness is that, right? What really should be going on in this practice is something that breaks down barriers not that sets them up, that makes us more ordinary not more special.

ALEXANDER: That‘s wonderful. Before we go into the final example that you‘re going to read, is there any other advice or any other thoughts that you‘d like to share with us?

MAGID: Well, I think we need to pay attention to the characteristic ways that both therapy and meditation can succeed and fail. On the therapy side, I think it‘s too easy to get stuck in a process of endless fixing. Therapy can focus too much on problems and damage and become an endless, Sisyphean task, something that will never be completed, that there‘s always more to uncover, more to work through, that somehow, nothing will ever get undone in that early trauma, once and for all.

Therapy can lose track of basic alrightness and a basic sense of, ―We just have to live as people as we are.‖ We don‘t have to be stuck in an endless process of self-improvement.

On the meditation side, you can get a similar problem if instead of trying to erase some damage, you endlessly pursue some idealized or transcendent enlightenment experience that you think is going to make you ―super‖ human instead of more human.

The other big danger that I see a lot in meditators, and in patients have come to me having had meditation practices, is too often they get caught up in the idea of meditation or spirituality as trying to make them ―good people,‖ or not going to be angry or selfish or upset. What happens is that they really turn their meditation practice in an attempt to ―bottom-ize‖ if not castrate themselves, that they‘re going to do this practice that will keep them from ever getting angry, it will make all the messy feelings of sexuality and anger, self-assertiveness go away, and the practice ends up to be one of self –effacement and resignation. This is a very dangerous byway that it can flow into. Sometimes people get stuck thinking they should be selfless in the sense of serving everybody else and they do it because they don‘t know how to deal with their own needs and the legitimacy of what they want and what they desire. Those people sometimes end up developing a practice of ―saving all beings minus one,‖ and they really need to look at the way their practices have become quite masochistic.

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So therapists have a lot that they can bring to a meditation practice in an awareness of how things they can go awry, and how meditation can be inadvertently put in the service of denial and repression. From the meditation side, I think it can bring a lot to therapists in the sense of establishing a feeling of basic alrightness, that we don‘t have to fix everything, we can really leave things as they are and that‘s okay.

ALEXANDER: Thank you. Now, I‘d love you to read your chapter, ―Sitting with Sam.‖

MAGID: Alright. ―After I had been a parent for all of three months I felt I was enough of an expert to give a talk on the subject at the Zendo. Not that I was an expert on babies; those few months taught me one lesson after another in how little I knew. In fact, one of the reasons my wife and I felt comfortable leaving Sam in the care of various babysitters a couple nights a week was that immediately it became obvious how much more experience they had with babies than either of us.

No, what I‘ve become an expert in is the many ways a baby can make a parent feel: proud; loving; exasperated; and so forth, and it‘s all those feelings, at one time or another, I‘ve had to sit with when sitting with my son. I say, ―Sit with him,‖ because of the particular role within the family I was assigned in those early days. My wife, who was staying home and breast-feeding, naturally bore the brunt of the work. I changed my share of diapers, of course, but there‘s no denying that she‘s the one who had to deal with him most of the time.

My special role came in the evenings late at night, particularly when Sam was having a rough day maybe because of gas, or over-stimulation or whatever, and was crying inconsolably. When nothing seemed to quiet him down I took over and held him in my arms and just sat with him while he cried. What I learned was that at some point, I had to stop trying to calm him down or make him stop crying, and be willing just to hold him while he went through whatever it was that he was going through. Sometimes I would gently chant, ―Moooooo.‖ I‘m told low droning sounds, like a vacuum cleaning or running a tap can quiet a baby, so maybe Sam found ―mooooo‖ soothing. Anyway, it calmed me down and helped me sit with him. You might say that I could just have well put Sam in his crib and let him cry, but somehow I think it made a difference that I was holding him, even when it didn‘t seem to do much immediate good.

I think what we‘re practicing in the Zendo is something very similar. We all come in with one kind of distress or another: pain; confusion; buzzing thoughts; and what we do is we sit with it. The structure of formal sitting, the posture of our bodies, our motionless silence, the quiet presence of those around us all hold us while we sit with our distress. And just as there is a difference between letting a baby cry all alone and holding him, so it‘s what makes a big difference in our lives whether we thrash around alone with our pain, or develop a formal discipline, either Zazen or psychoanalysis, that allows us to contain it, observe it, and sit still in the midst of it. We learn to stop our frantic efforts to escape or fix our distress. We watch the thoughts of blame or explanation that arise around it and we simply try to feel it and be with it. Practice becomes a container for our

119 pain and gradually, who we are becomes as much about being that container as it is about being preoccupied or identified with the pain.

Eventually Sam would quiet down and fall asleep, sometimes within a few short minutes, sometimes only after being up most of the night. Whatever the night brought, we went through it together.

Thank you.

ALEXANDER: Thank you, Dr. Magid.

This concludes our interview with Dr. Barry Magid. To order his book, Ordinary Mind: Exploring the Common Ground of Zen and Psychotherapy, call Wisdom Publications, 617- 776-7416, or order from amazon.com. In addition, Dr. Magid may be reached at 212-749-3430.

This also concludes our program on ―Spirituality in Clinical Practice.‖ We hope you have enjoyed these interviews and have learned from them.

As always, I need to say that the opinions expressed by our speakers are theirs alone and do not necessarily reflect the opinion of ON GOOD AUTHORITY.

Until next time, this is Barbara Alexander. Thank you for listening.

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