Religion In The Consulting Room


Religion poses a big problem for psychotherapists and patients alike. What is the place of religious belief in the consulting room? How can patients explore their religious emotions and beliefs in safety knowing that they will not be threatened? What sense can therapists make of this within the remit of the work that they have contracted to do? These questions can be understood better if we consider them from a historical perspective.

As far back as 1949, Paul Diel, a French psychoanalyst, wrote a book called Psychoanalysis of Divinity. He said:

'History teaches us that attempts to find scientific solutions to problems often come out of intense speculation and emotional turmoil. In this way we can see how chemistry has come out of alchemy and astronomy out of astrology. Following in this general line, psychology became a scientific discipline by distancing itself from moral and metaphysical speculations. Once a science has developed enough, it will turn back to the point where the split occurred. Thus chemistry faces alchemy when it turns one substance into another. Astronomy faces astrology when it is asked to explain the effects of the phenomena they observe. Psychology faces metaphysics when confronted with the meaning of life.'

Some of the seminal works of psychoanalysis bear witness to Freud's struggle to distance psychoanalysis from religion. A historical remnant of this tension is the implicit assumption held today by most psychotherapists that religious experience, i.e. the belief in God, or in the transcendence of being, is at its best a sublimation of lower instincts and at its worst a pathological evasion. If we are to examine this dimension, we need better tools that are devoid of affirmative and negative statements. The late Dr Wilfred Bion recognised this problem and left us a warning:

'The scientific, the psychoanalytical view of God can in no way describe the reality of religion, but flattens out religious dread, or religious love or religious hate, to a point where the individual cannot feel awe or dread, tremor or stupor. This is why modesty is becoming to the analyst, arrogance is not.

'However long we live we cannot possibly as individuals experience events such as those recorded by a few, mobilised from the whole of the human race, who in spite of differences of age, religion, race and language are all in agreement.'

When psychotherapists are faced with the problem of religion, they are confronted not only by patients who come from conventional religious backgrounds but also by people who experience spiritual thirst and have no adequate vehicle of expression. Can we recognise this thirst for what it is and reflect it back to the patient or shall we translate it into more familiar categories?

Before one can understand the religious phenomenon, one has to be able to recognise it when it is presented. The only way to recognise it is if we are open to the possibility that it exists. This can pose a problem to people educated in a secular society - it goes against the grain.

When I decided to explore the religious dimension, I found it necessary to adopt four basic assumptions:

a) I accept that a person has a metaphysical level;

b) I accept that a person can experience metaphysical states;

c) I accept that this metaphysical dimension is present in the consulting room;

d) I accept that we can only investigate this dimension as we become aware of it.

These principles raise the problem of how we are to understand the metaphysical level. Looking at this situation from a religious vertex, we can see that there is a broad consensus among religions: they all recognise that man has three levels of being: a physical, a psychological and a metaphysical. These levels have their being in man and are interacting within him at all times. The physical level is the world of the body with its organs and the five senses: sight, sound, taste, smell and touch. This world operates under specific laws that pertain to this level. The psychological level is the world of feeling and thoughts - a world conscious and unconscious. The psyche constantly interacts with sensations that emanate from the body, transforming them into psychological meaning. It is a world in movement; the laws that govern these two levels are space and time. The metaphysical level: this is the world of infinity and eternity - a world before space and time; a world in stillness; our cosmic background.

The psychological correspondence of this level can be traced back to the foetus and the new born baby. Early experiences of undifferentiation and oceanic feelings begin to shift as the individual starts living, i.e. experiencing time and space. In his interactions with his surroundings a process of individuation and separation starts to take place, which is the foundation for the emergence of the individual's sense of 'I' - his identity. This process represents a movement of consciousness from a general state to a focused one which we call self-consciousness, and it is the foundation of the psychological processes of separation and individuation.

Recognising a metaphysical level opens the way to exploring man's spiritual dimension. The desire and the need to understand the meaning of life is present in all of us. Homo sapiens - man - the knower - has the ambition to know the All, which is not the same as knowing it all.

Professor Stephen Hawkins in A Brief History of Time ends his book saying:

'Up to now most scientists have been too occupied with the development of new theories that describe what the universe is to ask the question of why. On the other hand, the people whose business it is to ask why, the philosophers, have not been able to keep up with the advance of scientific theories. In the 17th century philosophers considered the whole of human knowledge, including science, to be their field and discussed questions such as Did the universe have a beginning? However, in the 19th and 20th centuries, science became too technical and mathematical for the philosophers or anyone except a few specialists. Philosophers reduced the scope of their enquiries so much that Wittgenstein, the most famous philosopher of this century, said "The sole remaining task for philosophy is the analysis of language".

'However, if we do discover a complete theory, it should in time be understandable in broad principles by everyone. Then we shall all be philosophers, scientists and just ordinary people, be able to take part in the discussion of the question of why it is that we and the universe exist. If we find the answer to that it would be the ultimate triumph of human reason - for then we would know the mind of God'.

The ambition to find the meaning of life and existence is common to science and religion. Meaning lies at the root of what I call the spiritual dimension; man struggling to make sense of the All which is different from man's attempt to understand everything that is presented to him.

This psychological area is not usually on the conscious surface of the mind. People are too busy living, making sense of their thoughts, their feelings and their actions. The fact that something is not visible from the surface doesn't mean that it doesn't exist. It is a part of man's unconscious and as such has the potential of being brought to consciousness when one focuses on it.

It is difficult to explore this area within oneself or with our patients because in order to do so we have to turn the world upside down: we must stand Descartes on his head and change 'I think therefore I am' to 'I am therefore I think'. By doing this we open a field of investigation by allowing for the possibility of transcendence. To navigate through this world, we need a compass to guide us as there can be a fine line dividing a genuine metaphysical state and what we call madness. I use as my guide the religious dictum 'By their effects you shall know them.' What is the effect of spiritual beliefs on the patients? Does it give them strength, meaning and purpose? Does it deepen their understanding of their life and their place in the world? By extension this means that when I explore this dimension, I leave out trying to attribute meaning to the causes of the experience. I look at its effects in the hope that they can shed light on the meaning of the experience to the patient.

I will turn to a case study in which the religious aspect played an important part in the outcome of the analysis.

This patient was referred to me by a colleague because he was experiencing problems in his work and in his marriage. When we met, Mr J was in his mid twenties. He was tall, thin, well-dressed and wore large glasses. He seemed aloof, answered questions with great care, measured emotions in terms of percentage points and seemed particularly anxious if he got confused.

He met his wife in his teens and they have remained together ever since. During the early stages of the marriage they had problems in consummating it. At this stage they were helped by a marital counsellor who subsequently referred the wife for individual psychotherapy. Two years later Mr J decided that he too needed psychotherapy.

Mr J is the eldest of three children. He has two sisters younger than himself. He described his parents as having a good and stable marriage; his father overpowering, his mother rather subservient. He was sent to a good public school but he experienced it as barren; he came out of it with no academic achievements. As he wasn't good at sports he always tried to avoid them and made a few superficial friendships to pass the time.

When school ended his father wanted him to pursue further studies, but Mr J refused to comply. His father employed him to work in the small family business where he remained for some years. His experience of this time was that he was being underpaid and exploited. He felt his father was driving him too hard and was very dogmatic. He often used to get caught up in old family feuds that had nothing to do with him. During this period he met his future wife, a young lady, who belonged to a powerful family from another country. They decided together that it would be better if Mr J became independent from the family and they set up their own business along the same family line. This business had survived and provided them with a modest income.

He described himself as a once a week Jew. He kept a Kosher home (this means a ritually clean home as prescribed by Jewish law) for no reason other than that his parents and grandparents had done so. The couple would light the candles on Friday nights and he would go out to work on Saturdays. Mr J would go to synagogue three times a year for the High Holy Days with his father. He found his Judaism as unsatisfactory as school and work.

In the early stages of his analysis it became apparent that Mr J was fighting a battle with his father. He was trying to separate from him and find his own identity. He was obsessed by this father who 'took it out on him 99% of the time'. The preoccupation at this stage was mainly concerned with finding out who he was as he felt torn between the pull of his family and the powerful family of his wife.

He and his wife were inseparable. They lived and worked together. He described his marriage as a happy one. They had been together for nine years; his wife was very special and he loved her very much. He experienced the early sexual problems of the marriage in two ways: at one level he explained it all very rationally, saying that it was due to lack of knowledge and that he took it as a learning experience. On an emotional level this initial impotence had shaken him, increasing his insecurity about his potency as a man. These feelings got entangled with early experiences of envy and rivalry which he had felt towards his sisters as he competed unsuccessfully with them to gain his mother's attention. In this stage I experienced Mr J's relation with me as guarded, distant and polite. The things about him that struck me more were the high value he placed on rationality, his emotional co-operation and his eagerness to change.

Some time into the analysis his wife left her job and left the firm in his hands. He started separating from his two families and he sold an expensive car that he was driving and that he couldn't afford. Of this he said that he wanted a suit that fitted him as the one he was wearing was too big.

The process of separation was also taking place in the consulting room where he was able to admit to a fantasy that he had had about me since he first came. He thought that I might have been employed by his wife's family to interfere in the marriage in order for them to gain control over him. This opened the door to explore his ambivalence towards me and strengthened his trust in the safety and privacy of our work. He had found in the consulting room a place of his own, his own space where he could explore different parts of his personality that had been repressed a long time ago. As this realignment was taking place inside him, the way he related to the world changed - the discovery of this new space with me, led him to discover the wider world. The wider world had never been part of Mr J's perception. He was totally unaware of it and I think this got entangled with his extreme physical short-sightedness. When he started realising this new dimension he looked like a man waking from a long dream and discovering the world. As he recovered his own space he could recognise space around him; the others came into focus as his horizon line expanded.

One of the most important others that Mr J had in his life was Granny, a Jewish lady in her eighties with no family of her own. He first met Granny superficially when he was a boy and later got to know her well while he was working for his father. Granny was one of the firm's special customers. Granny and Mr J became very close friends with a strong bond between them.

As time passed Mr J became Granny's protector, the only person she really trusted, and Granny became Granny his adopted grandmother. When he met his wife she was immediately accepted as part of the group. They formed a little adoptive family, a family of their own under their control.

At a certain point in the analysis Granny got ill and she died a few months later. During her illness Mr J remained very close to her, organising what she needed at every step of the way and visiting her daily until the day she died. In death Mr J showed Granny the same devotion he had shown her in life. He organised her funeral and ensured that she was buried in a plot next to her mother's grave - Granny had reserved this space many years before.

The heart of the Jewish funeral service is the recitation of a prayer called Kaddish, a prayer in which God's name is sanctified. The laws that govern mourning establish that the prayer be recited at the funeral and every day for a year in the presence of nine other men. Ten men together form a Minyan, an important unit of Jewish prayer. The Kaddish is usually said by the deceased's surviving male children. Granny had no children: Mr J, her adopted grandson, would say Kaddish for her. He discussed this with the rabbi who told him that the law says: 'As long as the parents are alive a man needs their consent before he can say Kaddish for anyone'. As his father refused to grant it he searched for a group of devout Jews who undertook to perform this religious duty on his behalf. The death and the funeral marked his first encounter with his conscious Judaism and a good introduction to the intricacies of Jewish law.

Granny's will stipulated that a large portion of the fortune was to be distributed among Jewish charities in Israel. She left the decision of where the money should go to Mr J's discretion. The responsibility about this money weighed heavily on him. He wanted the distribution to reflect the efforts that Granny had to make to earn and preserve her capital. How could it be divided in a way that would do the most good? Before deciding he embarked in a long research of the world of charities, what they represented, what they did and how they spent their money. This research opened another dimension of his Judaism, namely the needs of Israel.

What I see as the second stage of his religious journey started with a blow delivered by fate. Some two years into the analysis, after trying unsuccessfully for some time to have children, he discovered that he was infertile. The shock of this realisation made him at first turn towards his God and question him in dismay. 'What kind of God are you if you must visit this upon me? The therapy then moved on to an attempt to understand the meaning of his infertility. He studied the biological aspects of the problem to a point where his knowledge about it impressed his own doctors. He explored with interest the psychological meaning and implications of his symptom in his four sessions a week. And last but not least, he studied infertility from a religious point of view by reading a great deal and consulting with rabbis and orthodox Jewish scientists.

He believed strongly that in order to get a complete picture he had to try to see it from all three levels.

A natural progression led him to the options that were left open to him. He and his wife could either give up their ambitions to have a family with children, or they could adopt or they could opt for artificial insemination. As you can probably guess, he now started studying in great detail each of these options from a physical, an emotional and a religious point of view. After exploring all the pros and cons, Mr J was facing the decision of what to do, what road was he going to take. At the time, I remember interpreting that he seemed to be using the consulting room as the place where his own laws, the real Halah (law), was being defined. He experienced the therapy as his own place where he could bring and sort out the confusion of his own thoughts and feelings and then plan his actions logically. Logic was very important to Mr J and 'logicalise' was a word very close to his heart.

As Mr J's analysis progressed, his interest in Judaism and in his Jewish roots increased. Judaism meant to him that God is always present in the world and in his life even though, at times, He might be seen only as a theoretical possibility. He started to find out about the meaning of the religious rituals he and his wife had been performing all these years. When the empty rituals acquired religious meaning they came to life by appealing to his intellect as well as to his emotions. As understanding of what he was doing religiously deepened, he felt that it was important that his Judaism should be an adequate expression of his feelings and understanding at that point.

This inward process was accompanied by an expansion of his focus of interest brought about by his active exploration of the Jewish community. As time passed he became more observant. He valued his Judaism highly and there was always present a sense of wonder and enjoyment in the development of his religious life.

Mr J believed seriously that it was important to try his best in everything he did. This included in some fundamental way to do his best to understand who he was. He treated his therapy in the same way as he treated his religion. He gave it the same respect and serious attention. He would often comment that analysis is not different from religion as they both shed different light on the same problem. They complement each other.

I have paid particular attention to the evolution of the religious dimension of this case because it presents the therapist with a problem. The patient is looking for a higher or deeper meaning to his life and believes that analysis is only part of the answer. This understanding led him to believe that there is more to life than meets the therapist's eye; another dimension, the spiritual one. As psychotherapists we do not know whether this is true.

The only way to deal with this material, as with any other, is to explore it before attempting to explain it. To explore means to go in. It implies being able to identify with the patient. This is what is called empathy. But it is also necessary to detach oneself from that identification in order to be able to observe the patient with discernment. With the best will in the world it is still difficult for therapists to deal with religious material other than as superstition or magic. It is always possible to interpret religious experience as an attempt on the part of the patient to split off parts of himself and make them inaccessible to the therapy.

Making it accessible depends as much on the therapist as on the patient. This requires openness to this dimension and the modesty it takes to say: "I don't know." "I don't know the causes but I am interested in what you are experiencing." "I will listen to what you tell me with care because I am interested to know what you think the causes are." "I will observe how all these things affect you and I will tell you what I see." "I hope this will help you to continue making up your own mind."