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DSM-IV Religious and Spiritual Problems

LESSON 6.2 Psychotherapy

Spiritual Interventions in Psychotherapy Role of PsychotherapyPhase 1: Telling the Story of the Experience Phase 2: Tracing the Symbolic/Spiritual Heritage Phase 3: Creating a New Personal Mythology

Spiritual Interventions in Psychotherapy
Spiritual interventions can be essential to facilitating recovery and change. At times these could include:

Educating the patient about the spiritual emergence process that is part of a spiritual journey with a potentially positive outcome
Encouraging the patient's involvement with a spiritual path or religious community that is consistent with their experiences and values
Encouraging the patient to seek support and guidance from a credible and appropriate religious or spiritual leaders
Encouraging the patient to engage in religious and spiritual practices consistent with their beliefs (e.g., prayer, meditation, reading spiritual books, acts of worship, ritual, forgiveness and service)
Modeling his/her own spirituality (when appropriate), including a sense of spiritual purpose and meaning, hope, and faith in something transcendent

Role of Psychotherapy
Psychotherapy can help patients with religious and spiritual problemsto shape their experience into a coherent narrative, to see the "message" contained in their experiences, and to create a life-affirming personal mythology that integrates their spiritual problem. These three phases of psychotherapy are directed toward that integration are described below. In addition, spirituality plays a special role in psychotherapy with such patients.

Phase 1: Telling the Story of the Experience
Psychotherapy can be seen as a process of helping clients construct a new narrative, a fresh story of their lives. Psychotherapy does not consist in the cathartic healing effect of releasing traumatic repressed events and their emotions, but in reconstructing a person's authentic story (See What is narrative therapy?). In making interpretations, the therapist retells the patient's story, and these retellings progressively influence the what and how the story told by patient. The end product of this interweaving of texts is a radically new, jointly authored story. Or as Hillman [1] explains it, the client comes to therapy to be "restoryed":

The patient is in search of a new story, or of reconnecting with her old one...The story needed to be doctored, not her. (pp. 17-18).

The specific therapeutic direction will depend on the nature of the problem. A loss of religious faith or conflict over spiritual values requires that the person begin to explore a new spiritual direction that is congruent with the person at this point in his/her development. Often with spiritual emergencies, the event itself has an inherently disjointed quality that has led therapists, patients, and society to devalue such experiences. Further exploration of such anomalous experiences is believed by many mental health professionals to be unnecessary and even to run the risk of exacerbating symptoms.

People who have had spiritual emergencies often do not receive validation for their experiences, or even the opportunity to talk about them. In the three case studies I have researched and published (Case Library), the hospital records did not mention any of the spiritual content present in these patients' episodes. The inpatient chart notes simply described them as delusional, having religious hallucinations, being preoccupied with space aliens, and making claims of having special powers. That information alone was sufficient to make the diagnosis of a psychotic disorder. In the medical model, further exploration of person's experiences would be unnecessary and could even exacerbate symptoms by reinforcing his/her "delusional system." Yet all three reported that working with me to put their story into writing was very helpful to them.

The conventional practice of discounting the meaning of spiriutal emergencies is not therapeutically productive. The spiritual emergency itself isolates the individual from others. Then the subsequent devaluation and condemnation of the experience as "only the product of a diseased mind" results in further isolation, just when the person needs to reconnect to the social world. Thus, speaking one's story, putting the experience into words, is usually the first step in developing a life-affirming personal mythology that integrates the spiritual dimensions of the crisis.

At the turn of the century, Kurt Jaspers, MD, one of the founders of the nomenclature and methods used in understanding psychotic disorders, argued that there was an "abyss of difference" between psychosis and "normal" consciousness:

The profoundest difference in man's psychic life seems to exist between that type of psychic life which we can intuit and understand, and that type which, in its own way, is not understandable and which is truly distorted and schizophrenic...we cannot empathize, we cannot make them immediately understandable, although we try to grasp them somehow from the outside (Jaspers [2] p. 219).

Yet understandability is the result of a two-way interaction. Laing [3] has criticized the placing of responsibility totally on the patients for making their realities understandable to others.

"Both what you say and how I listen contribute to how close or far apart we are" (p. 38).

Work with spiritual emergency patients requires reaching across this abyss to connect with their reality.

One of the first objectives in narrative therapy is to find a mutually acceptable name for the problem. This is a continuation of the work in the acute phase to Normalize the experience (see Lesson 5). The term spiritual emergency appropriately describes and normalizes such crises. It provides a non pathological explanation for patients, family and friends to the rapidly developing literature on these types of problems, and it can become the basis for a new personal mythology.

It often helps to have the patient talk about and write out a full account of all they experienced. The word myth comes from the Greek mythos, meaning speech. I have found that simply constructing a time line marked with ages and key events serves a therapeutic ordering function. Then the work of Phases 2 and 3 can move more easily toward integrating the experience.

Phase 2: Tracing its Symbolic/Spiritual Heritage
People in such crises do want their spiritual backgrounds and values to be taken into account. In my own spiritual emergency, I spent 2 months firmly convinced that I was a reincarnation of Buddha and Christ and was on a mission to write a new "Holy Book" that would unite all the peoples of the world. And I had been raised as a Jew! So, once I was back with both feet on my ground, this gave me great cause to explore these forms of spirituality with which I'd had minimal contact. In retrospect, I consider this period to be my spiritual awakening. But I could integrate it only after several years of therapy and work with traditional healers (See Self-Case Study Shamanic Crisis).

The treatment literature documents that there is much therapeutic value in addressing a person's religious delusions [4. In cases where the person developed the grandiose delusion that they were God or the messiah, these stereotypical delusions of grandeur, inflation, and possibly inappropriate or demanding behavior could be embarrassing to the person. But the valid religious/spiritual dimensions of the experience can be salvaged through psychotherapy:

What remains . . . is an ideal model and a sense of direction which one can use to complete the transformation through his own purposeful methods (Trials of the Visionary Mind: Spiritual Emergency and the Renewal Process, by John Perry, MD, p. 38).

I now view my own experience of having been Buddha and Christ as the ideal models for my spiritual life, and this has given me a sense of direction. My career as a psychologist researching spiritual crises, and my spiritual path derive from that event.

James Hillman, Ph.D., [5] maintains that,

Recovery means recovering the divine from within the disorder, seeing that its contents are authentically religious (p. 10).

This recovery often involves helping patients reconcile their idiosyncratic personal symbols with parallels in symbolism and religious imagery. Eliade [6] pointed out that the personal unconscious and "private mythologies" (which are part of spiritual emergencies) cannot awaken an individual. It requires:

The general and the universal symbols [to] awaken individual experience and transmute it into a spiritual act, into metaphysical comprehension of the world (p. 213).

Much of my work in Jungian analysis consisted of learning how to explore the meaning of my personal symbols as they appeared in dreams and in my own spiritual emergency. This search for meaning by exploring parallels in traditional myths and religious texts has also played a role in the integration of many of the spiritual emergency patients with whom I have worked. I have documented this process in the case study Myths in Mental Illness.

Phase 3: Creating a New Personal Mythology
People want more from therapy than a clear account and chronology (phase 1) and symbolic analysis (phase 2). They want an expanded and deepened sense of the meaning of their lives. Weaving the spiritual emergency into a life affirming personal mythology is essential for positive transformation and integration of the experience.

Personal Mythology (Definition)
Each of us has a personal mythology — beliefs about life that make up our view of the world. Stanley Krippner, Ph.D., co-author of The Mythic Path: Discovering the Guiding Stories of Your Past — Creating A Vision for Your Future, defines a personal mythology as an individual's system of complementary and contradictory personal myths. A personal myth is a cognitive-affective structure consisting of strongly ingrained beliefs with potent emotional components. Personal myths shape our expectations, and guide our decisions. They influence the way we behave with other people. They address life's most important concerns and questions, including

Identity--Who am I? Why am I here?
Direction--Where am I going? How do I get there?
Purpose--What am I doing here? Why am I going there? What does it all mean?

Personal Mythology in Psychotherapy
When people encounter religious and spiritual problems, they are usually dealing with the existential issues delineated as part of personal mythology. So they need to develop a more sustaining personal mythology for who they are at that moment. Unfortunately, with spiritual emergencies, many of the personal myths that people develop are "dysfunctional." They emphasize pathological qualities and are not attuned to the person's actual needs, capacities, or circumstances.

The therapist's task is to help such patients develop a new personal mythology. This is a narrative approach to psychotherapy focusing on the shared retelling of the patient's story, reconstructing it for the patient's benefit.

Personal myths are developed using

biological sources--physical limitations, genetic endowments
cultural sources--economic and political systems, books, movies, folklore
personal history--family, romantic relationships, friendships, work

Spiritual sources often play a significant role in shaping personal mythologies. They can include nonconsensual reality experiences such as visions, past-life experiences, parapsychological experiences, and also spiritual emergencies. Such spiritual sources involve transcendence of ordinary life concerns and an experienced contact with a "higher" or "deeper" reality.

Spiritual emergencies often involve experiences of this type which can become the foundation for a new personal mythology. The therapist can help post spiritual emergency patients build a new personal mythology with spiritual sources drawn from their crisis.

For many people, recovery from a spiritual emergency is experienced as a spiritual journey, a personal myth. Sally Clay, who spent two years hospitalized and now works as a patient advocate, has written that,

For me, becoming "mentally ill" was always a spiritual crisis, and finding a spiritual model of recovery was a question of life or death (Clay [7]).

Not only are people who have had such a crisis challenged to compensate for weaknesses, but they are also invited to integrate their unique set of concerns, interests, temperament, and imagery, which may give clues to future vocational and avocational choices, social affiliations, and ideologies.

My own spiritual emergency set me on the path of becoming a "healer," and provided me with a vocational calling as a psychologist working with serious mental illness and with spiritual emergence. The Jungian analyst John Perry, MD, who developed Diabysis, an innovative treatment center for persons in an acute psychotic crisis, observed that,

It is also probable that those persons who come through their journey enriched and gifted may turn out to be the best source of congenial therapists, who would be able to react with unusual understanding to others going through their psychosis.
(The Far Side of Madness, p. 158).

Jeanne Achterberg, Ph.D., [8] also noticed the prevalence of "wounded healers" in the health professions.

The books, The Mythic Path: Discovering the Guiding Stories of Your Past Creating-A Vision for Your Future by David Feinstein, Ph.D. and Stanley Krippner, Ph.D., and Your Mythic Journey: Finding Meaning in Your Life Through Writing and Storytelling by Sam Keen, describe a variety of methods that facilitate the deepening of life-stories and the illumination of a person's personal mythology. It isn't always necessary for a person to work with a therapist to find the myth at the center of his/her life story.

However, the symbols encountered in spiritual emergencies are often idiosyncratic without a coherent cultural context. Jung noted that fragments of mythic themes and symbols occur frequently in the experiences of psychotic persons, but,

the associations are unsystematic, abrupt, grotesque, absurd and correspondingly difficult, if not impossible, to understand. They are further distorted by their chaotic randomness. (Psychogenesis of Mental Disease, pp. 262-263)

Therefore therapists are often helpful during the integration phase to help weave the images and symbols into a coherent personal mythology.

1 Hillman, J. (1983). Healing fiction. New York: Station Hill Press.

2 Jaspers, K. (1963). General psychopathology. Manchester: Manchester Univ. Press.

3 Laing, R. D. (1982). The voice of experience. New York: Pantheon.

4 Eisenbruch M. (1992) Commentary: Toward a culturally sensitive DSM: Cultural bereavement in Cambodian refugees and the traditional healer as taxonomist. J Nerv Ment Dis 180(1): 8-10.

5 Hillman, J. (1986). On culture and chronic disorder. In R. Sardello and G. Thomas (Eds.), Stirrings of culture. Dallas: The Dallas Institute Publications.

6 Eliade, M. (1960). Myths, dreams, and mysteries. New York: Harper & Row.

7 Clay, S. (1987). Stigma and spirituality. Journal of Contemplative Psychotherapy, 4, 87-94.

8 Achterberg, J. (1988). The Wounded Healer. Shaman's Drum, 11, 18-22.


People who have had a difficult period of spiritual emergence should be encouraged to

a) move on with their lives and leave bizarre experiences behind b) explore the spiritual dimensions of their experiences c) join a religious group to provide an appropriate container for their experiences.

Record your answer for later insertion into the Quiz.




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