Psychology: Psychotherapy and Religion

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Historically, the relationship between psychotherapy and religion has been strained, because until recently it has been dominated by psychoanalytic theory and has turned on that field's conceptualization of illusion. Influenced as it is by the psychobiological origins of psychoanalytic theory, psychotherapy traditionally has considered religion an illusion in a strictly pejorative sense. Only relatively recently have many psychotherapists come to understand that illusion is a psychological need and that, as such, it can be healthily enjoyed in a socially beneficial way or distorted into pathology, just as any need can be. Religion has defensively reacted to psychoanalysis's largely negative consideration of it by campaigning against psychoanalysis, ignoring it altogether, or prematurely incorporating its theory. Understandably, religion has bridled at being considered merely illusory, for this consideration inherently denies the reality of religious experience. Often the psychoanalytic consideration of religious material has used a methodology based in nineteenth-century physical science that, because of its own assumptions, makes study of religious experience impossible. The scientific origins (some would say aspirations) of psychoanalysis have enabled the field to lay claim to a position of objectivity, which must then see religion experience as illusory. Fortunately there have been positive developments in the relationship between psychotherapy and religion: Psychotherapy has begun to appreciate the psychological and cultural role of religion, and religion has begun to utilize psychotherapy more appropriately and less defensively. This article examines the main features of this developing relationship.

Psychoanalytic Theory

Any consideration of the relationship between psychotherapy and religion must start, of course, with the work of Sigmund Freud (18561939). And there the difficulties also begin.

Freud and illusion

It is a testament to Freud's greatness that readers are frustrated with him for his shortcomings, which are clearly evident in his consideration of religion. (His shortcomings in his attempts to understand women and female experience, another glaring area of difficulty, are beyond the purview of this article.) Regardless of his greatness, the limitations of his era's scientific methodologyespecially its psychobiologyand his own personal prejudice against and ambivalence toward religion combined to make it impossible for him to study religion objectively (i.e., in a way which would grant credence to others' subjectivity). Freud was able to see clearly the religious pathology in individual cases of neurosis and the social hypocrisy that probably has always been a feature of organized religion, but it is a deep irony that the man who cleared the way for the recognition of the developmental interrelation of pathology and health was not able to apply his own discovery to religious experience.

In numerous works, but nowhere as clearly as in The Future of an Illusion (1927), Freud considers religion as illusion. He contends that religion originated in early humanity's (and continues to originate in the child's) primordial fears and need for help. The idea of God is the psyche's projection onto the cosmos of infantile, unconscious wishes for omnipotence and protection, an effort to control the cosmos's impersonal harshness by personalizing it as a father-god. God is therefore only a psychic phenomenon, the product of wishful thinkingin short, an illusion. For Freud, then, illusion is a pejorative concept, an adaptation that, if possible, should be overcome in favor of facing reality without illusion. Although Freud does distinguish between delusion and illusion (the former definitely a false belief and the latter a belief that, whether true or false, is arrived at independently of rational means), it is nonetheless the case that by the strictures of the nineteenth-century scientific paradigm that Freud employed, religion is false because it is not real.

Psychoanalysts and other psychotherapists whose practice has been influenced by Freud, then, have little use for religion, seeing it as a defense the maladapted ego has formulated against the harsh realities of the world. In all likelihood, given a patient with a strong enough ego, such a therapist would work to encourage the patient to see that this defense is not needed. There would be some latitude here, because psychoanalytic theory has adherents at all stages of its development. There are Freudian psychoanalysts and also psychoanalytic institutes that represent the full range of Freudian thought from psychobiology to pre-ego psychology. Typically, however, the faculties of these institutes come from backgrounds in psychiatry or clinical psychology (and, more recently, social work) and therefore are little influenced by religious perspectives.

Transitional figures

Few psychoanalysts after Freud were as concerned as he was with religion. Freud's pronouncements on religion receded from controversy and became the status quo in psychoanalysis until theoretical developments necessitated their being questioned. Psychoanalytic theory developed into two broad, interrelated categories, one continuing Freud's psychobiological interests and focusing on mechanistic descriptions of psychodynamics and the other pursuing the more holistic study of the experiential psychic life of the person. In the first group, Anna Freud (18851982) and others contributed to the shift in psychoanalysis (a shift that had actually already been begun by Freud himself) toward the study of the ego and its defense mechanisms. In this way, the older view of the adaptation to reality at all costs began to be modified by this school, which came to be known as ego psychology. In the second group, Melanie Klein (18821960) and others began to study the earliest development of the person in terms of what have come to be called object relations theory. In psychoanalytic theory, an object is the psychological representation of a person in the most elementary termsas a good object, one which is nurturing, or as a bad object, one which is persecutory. (Klein thus laid the groundwork for D. W. Winnicott's study of transitional phenomena, as well as for self psychology and the study of narcissism.) Both theoretical groups unwittingly undermined Freud's attitude toward religion: The first came to appreciate less stringent adaptation to reality than had been advocated by earlier analysis, and the second prepared the way for examining the methodsincluding illusion itselfthat the psyche necessarily uses to come to grips with reality.

Three other psychoanalytic theorists who should be mentioned in a discussion of psychotherapy and religion are Eric Fromm (19001980), Victor Frankl (19051997), and Erik H. Erikson (19031987). The first two are included not so much because they contributed in a fundamental way to the development of psychoanalytic theory, nor even because they advanced the psychoanalytic understanding of illusion, but because they took religion seriously on its own terms and thus began to break away from Freud's reductionistic methodology in studying religion. Fromm, as a representative of the first group of psychoanalytic theorists previously mentioned, saw religion's value from a broad cultural perspective, whereas Frankl, as a representative of the second group, appreciated religion's psychological function in assisting the individual's search for meaning. The work of Erikson must also be considered in the psychoanalytic examination of religion. Erikson, popularly known for his study of the "identity crisis," pioneered the discipline of psychohistory. With Young Man Luther (1958) and Gandhi's Truth (1969), Erikson studied what he called homo religiosus, that is, the person whose nature and historical circumstance demand a religious existencea kind of life that, Erikson insisted, can be psychologically healthy. Erikson treats the religious quests of both Luther and Gandhi with dignity, humaneness, and compassion. Even two decades before, it would have been unheard of for an analyst of Erikson's stature to psychoanalytically examine a religious figure without reducing him to a case study in psychopathology.

Winnicott and transitional phenomena

As the first pediatrician to be trained as a psychoanalyst, the Englishman D. W. Winnicott (18961971) was in a unique position to study the psychological development of infants and children, as well as the relationship between parents (particularly mothers) and their children. Winnicott's primary theoretical interest was the psychological emergence of the infant into the social world. In Winnicott's view, the bridging of these two worlds is accomplished through the presence of good enough mothering and the child's use of transitional objects. For Winnicott, a good-enough mother is concerned about her child and sensitive to his or her needs, but she does not err either by psychologically impinging on the child or by traumatizing him or her with inconsistent care. She sees her child as progressively separate from herself; psychologically as well as physically, she weans her child carefully. In weaning, she often allows the child transitional objects: physical objects such as teddy bears and blankets that, through their association with the mother, help to ensure the infant's own psychological continuity. As such, they ward off insanity, which Winnicott saw as psychological discontinuity.

Winnicott's central theoretical breakthrough is his study of how transitional objects are used by the child as a bridge from the child's inner reality to the outer reality of the adult world. By studying these phenomena, he became the first psychoanalyst to study illusion systematically and, thus also, to study the psychoanalytic correlate of religion. In his 1951 paper "Transitional Objects and Transitional Phenomena," Winnicott placed the antecedent of religious development in the period of transitional phenomena and, in this way, illustrated the object-related nature of religious experience. (He did not, however, trace the development of the representation of God.) For Winnicott, transitional phenomena are located in the psychological space he calls intermediate space or potential space. In successful psychological cultural development, this space becomes the location of all cultural experience, including religion, which he also ties to good enough mothering: "Here where there is trust and reliability is a potential space, one that can become an infinite area of separation, which the baby, child, adolescent, adult may creatively fill with playing, which in time becomes the enjoyment of the cultural heritage" (Winnicott, 1971, p. 108).

What was pejorative illusion for Freud becomes for Winnicott positive potential space or the location of cultural experience. Winnicott redeems the idea of illusion in psychoanalytic theory and thereby redeems the psychoanalytic study of religion. Whereas Winnicott fully recognizes pathological illusion, he contends that illusion per se is by no means pathological. For Winnicott, although illusion is not real, it is not untrue. The psychologically healthy person is one who can use the transitional phenomenon of illusion in a healthy way. He writes, "We are poor indeed if we are only sane" (1958, p. 150).

As excellent example of the application of object relations theory to religion can be found in Ana-Maria Rizzuto's The Birth of the Living God: A Psychoanalytic Study (1979). Rizzuto develops Winnicott's idea of transitional objects and applies it to religion in a systematic way by focusing on the development within the individual psyche of what she calls the God-image. (In this way, she avoids the argument about the reality of religious experience.) Rizzuto argues that the God-image is a necessary and inevitable part of the human psyche (whether it is used for belief or not), and she traces its origins from the infant's earliest object-relations. The God-image is a specific object, she states, because it is formed not through experience or reality-testing, but instead is created out of imaginary materials. Further, she argues that even though the God-image may be subject to repression, it can never be fully repressed. Instead, it is evoked at crucial times of life, such as the transitions between major stages of development. Rizzuto's contribution is especially important in two ways. First, departing from Freud and aligning herself with Winnicott's positive appreciation of illusion, she comes to the conclusion that religious belief is not a sign of immaturity, let alone pathology. Rather, she asserts it is simply a part of the psyche's development. Second, by tracing the personal development of the God-image, she points up the differences between the official God of religious doctrine and the living God of personal experience. She implies that for religion to continue to be a living force the personal, living God must be recognized and incorporated into organized religion.

The profound influence of Winnicott's work has also led psychoanalysts from outside objects relations theory to employ his theory in the integration of psychotherapy and religion. Ann Belford Ulanov, a Jungian psychoanalyst and a theologian, applies Winnicott's idea of potential space to what she sees as the space between the human and the divine. In Finding Space: Winnicott, God, and Psychic Reality (2001), she suggests that Winnicott's focus on the experience of being real can help counter the sense many have of contemporary religion as passionless.

In general, psychoanalysts and psychotherapists influenced by the work of Winnicottand their number is likely to increase as the profound importance of his work continues to be recognizedappreciate the importance of transitional objects of all kinds, including religion and religious beliefs. The aim of such a therapist would be to provide a good enough therapeutic environment (through the therapeutic relationship) and not simply to interpret unconscious conflicts, so that clients' natural ability to develop transitional objects emerges and they can become their own resource for bridging the psychological and social worlds. In part, this bridging can result from playing, an activity Winnicott devoted considerable theoretical effort to understanding and an activity (such as the arts and religious ritual and experience) that is in the intermediate area between inner and outer realities. The correlation of play and religious practice may well be an area explored in future applications to religion of psychoanalytic thought as influenced by Winnicott.

Self psychology and relational psychoanalysis

As they have in the past, those who seek to integrate psychotherapy and religion look to new developments in psychoanalytic theory, not only to justify religion against the historical onslaught fueled in part by psychoanalysis itself but also to deepen understanding of these facets of human experience. Self psychology, a school of psychoanalysis developed in the 1970s by Heinz Kohut (19131981), and relational psychoanalysis, a second school developed in the 1980s primarily by Stephen Mitchell (19462001), are late twentieth-century developments in psychoanalytic theory used in this way.

Like Winnicott, Kohut was not directly concerned with religion. He worked with patients suffering from narcissistic personality or behavior disorders, conditions classical psychoanalytic theory considered unable to be analyzed because such patients were so self-preoccupied that they could not sustain meaningful relationships with others, including analysts. Kohut was able to analyze the narcissistically arrested because he saw that parental misattunement (and not only overindulgence) created narcissistic disturbances in children. He reasoned that if these patients were responded to empathically (i.e., from within the perspective of their own developmental needs), their development would proceed. In contrast to traditional psychoanalytic theory, Kohut held that narcissism has an independent line of development, so that the extreme self-love of primitive narcissism is not transformed by maturation into object-love but develops instead into mature forms of narcissism (e.g., personally or professionally advocating for one's self). In the course of his writing, Kohut shifted his focus away from narcissism itself and came to recognize that these patients suffered from what amounted to disorders of the self (thus, self psychology in contrast to ego psychology).

In contrast to Kohut's developmental arrest model, relational psychoanalysis argues that "the pursuit and maintenance of human relatedness is the basic maturational thrust in human experience," as Mitchell writes in Relational Concepts in Psychoanalysis, An Integration (1988, p. 289). Relational psychoanalysis, then, emphasizes the social over the individual. Although it is a very influential perspective in psychoanalysis, it is not a unified school of thought that represents a single point of view. Rather, it is inclusive of the many psychoanalysts who have become disenchanted particularly with classical psychoanalysis. Still, there are some points on which these analysts agree. For example, Mitchell portrays the analytic process as the analyst's struggle to disentangle from the patient's preset relational configurations. Further, in one tie to the classical psychoanalysis of Freud as well as Klein's object relations theory, relational psychoanalysis sees aggression as inborn and thus part of every relationship (including the analystpatient relationship).

Although psychoanalysts of both self psychology and relational psychoanalysis have occasionally written on religion and pastoral counselors have occasionally utilized both psychoanalytic schools, no single voice has yet emerged from either discipline uniquely employing the insights these theories might provide in the understanding of psychotherapy and religion. Even mainstream psychoanalysis, then, has moved from considering illusion in a pejorative to a positive light. Many other disciplines, including those considered in this article, start from the experiential basis of illusion.

Analytical Psychology (Jung)

In a consideration of the relationship between psychotherapy and religion from the perspective of the concept of illusion, a unique position is held by analytical psychology (popularly called Jungian psychology or theory, after its founder, Carl Jung, 18751961). Jung and the Jungians have been outside the mainstream of psychoanalytic theory since the early decades of the twentieth centurya divorce that has impoverished both mainstream psychoanalysis and the Jungians themselves. The isolation of the Jungians has slowed the humanization of classical psychoanalytic theory, narrowing its field of study by excluding the consideration of many common human phenomena, and it has isolated the Jungians to the extent that, with a few exceptions, their vocabulary and model of the psyche has little relation to the rest of psychoanalytic theory. Moreover, the separation of the Jungians from classical psychoanalysis has had the effect of further divorcing the disciplines that make use of these two schools of psychoanalytic theory. Freud has been used primarily by the social sciences, whereas Jung has been employed by the arts and humanities, especially theology and religious studies.

Theology's kinship with Jungian theory can be explained by Jung's refutation of the classical psychoanalytic correlation of religion and illusion. The Jungian position on illusion is represented by Jung's concept of the psychological fact: Jung states that all psychic products, including visions, dreams, and hallucinations, are facts that should be considered as having the same basis in reality as other facts, including physical facts. There is, therefore, almost no such thing as illusion in Jungian psychological theory. It is almost an illusionless psychology. Jung could be reductionistic, but his reductionism was unlike Freud's reduction of religion. Jung was able to see religion more clearly on its own terms as a human activity that, although it could often be contaminated by social hypocrisy or personal pathology, could nonetheless be based on a reality of experience irreducible by psychological method to other unconscious motives. Here Jung makes an important methodological point: It is not the business of psychology to prove or disprove the existence of God. He held that psychology can discuss the psychic effects of the God-image and its mythic antecedents, but it cannot discuss the existence of God apart from the human psyche. The insistence on the reality and importance of religious experience was a position Jung held to the end of his life.

The religious was deeply important to Jung. In part, this was the result of his own personal history. His father was a clergyman, as were a number of his uncles. But it was also a consequence of his experience as a psychoanalyst. In fact, in "Psychotherapy or the Clergy" he went so far as to state, "Among all my patients in the second half of lifethat is to say, over thirty-fivethere has not been one whose problem in the last resort was not that of finding a religious outlook on life." He went on to add, "This of course has nothing whatever to do with a particular creed or membership of a church" (Jung, 1967, vol. 11, p. 334). Jung's experience as a psychoanalyst informed and was informed by his work as an analytic theorist. It was his theory that the psyche is comprised of archetypes in a collective unconscious. That is, Jung held there was an unconscious aside from the personal unconscious of the individual's unremembered or repressed past, and this was the collective unconscious whose contents are archetypes (i.e., typical images and patterns of human behavior, but not predestined behavior itself, that endlessly recur and are found in the psyche precisely because it is human). The most important and central archetype is the self (similar to, but not the same as, the self in Kohut's self psychology). Jung thought the psychological purpose of the second half of life was for the personal ego to come to terms with the self, the apersonal center of the collective unconscious. Jung has often been criticized by less religiously inclined psychoanalysts for projecting religious meaning onto the self and thus, his critics claim, for advocating a religious psychology. He believed he was simply an empirical scientist.

Developments within Jungian theory have expanded the dialogue between psychotherapy and religion outside traditional boundaries. One somewhat formally organized schism of Jungian theory is called archetypal psychology. Led by James Hillman, it has an almost exclusive concentration on the archetypes of the collective unconscious. Polytheism is studied by this group. A second movement is marked by the rise of interest in the goddess among some Jungians. They argue that modern consciousness, including more specifically modern religion, has a patriarchal bias. A number of Jungian analysts and writers have focused on studies on the historical goddess religions and sometimes have urged a return to religious focus on the goddess in the lives of modern individuals. Two phenomena of popular culture reflect these ideas, although neither is strictly about the goddess. In 1992, Jungian analyst Clarrisa Pinkola Estes published Women Who Run with the Wolves in which she argued that women's wholeness depends on reengaging their repressed instinctual nature, and in 2003 Dan Brown wrote The Da Vinci Code, which suggested that the sacred feminine is on the rise.

The psychoanalyst or psychotherapist who has been influenced by Jung and by developments in Jungian theory is necessarily respectful of a client's religious issues. From the beginning, in contrast to other psychoanalytic institutes, Jungian institutes have accepted candidates with theological degrees. The reality of religious experience is therefore appreciated in a way that is unusual among psychoanalytic institutes. Jungians are also trained to differentiate psychologically healthy from psychologically unhealthy religion. Yet an often-heard criticism of Jungian psychology applies here: Usually a client is not encouraged to reintegrate their religious experience back into already established religious groups. Individuality is prized in the Jungian system in a way that can impoverish the individual, as it unwittingly demeans group experiences.

Spirituality in Psychotherapy

A consideration of psychotherapy and religion must include the remarkable growth of a number of new movements that can be gathered under the rubric of spirituality. A number of social movements and developments in science have combined to influence the development of spirituality. In the United States, the counterculture movement in the 1960s, which arose in part in protest of the Vietnam War, exposed great numbers to Eastern cultural practices for the first time, especially to Indian gurus who promoted a variety of spiritual practices. Transcendental meditation was adopted from these sources and became increasingly legitimate as scientific studies showed its effectiveness in promoting psychological and physical health. In academic psychology, humanistic psychology as the foundation for treatment gained influence. Especially important were Carl Rogers's (19021987) client-centered therapy, which featured the therapist's "unconditional positive regard" of the client, and Abraham Maslow's (19081970) theory of hierarchy of needs, which begins with the physical needs of the body and culminates in self-actualization. Humanistic psychology arose to counter psychoanalysis, particularly the classical (Freudian) psychoanalytic theory of the previous decades, and laid the groundwork for incorporating other, seemingly nonrational needs into psychotherapy. Even modern physics, especially relativity theory and quantum mechanics, can be thought to contribute to the development of spirituality, as they describe physical reality in profoundly counterintuitive ways.

Several common themes underlie these disparate developments. Both the new physics and the mystical thought of centuries hold that everything is interconnected and that order follows from chaos. Older ways of thought are seen as linear, and these newer ways are held to be nonlinear. Critics of older, established religions see them as dualistic in that typically the self is separate from a deity. Traditional Christian concepts such as original sin, a concept that emphasizes the separation of the individual from the holy, are sharply criticized. Those who embrace these newer ways of thinking hold that any religion that produces separatism is antispiritual; the concepts of joining and union are considered spiritual to them. In religion, for these people, there has been a shift away from monotheism toward polytheism and especially toward nontheism.

Many have observed there is a basic conflict in organized religion. To maintain itself, an organized religion needs to continue to promote its own doctrines, and this is often in conflict with individual religious experiences. Thus it follows that the mystic tradition in many religions is marginalized. Yet individual experience is also at the heart of religion (as contrasted to religious organization). This discrepancy has reached the point that many have come to feel that organized religions are stifling and rigid. However, this perception is not without paradox. Interestingly, at least in the United States, established religions such as Roman Catholicism and mainline Protestantism, which judge individual religious experience with external standards, are losing members, yet newer religious organizations, especially fundamentalism, which also emphasize external judgment, are thriving.

Some of those who are disenchanted with organized religion have begun to practice or develop spiritual practices on their own; others have turned to nontraditional sources, including psychotherapists who include spirituality in their practices. These practitioners span a wide spectrum of theoretical backgrounds and include a wide variety of techniques in their psychotherapeutic practices, including meditation, yoga, and chantingnone of which would have been considered appropriate in psychotherapy (not to say psychoanalysis) even fifteen years ago. Although spirituality in psychotherapy is not widespread, there is reason to believe that it will continue to expand its foothold and perhaps even transform the discipline.

Religious Counseling

In the relationship between psychotherapy and religion, religious counseling, in contrast to psychoanalytic theory, takes as its foundation the legitimacy of religious experience. Organized religious counseling has been influenced by three factors that have interacted with each other over time: seminary education, clinical pastoral education, and pastoral counseling itself as a discipline.

Seminary education

Two interrelated factors have influenced the development of religious counseling in seminary education: the need for seminarians to be taught counseling and the development of the discipline of pastoral counseling. The first factor is important because, according to polls, more people in the United States will consult clergy before other professionals for help with personal problems. Yet an already-crowded seminary curriculum does not typically allow for in-depth training in counseling (let alone psychotherapy), and when it does, the counseling tends to be based not on psychological insight but on biblical precepts, which are culturally bound and can be punitive. As religious conservatism continues to grow and to become institutionalized, psychology and psychoanalysis are likely to become even less influential in pastoral counseling. Despite these possible developments, two classics in the field remain valuable: Paul W. Pruyser's The Minister as Diagnostician (1976) and Wayne E. Oates's When Religion Gets Sick (1970).

Very broadly, the character of a seminary education is formed by the denominational affiliation of the seminary, by the intellectual climate of its geographic locale, and in part by whether it is associated with a university. In the northeastern United States, psychology programs in seminaries traditionally reflect the psychoanalytic and history of religions approaches of the area. In the Midwest, scholars have been working toward a methodology of pastoral care. In the West, the influence of humanistic psychology and the psychologies arising from the counterculture of the late 1960s and early 1970s influenced the writing of those at the consortium of seminaries near San Francisco.

Clinical pastoral education (CPE)

Although first organized in 1925, CPEa formalized system to clinically train seminarians and clergy to work with persons in hospitals, mental institutions, and prisonshad a number of antecedents. These movements had in common the urge to study spirituality scientifically, as well as a discontent with the theological education of the time, which was perceived as too concerned with theological doctrine and not concerned enough with the reality of the emotional life of the person. (This was the time of the first impact of psychoanalysis in the United States.)

The development of CPE is usually attributed to Anton T. Boisen (18761965), a Congregational minister. Boisen had suffered a breakdown with psychotic features in the early 1920s and was consequently institutionalized. He graphically depicted his efforts to find meaning in his experience in Out of the Depths (1960), a book that still makes interesting reading. Slowly he and others were able to establish an ongoing, organized ministry with its own training program. A powerful speaker who used his own experiences, Boisen was able as a chaplain to engage in therapeutic relationships with the most disturbed patients at the Worcester (Massachusetts) State Hospital, the same hospital in which he had been institutionalized. The amusing and chaotic experiences of the seminarians who comprised the first group of CPE trainees are recorded by Doris Webster Havice in Roadmap for Rebel (1980). The growing influence of CPE, as well as closer cooperation between CPE and various denominations, led to the formation in 1967 of the Association for Clinical Pastoral Education from several smaller organizations.

A psychotherapeutic practitioner influenced by CPE essentially functions as a pastoral counselor, balancing a clinical perspective on psychodynamics with his or her own religious belief and, typically, with the client's religious belief as well. It is possible that CPE will need to change its focus, as there are now fewer mental institutions and hospital stays have been reduced by insurance policies and advances in medical technology.

Pastoral counseling

As a response the development of CPE in the mid-1920s, in the 1930s seminaries began to lay the groundwork for the continuing integration of religion and psychology. Following World War II, due to what would now be recognized as the trauma of the war, attendance at religious services reached record levels. Psychotherapy also burgeoned during World War II as it had in World War I (in fact, almost every major figure in American and English psychoanalysis was directly involved in the war effort), largely in an effort to treat traumatized soldiers so that they could be returned to battle in the best condition. One response by seminaries to the cultural needs of the time was to create chairs and departments of pastoral care (although the titles varied considerably). Four theologians emerged as leaders of the theory and practice of pastoral care: Seward Hiltner, author of one of the first books in the field, Pastoral Counseling, who was originally at the University of Chicago and later at Princeton; Paul Johnson at Boston University; Carroll Wise at Garret Seminary at Northwestern University; and Wayne Oates, a Southern Baptist physician affiliated with the Louisville, Kentucky, School of Medicine.

Graduate programs integrating theology and psychology began to be developed at this time, also (again, the titles of these programs varied considerably). These programs began in Protestant seminaries; only later did Catholic and Jewish seminaries develop them. Professional organizations began to develop, as well, the most prominent being the American Association of Pastoral Counseling (AAPC), which was founded in 1963. Aside from the cultural forces outlined, AAPC was established in part by Protestant ministers who in their ministries had become burned out and who had gone into their own therapy to deal with their professional exhaustion and sometimes estrangement from the church. Consequently, there was a theoretical focus on the individual, reflected in the influence of leading contemporary psychological humanistic theory, such as Rogers' client-centered therapy or Fritz Perls's gestalt therapy.

As so often happens in therapeutic movements and psychoanalysis, the theory goes faddishly in one direction; in this case, pastoral psychology started to disregard its own theological resources, forgetting nineteen hundred years of rich history. The focus was so much on individual psychology that those outside the field started to make legitimate critiques of the loss of a theological perspective, and in response psychiatrist Karl Menninger wrote Whatever Became of Sin? (1973). These critics encouraged pastors to recognize the universe of concepts from their own field at their disposal that could be helpful to those in their care. A contemporary theoretician who has made a similar convincing argument is Deborah Van Duesen Hunsinger in Theology and Pastoral Counseling, a New Interdisciplinary Approach (1995), in which she argues that theology and depth psychology are two different frames of reference and demonstrates how these two ways of thinking relate to each other in an inter-disciplinary approach that maintains the integrity of both disciplines.

More recently, AAPC has made attempts to be more truly interfaith and to move away from focusing solely on the individual, trying to overcome its basically liberal, anti-evangelical Protestantism. In AAPC, an appreciation has developed of the social dimension of faith, from the familial, community, and societal problems (such as domestic abuse, power problems in congregations, and clergy sexually acting-out). Another aspect of including a social dimension is an evaluation of what social systems and faith communities have to offer in terms of individual health. In this regard, it is important to note that considerable empirical research has demonstrated that spiritual belief has a markedly positive effect on physical health and psychological well-being. For example, in Spirituality and Patient Care (2002), Harold Koenig, an associate professor of psychiatry and medicine at Duke University in North Carolina, demonstrates that people who go to church are better off by almost every measure.

Social Work

In considering the relationship between psychology and religion, social work is especially important. In the United States, social workers provided more psychotherapy than members of any other profession. The historical development of social work is intimately tied both to psychoanalytic theory and to religion and thus might be expected to be caught in the middle of the conflict between the two. This is not at all the case, however. With few exceptions, insofar as they still emphasize clinical training (albeit a declining focus) social work schools have opted to align themselves with psychoanalytic theory as academically and professionally the more powerful of the two approaches and to eschew any religious connections.

Social work developed in urban areas in the United States from the recognition on the part of many clergy that, following the Judeo-Christian obligation to be charitable, there was a dire need for social services and that these services required organization to be effective. The religious innovators of social work projects included individual clergymen such as Joseph Tucker, a Unitarian minister who organized charity for the poor in early nineteenth-century Boston; Stephen Humphreys Gurteen whose Charity Organization Society in Rochester, New York, gave rise to community welfare councils and to agencies serving families; and Charles Loring Brace whose "orphan trains" relocated large numbers of poor urban childrennot always orphansto the midwestern and western United States. Religious organizations also emerged, including the Young Men's Christian Association and the Salvation Army. Despite these historical associations, however, the three major religious traditions involved in social work in the United States have not directly tied religion into their social services. They have varied in how they relate religion to the services they deliver. Historically, Protestantism's decentralized structure has led to the secularization of the social services it delivers. Roman Catholicism, on the other hand, with its hierarchical structure, has tended to develop social agencies that are under church auspices. Jewish social services fall between these two extremes, offering services with a religious affiliation but without direct religious supervision. In part, this lack of a direct link between religion and the delivery of services has been mandated: These agencies have been prohibited from proselytizing because their programs often receive federal government funding. However, political changes in the United States may eventually alter this historic tradition.

The training that social workers receive also increases the separation between religion and the delivery of services, especially psychotherapy. This is true even though a growing number of graduate schools of social work award joint degrees with seminaries. (In part, this movement toward joint degree programs is motivated by economic and not just intellectual concerns: Both seminaries and schools of social work have seen a steady decline in enrollments for the past three decades.)


This article has traced the history of the relationship between psychotherapy and religion from its development in psychoanalysis as pejorative illusion in Freud, to the positive potential space in Winnicott, through Jung's defense of religious experience as a psychic fact, to the emergence of spirituality in psychotherapy, to the religiously based disciplines of pastoral counseling and CPE, and ending with the studiously nonreligious discipline of social work. It is only to be hoped that the modern disciplines springing from psychoanalytic theory will mature to the point of accommodating themselves to the powerful and lasting influence of religion on human life. This accommodation is well under way, as almost all writers in the integration of psychotherapy and religion recognize that religion is inherent in human life.

See Also

Freud, Sigmund; Jung, C. G.


An excellent short conceptual introduction to the development of psychoanalytic theory from Freud to Winnicott is Harry J. S. Guntrip's Psychoanalytic Theory, Therapy, and the Self (New York, 1971). Jay R. Greenberg and Stephen A. Mitchell's Object Relations in Psychoanalytic Theory (Cambridge, Mass., 1983) provides a good introduction, although the reader is cautioned that their readings of the development of psychoanalytic is biased toward object relations theory, as is to be expected (and as is indicated by the title.) The interrelation between religion and the work of numerous psychoanalysts is discussed in Ann Belford Ulanov and Barry Ulanov, Religion and the Unconscious (Philadelphia, 1975). The best study of Erikson's work is Lawrence Freidman's Identity's Architect: A Biography of Erik H. Erikson (New York, 1999). F. Robert Rodman's Winnicott: His Life and Work (Cambridge, Mass., 2003) is an excellent biographical introduction to the life and work of this seminal psychoanalyst. For original source information, see D. W. Winnicott, Collected Papers (London, 1958) and Playing and Reality (London, 1971), which includes a reprint of his paper "Transitional Objects and Transitional Phenomena." For a treatment of object relations theory, see Ana-Maria Rizzuto's The Birth of the Living God: A Psychoanalytic Study (Chicago, 1979). For an application of Winnicott's theory of potential space, see Ann Belford Ulanov, Finding Space: Winnicott, God, and Psychic Reality (Louisville, Ky., 2001). Stephen Mitchell's Relational Concepts in Psychoanalysis, An Integration (Cambridge, Mass., 1988) outlines his understanding of relational psychoanalysis.

Michael Palmer, Freud and Jung on Religion (London, 1997) is the best introduction to this topic. Two noteworthy books on Jung and religion are Murray Stein's Jung's Map of the Soul (Chicago, 1998) and Jung's Treatment of Christianity (Wilmette, Ill., 1985). Ann Belford Ulanov's The Feminine in Jungian Psychology and in Christian Theology (Evanston, Ill., 1971) has several chapters that pertain specifically to religion. For primary source information, see Carl Jung, The Collected Works, edited by Sir Herbert Read, Michael Fordham, and Gerhard Adler (Princeton, N.J., 1969); for his understanding of psychological fact, see volume 11, pp. 3105. For a feminist approach to Jung, see Clarrisa Pinkola Estes, Women Who Run With the Wolves (New York, 1992). Three books are recommended as an introduction to spirituality and psychotherapy: Henry Grayson's Mindful Loving (New York, 2003) redefines the concept of the self from the psychoanalytic to the spiritual perspective, its relation to the new physics and includes an introduction to spiritual practices; Tara Brach's Radical Acceptance: Embracing Life with the Heart of a Buddha (New York, 2003) emphasizes practicality and personal openness, using Buddha for personal growth; and Mark Epstein's Thoughts without a Thinker (New York, 1995), which relates Buddhism to psychotherapy through focusing on meditation.

The best initial introduction to pastoral counseling is John Patton's Pastoral Counseling: A Ministry of the Church (Nashville, Tenn., 1983). Margaret Kornfeld's Cultivating Wholeness: A Guide for Care and Counseling in Faith Communities (New York, 1998) emphasizes basic skills for clergy and has an excellent annotated bibliography. Brooks Holifield's A History of Pastoral Care: From Salvation to Self-Realization (Nashville, Tenn., 1983) is an excellent history of the field. Paul W. Pruyser's The Minister as Diagnostician (Philadelphia, 1976) and Wayne E. Oates's When Religion Gets Sick (Philadelphia, 1970) are considered classic studies in the role of the seminary-trained pastoral counselor. Also see Seward Hiltner, Pastoral Counseling (Nashville, Tenn., 1949), one of the first books in the field. For an early accounting of CPE, see Anton T. Boisen's Out of the Depths (New York, 1960) and Doris Webster Havice, Roadmap for Rebel (New York, 1980). For a critique of pastoral counseling, see Karl Menninger, Whatever Became of Sin? (New York, 1973) and Deborah Van Duesen Hunsinger, Theology and Pastoral Counseling: A New Interdisciplinary Approach (Grand Rapids, Mich., 1995). For religion's effect on personal well-being, see Harold Koenig, Spirituality and Patient Care (Radnor, Pa., 2002).

Michael D. Clifford (1987 and 2005)

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