by Richard B. Patterson

For decades, spiritual concerns were not considered appropriate for the enterprise of psychotherapy. This was most likely due to the desire of many practitioners to have psychotherapy viewed as a scientific and medical enterprise. Nonetheless, spiritual concerns persisted in demanding the attention of therapists. The humanistic movement in psychotherapy with its emphasis on acceptance opened doors as did the spiritual reflections of theorists such as Viktor Frankl.

In the '70s and '80s, a renewed interest in the works of Carl Jung as well as a greater overlap between psychotherapy and the12-step program of Alcoholics Anonymous also fostered greater openness. The dialogue between spiritual writers and psychotherapists is still at times strained, but persons in need of help with spiritual matters are finding greater openness in the offices of secular psychotherapists.

What types of spiritual issues might be relevant for the enterprise of psychotherapy? Viktor Frankl sensitized therapists to the importance of a sense of meaningfulness in one's life and saw the involvement of meaninglessness in much modern depression. Issues relating to midlife crisis are certainly grist for the psychotherepeutic mill and certainly incorporate spiritual dimensions. We are understanding more about the profound spiritual dimension to post-traumatic stress. There is even research under way at the University of Wisconsin on the process of forgiveness, a spiritual theme once regarded as matter suitable only for the office of a religiously affiliated person such as a minister or rabbi. Other spiritual issues which appear more and more relevant to the activities of secular psychotherapy include the spiritual needs and fears of the terminally ill and the one Jobian question which therapists still tend to dodge: "Why me?"

On the other hand, we know more and more that, as therapists, what we say and do are greatly influenced by who we are. Thus, our response to spiritual issues will be shaped somewhat by our own spiritual beliefs. Further, more and more counselors approach their enterprise from a specific set of beliefs which they view to be correct. Thus, a client wishing to discuss spiritual concerns might be met by a therapist eager to quote from the Bible or eager to hang a crystal around the client's neck.

How then can the consumers of psychotherapy who wish to feel free to discuss spiritual issues be sure that they will find a therapist open to the discussion on the one hand, yet not in a hurry to profess a specific set of beliefs on the other? The key is to be willing to ask questions. Here are a series of questions clients might want to consider asking a prospective therapist at or prior to the first session:


"Are you open to looking at spiritual issues with me? For instance, if I were to think that my image of God is getting in the way of my growth, is that something you would be comfortable talking about with me?"
"Do you counsel from a specific religious perspective? If so, what?"
If you approach a therapist with a known religious affiliation, you might want to inquire about their willingness to help you with an issue not commonly accepted within that religion's doctrine. For example, I understand you are a Roman Catholic. "Do you feel you can work with someone who is gay without trying to convince them they need to become heterosexual?"
By the same token, if you wish to counsel with someone who incorporates a religious perspective, you might want to ask something specific such as " Do you counsel from a Biblical perspective? If not, can you recommend someone who does?"
If you are exploring a religious perspective or are involved with something esoteric, the following question might be important: "Are you familiar with (religion or spiritual theory)? If not, are you willing to learn a little about it so that you can help me?"
Certainly, too, if you have specific beliefs which you feel need to be shared by the therapist for you to be comfortable then the following might help: "Do you believe in (e.g., reincarnation, Jesus Christ as your personal Savior, the power of crystals, etc.?" Keep in mind, though, that the fact that a therapist may not share your belief does NOT mean that you can't work together. What may matter most is an atmosphere of safety and acceptance.

Dialogues of a spiritual nature have been some of the most rewarding therapeutic dialogues I have had with clients over the years. Persons of a wide range of religious perspectives have enriched me greatly through their sharing of spiritual struggles. I am thankful that I ignored advice I was given years ago when I was a therapist-in-training dealing with a man who was afraid he was going to hell. I was advised "Refer him to the chaplain."

As a therapist I am neither a theologian nor a scholar of comparative religions. I am merely a fellow traveler on a spiritual journey. Psychotherapy remains for me a vital option for enriching such journeys.


Richard B. Patterson is a clinical psychologist in private practice in El Paso, TX. He is the author of three books on psychology and spirituality.