Psychoanalytic Psychotherapy and Spirituality ~ gibbsonline.com

                                One of my favorite paintings is of a gigantic Buddha. He’s reached

                                Nirvana, in other words, he's dead. Around him are lots of figures,

                                men, women, animals, ghosts, other beings, the point being that there

                                are many levels of understanding. So far as spirituality goes, that couldn't

                                be more true. There are many levels of understanding, from the most

                                primitive to the most wise.

                   

                                                         Meryl Johnson (Scientist/Artist/)

                                                                   ABSTRACT

                        This paper aims to integrate “spirituality” into mainstream psychoanalytic  

                        psychotherapy. It locates the origins of spiritual concerns – faith, trust, hope

                        love, and persistence in pre oedipal consciousness. In so doing it lays the

                        theoretical and practical foundations for a grounded spiritual psychotherapy

                        without the inclusion of an assumed deity – whether one exists or not.

                                                       Who Is The Final Authority?

                           In a recent obituary of Sidney Morgenbesser – a noted philosopher –

                           is a wry and witty example of the complexities implied in my abstract .

                           Near death, still discussing the nature of God with a friend, he asked:

                           “Why is God making me suffer so much?  Just because I don’t believe

                            in him?” (New York Times, Obituary, Aug.4th, 2004)

             Psychoanalytic Psychotherapy and Spirituality

                                                       Gibbs A. Williams Ph.D.

In preparing this paper a patient fortuitously reported what appears to be a quintessentially transparent “spiritual” dream.  The context surrounding this dream was a deepening of S’ protracted crises of faith. If ever there was material representative of “spirituality” in the context of a psychoanalytic psychotherapy I couldn’t conceive of a more relevant example.

Immediate Context: {S has been in treatment for fifteen months two sessions a week}

S had been in an ever deepening despair.  Despite a quality alliance he had been feeling overwhelmed and exceedingly pessimistic about mastering his sad state of affairs. Among other issues he was concerned that something vital was missing in our connection.  S called to say that surprisingly he was feeling much better since our phone session from the preceding day. He excitedly added that following his session he had a remarkable dream.

S’ Dream:  “S Feels Saved After Jesus Gives Him a Gift”

I am in a session with Gibbs (his therapist). Feeling menaced by a witch/vampire: five feet tall, crazed, I run to avoid it. I know its name but I can’t recall it. // {Shift} Me and my wife have to get home before dark. I am weighted down. We are running back to my childhood home in the Bronx. I am carrying all my stuff. My wife can’t carry the relatively little amount she is supposed to carry. I beg her to hurry up. We need all we have or we won’t be able to live. We are both on our last legs. She fumbles. I think we are {soon to be} dead. All of a sudden a car pulls out. Out steps Jesus Christ. He is male strong – the direct opposite of a witch/vampire. He cries out and tells me that he has something for me. He says that it is something to keep the vampire away – a pin or broach like object with a picture of him on it. He says to me: “You wear this and you will be saved from the vampires….”  S added that he found the event to be quite remarkable.

This dream appears to be the fulfillment of an undisguised wish for divine intervention in the life of this particular patient dangerously near the end of his psychological rope. As such this dream radiates an aura of “spirituality”. It also raises important questions for the psychoanalytic psychotherapist. The first and perhaps most important question is how best to respond to this “spiritual” material? Taking the dream as a whole, it might be treated either as a factual event, a wholly imaginative construction of the dreamer, or perhaps a combination of both.

That which is referred to as “spiritual” content often appears to defy conventional laws of cause and effect hence presenting a serious challenge to both the theory and application of psychoanalytic psychotherapy. This paper accepts the implications of this important challenge. In so doing I will attempt to specify what is meant by spiritual content as presented by representative patients; generate ideas as to what constitutes meaningful and effective interventions; list implications for the transference and counter-transference of identified patients; and suggest a criterion for measuring relative therapeutic progress.

An Operating Definition of Spirituality

Although spirituality is not easy to define, for the purposes of this paper I will accept some researcher’s definitions. These are follows: 

Edwards (1980) conceptualizes spirituality to be:

                   …the underlying dimension of consciousness that openly waits and searches

                   for a transcendent fulfillment of our human nature. Spirituality differs from

                   faith and religion in that it is at the ground of our being and seeks to transcend

                   the self and discover meaning.

 Frankl (1997) considers spirituality to be “meaning and purpose in life.”

 Almaas (1983) asserts that “spirituality is actually our fundamental nature, the

 ground of  ultimate truth of ourselves… its ontological presence, essence.”

It should be noted that the first two definitions of spirituality assume that there is a   preformed cohesive self structure that will enable a person to experience and articulate what is referred to as “spirituality.”  For the purposes of this paper, spiritual psychotherapy is aimed for those patients who do not come into psychotherapy with an already structured whole self.

Such under-structured devitalized patients seek major change and hope it occurs instantly. They desperately wish that the psychotherapist has some miraculous power that will provide a pathway to a rapid and lasting enlivening transformation. Perhaps some of us have such powers, most don’t.
 

                          … It used be said that an ‘intact ego’ is a precondition for

                          psychoanalysis. But in the light of the most recent psycho-

                          analytical advances, it is precisely this that is s hard to find.

                          … ‘Radical’ psychotherapy must aim, not simply at the

                          resolution of specific conflicts, but at the fundamental re-

                          growing of the basic ego, the whole personal self. (Guntrip, p.317)

Summary:

Spirituality is associated with ultimate purpose, absolutes, meaningful connectedness, significant psychological change (transformation) and transcendence. Once a psychotherapist has identified spiritual material the next question is how best to intervene.

Factors Governing the Nature of Any Therapist’s Intervention

Intervention, particularly with dramatic “spiritual” material as S’ dream, will be governed

by a variety of conscious and unconscious factors. The most important of these is determined by the therapist’s awareness {or lack of awareness} of his/her own attitudes towards spirituality as well as the meaning this realm of experience has for a given therapist.

Snall and Kerievsky’s (l991) paper "When Therapists Recognize the Relevance of Spiritual Issues to Their Client's Situations, They Are More willing to discuss them,"   surveys the identification of the spiritual dimension in psychotherapy. They quote Johnson (1989) and Siporin (1986) who indicate that a therapist dealing with spiritual content will respond to it in a way that is congruent to the therapist’s conscious or unconscious theory, attitudes, and, interest in this realm of experience. Thus, if the therapist does not connect with “spirituality” in some way it is highly likely that it will be overlooked in the therapy of  patients who do.
 

A quotation from the psychoanalyst R.D. Laing is apropos:

                      The range of what we think and do is limited by what we fail to notice

                      and because we fail to notice that we fail to notice there is little we can

                     do to change until we notice how failing to notice shapes our thoughts

                     and deeds.

Extending Laing’s observation to the realm of spirituality suggests that awareness or lack of awareness of “spirituality,” along with implicit or explicit theories about the nature of spirituality, will yield alternative organizing concepts used in identifying, exploring, interpreting, and working through “spiritual” material.

Awareness of the psychotherapist’s personal attitudes to “spirituality” has been linked to attitudes about the nature, conduct, and ultimate value of the psychoanalytic process. In this regard a recent edition of the Psychoanalytic Psychology” journal (summer/2004) is instructive.  These articles are: Rizzuto, A. M.D. (2004) “Roman Catholic Background and Psychoanalysis;” Aron, L. Ph.D. ABPP, (2004) “God’s Influence on My Psychoanalytic Vision and Values;” Fayek, A. Ph.D. (2004) “Islam and Its Effect on My Practice of Psychoanalysis;” and Sorenson, R.L. Ph.D. PsyD. (2004) Kenosis and  Alterity in Christian Spirituality.”

Alternative Perspectives in Understanding the Nature and Knowledge of  Spirituality

A Non Psychoanalytic Approach in Working with “Spiritual” Material

In conjecturing about the nature of spirituality {i.e. reflecting on how best to view S’ “spiritual” dream material} there are two distinct epistemological perspectives. These two contrasting approaches will be referred to as (1) a mystical/magical supernatural transcendent perspective; and, (2) a grounded immanent psychodynamic perspective. These two perspectives will be discussed in turn.

The former, a non psychoanalytic perspective, the most commonly held spiritual viewpoint, asserts that there is a conscious God {Higher Power} who is knowable through intuition and feeling (faith and belief). In this view, direct knowledge of God {the realm of absolute spirituality} would be unmediated knowledge – by passing the five senses - appearing to violate the conventional scientific laws of cause and effect. This basic epistemological assumption in viewing the nature of spirituality is the foundation upon which the Analytic Psychology of Carl Jung, and the “spiritual therapy for alcoholics” commonly referred to as “The Twelve Steps” have been erected.

It is noteworthy that many new patients with “spiritual” concerns admit to being substance abusers {alcohol, drugs, sex etc.} In this connection, the Twelve Step Program of Alcoholic’s Anonymous identifies the alcoholic’s core difficulty as clearly a “spiritual problem.” {It is noteworthy that a major concern of S was his fear that he was addicted to pain killers.}

Whitfield, (1984) in “Stress Management and Spirituality During Recovery: A Transpersonal Approach, (Part I. Becoming)” identifies the alcoholic’s “spiritual” problem as “a falling away from god consciousness.” The falling away is due to the alcoholic’s: “rejection of God’s will,” resulting in a symptomatic… lack of faith, hope, trust, and love of God.” The falling away from God consciousness converts the original whole self into one that is divided.  While implying that the alcoholic’s problem is a combination of psycho/spiritual material, Whitfield emphasizes the spirituality dimension over the psychological dimension with respect to treatment. (The Twelve Steps and the Twelve Traditions, p.4)

Having identified {diagnosed} the alcoholic’s problem as an individual self that is out of spiritual alignment {divided} with the realm of absolute spirituality {God consciousness}, an intervention logically follows: reestablish the broken “spiritual” connection. Whitfield defines “spirituality” as: “the self connected by consciousness to the Higher Power.” (Whitfield, p.4 ) Note: In addition to treating alcoholics, the Twelve Steps Program is widely used to treat other forms of addiction and substance abuse.

Whitfield {1984} accounts for the “falling away from spirituality” {a regression from unity consciousness to deflation consciousness} as the result of unbearable tension due to stress. He identifies the source of this stress as due to the alcoholic’s chronic sense of frustration resulting from an inevitable inability to attain and sustain unrealistic expectations of himself and the object world. The alcoholic’s spiritual problem arises as a direct result of an attitude of “dissent.” The dissent takes the form of a negative attitude expressed as a “defiance of {God’s Will} instead of an alliance.” This defiant attitude to God renders the alcoholic doomed to eternal frustration. Further it is the frustration that the alcoholic experiences as overwhelmingly stressful that compels him to turn to alcohol {and other narcotizing substances such as drugs, sex, and the like} to obtain relief from unbearable tension. (Whitfield, p.3)

Whitfield believes that “spirituality” expressed in negotiating the Twelve Steps spiritual program is the best stress reducer. Towards this end “spiritual” interventions are utilized as the key to achieving success defined as attaining a spiritual transformation. Whitfield lists primary spiritual interventions as “meditation, sharing feelings, thoughts and experiences with other AA members in meetings, and prayer.” (Whitfield, p.7 )

There is no doubt there exists a group of patients {perhaps best characterized as “True believers,”} who, having negotiated the Twelve Steps-reconnecting to their Higher Power  believe their therapy  has resulted in their feeling  transformed.

However, If Whitfield’s formulation is valid, we would reasonably expect that all who suffer from “spiritual” problems would be potentially curable once negotiating the Twelve Steps program. The facts suggest otherwise as there is a second group of patients, perhaps best described as “agnostics,” who from the inception of their treatment are unable to make meaningful connections with some essential aspects of the Twelve Step Program.  This means that for them The Twelve Steps is doomed to failure as it simply doesn’t work with these people. For such agnostic people there is a pressing need for a psychoanalytic theory of spirituality.

In addition to drop outs from The Twelve Steps, many psychoanalytic psychotherapists have reported an increasing demand from new patients for integrating what is defined in this paper as spiritual material into the framework of psychoanalytic theory and practice.

Common to analytic and non analytic therapies is first and foremost the patient who is seeking relief and sometimes enlightenment. In working with the dimension of spirituality – the first issue is to identify spiritual material as such. What then is characteristic of patients in need of “spiritual” psychoanalytic psychotherapy?

Identifying Spiritual Material

What most preoccupies new patients needing “spiritual” psychoanalytic psychotherapy is the quality of their distress – in this case – “spiritual” distress. Patients suffering from “spiritual” distress complain about feeling lost, totally confused, empty, out of control, overwhelmed, depleted, helpless, and hopeless. One patient vividly captured the essence of this feeling matrix stating he has always felt as if he had “a hole in his soul.”

Typically described are such comments as “nothing good ever lasts”, “why do these things only happen to me”, “there is nothing substantial for me to hold onto”, “I feel as if I have lost myself”, “I loathe myself”, “I wish I hadn’t been born”, “I am like the walking dead”, “no one loves me”, “the outlook is bleak”, “I want to feel meaningfully connected but instead all I really feel is meaningless disconnectedness.” Often there are explicit references to experiencing universal distrust, a lack of faith, an inability to generate and sustain hope, incapacity to maintain and sustain balance in the midst of internal and external forces, and a gnawing fear that the person can neither love nor be loved. 

In addition to these complaints there is what might be classified as “the biggest issues” concerns. These concerns are subsumed under the following rhetorical questions: Who am I; what do I really want, what is my life’s purpose; what is the point of getting up each day; where did I come from and where am I going; what is really real and how do I know it. These are questions that are associated with the province of speculative philosophers like Plato, Aristotle, Spinoza, Kant, Hegel, Whitehead and the like. Note that all of these concerns have a common theme of primary motivation that is blocked.

For the most part, complaints listed above and collectively identified as “spiritual” concerns have largely been the province of non psychoanalytic therapies (i.e. Jungian, Transpersonal, The Twelve Steps). The reason this paper is being written is due to a notable trend among many psychoanalytic psychotherapists to conceptualize such complaints as psycho/spiritual material. It is noteworthy that organizations such as The Center for Spirituality and Psychotherapy (www.psychospiritualtherapy.org) and The Psychotherapy and Spirituality Institute (info@mindspirit.org) in New York City have sprung into existence only within the last eight years.

Acknowledging the fact that it has only been relatively recent that the dimension of “spirituality” has been considered to be, in and of itself, a valid concern for most psychoanalytic psychotherapists, the question may be asked why has it taken so long to incorporate a theory of spirituality into mainstream psychoanalytic psychotherapy theory and practice?  To do justice to this question an historical digression is in order.

In pursuit of important tasks such as the integration of overlooked areas of human experience into the accepted cannon, it is common place for psychoanalytic psychotherapists to consult Freud for expert guidance. As often occurs, the founders of movements – primary sources - often have their original ideas drastically misinterpreted by other well meaning but inaccurate secondary sources.

In this light, it is a common misnomer that Freud – the founder of Psychoanalysis – was purportedly dismissive of spirituality. The reason for this is a confusion between Freud’s strong stand against organized religion {he was an admitted atheist}, and his equally strong affirmation of “spirituality”.

Bruno Bettelheim (1983) writing about   Freud and Man’s Soul   states:

                    {While it is quite true that Freud distained organized religion it is also true that

                     he affirmed spirituality – an immanent spirituality without a deity.} “Freud  

                     believed his readers would benefit from {taking a journey in inner space}…

                    {a} spiritual journey of self discovery. (Bettelheim, p.4)

Continuing:

                    Freud often spoke of the soul – of its nature and structure, its development, its

                   attributes,  how it reveals itself in all we do and dream. (Bettelheim, p.4)

<>In a letter to his friend Oskar Pfister, Freud makes his ideas about spirituality quite clear. Drawing a parallel between
two of his important papers: “The Question of Lay Analysis” and “The Future of an Illusion” {As to organized religion} Freud says:

                  In the former I want to protect analysis from physicians, and in the later from

                  priests. I want to entrust to a profession that doesn’t yet exist, a profession of

                  secular ministers of souls, who don’t have to be physicians and must not be

                  priests.{Quoted in Bettelheim (1983) p. 11)

Bettelheim adds:

                 … Psychoanalysts were not to think or function as healers of bodies do, nor

                  were they to be purveyors of an esoteric or revealed truth. {By this was meant

                  that each patient should discover his own truths in his personal journey in his/her

                  inner space.} p. (p.14)     

With respect to the spiritual dimension, the question for psychoanalytic psychotherapists is how to aid a patient to discover his own “spiritual” truths in the frame work of psychoanalytic psychotherapy.

It is assumed that all people seeking and needing “spiritual” therapy will present the same or similar list of complaints, and issues. What will differ are alternative ways their therapist understands their material. As has been stated, understanding the nature of “spiritual” material is guided by the therapist’s explicit and implicit basic ontological and epistemological assumptions determining their views of the nature of reality and knowledge of reality.

In this connection, G. Williams {2000}, a psychoanalytic psychotherapist, in ”The Psychodynamics of Spirituality: The Personal Unconscious and the Higher Power,”  worked with six “non believers,” five of whom were drop outs from Alcoholics Anonymous, unable to meaningfully connect with AA’s conceptualization of the Higher Power as a transcendent divine realm of absolute spirituality. In their intake interviews, the five patients and one other were characterized as “spiritually” obsessed.” The question became how best to work with the “spiritual” concerns of these six non believers in the framework of psychoanalytic psychotherapy. gibbsonline.com

Towards Identifying the Core Issue in Spiritual Psychoanalytic Psychotherapy

Most of the research that focuses on spirituality as an important dimension starts with a list of “spiritual” complaints. Few attempts have been made to identify a core underlying root cause of these symptoms. Those that have done so point to the structure of the whole self as the area most likely to yield precise knowledge as to the root causes of “spiritual” symptoms.

In this connection, it is basic in non psychoanalytic discussions of the nature of spirituality to identify the two most important concepts as those of God {Higher Power, a realm of absolute spirituality}and a self  that is either connected or not connected to the assumed spiritual source.

The self is assumed to be preformed before birth and will be experienced as whole and integrated as long as it is connected to its spiritual source. Once “defying” or somehow becoming disconnected with its spiritual source the once unified self now experiences itself as divided. The divided self in turn generates a complex of “negative” feelings, fantasies, and conflicts, listed above taking the form of a “spiritual” disease.

The self conceptualized by non psychoanalytic psychotherapies viewed in the light of its relationship to spiritual concerns appears to be a relatively uncomplicated self. It is either full or empty; it is either meaningfully connected with a transcendent spiritual source {i.e. “God’s Will”} or it is disconnected.

What is apparently omitted from consideration is what we psychoanalytic psychotherapists collectively refer to as complex intrapsychic psychodynamics. In this connection I agree with Guntrip’s (1969) comments about the nature of psychoanalytic psychotherapy. Says Guntrip:

                          … {Psychoanalytic} psychotherapy is a term that now becomes

                          meaningless unless it stands for trained psychodynamic treatment

                          of the personality in depth. Everything else is ‘psychological first

                          aid.’, however valuable and necessary that often is in practice. 

                          (Guntrip, p. 329)
                        

Treatment for spiritual ‘disease’ {overwhelming stress} in non psychoanalytic programs consists of providing a transitional experience for the patient designed to promote just right conditions for enabling the person to reconnect with his transcendent spiritual source thereby reducing his stress.

For Whitfield this transitional experience is exclusively a spiritual solution.  Discounted is even the remotest possibility of an adequate psychological solution. Whitfield bases his categorical assertion on the assumption that: "none of the traditional Western psychological frameworks or theories adequately relates the mind/ego and the self." (Whitfield, p.16)

Whitfield makes a distinction between being (characterized by passivity) and doing (characterized by activity). He believes that the self resides in the realm of passive being; whereas the ego’s realm is that of active doing. Whitfield reasons that because Western psychological frameworks only deal with the mind equals the ego, the self is only thought of in linear rational ways. This equation of mind = ego = self are relevant to issues of doing (action) {not, our Being}. For Whitfield this too narrow conception of self leaves out the crucial dimension of spiritual experience which for him is the essence of the self. Further, says Whitfield, "our spirit is not knowable by our intellect – it is only Be –Able. It is known through contradiction and paradox." (Whitfield, p.10) 

Thus for Whitfield, the self is a state of pure being that is "a sanctuary from stress." This 'place' is described by him as "spirit, essence, true nature, soul, higher self, The Self. (Whitfield, p.13) It is only knowable through intuition and feeling not by the intellect.

It is to be noted that in working with “spiritual” material, Whitfield strongly implies that   therapists should be careful not to err by being overly rational with essentially “non rational” content. {I believe that if  psychoanalytic psychotherapists fall sway to such a specious anti – intellectual argument all work in attempting to make the {unseen} personal unconscious conscious would instantly cease.}

As will be demonstrated, current trends in psychoanalytic theory, research, and practice present a formidable rebuttal to Whitfield’s point of view.

Before undertaking this task, I believe that a key problem in integrating the territory of spirituality into the perspective of psychoanalytic psychotherapy has been that of differentiating spiritual from psychological issues. In this regard Guntrip’s (1969) clarifying comments are helpful:

                      Insight, integration, individuation, and personal relationships

                     are but distinguishable aspects of one and the same thing, which

                     is called mental health from the psychiatric point of view and

                     peace or salvation from the religious point of view. (Guntrip)

Guntrip also points the way to conceptualizing the self in terms of its beingness.

                    Science never knows the “person”; it only has information about

                    the person … There cannot be a whole complete human being

                    without an integration of feeling with thinking, provided by

                   ‘doing’, arising out of the fundamental experience of ‘being.’

                    (Guntrip, p.271)

Guntrip’s identification of “insight, integration, individuation, and personal relationships” are all manifestations of an individual self.

Psychoanalytic psychotherapists who recognize the dimension of spirituality as a valid territory of exploration implicitly or explicitly center on the self as that structure {or lack of structure} most likely to yield precise knowledge as to the root causes of “spiritual” symptoms. But the self {including its nature, location, origin, and development} is not the same self as the one talked about by non psychoanalytic psychotherapists.

<>It is to be noted that Freud was moving in this direction but was cut short because of his untimely death. He was beginning to explore the origins of identity {the self} pushing developmental theory and observation back to the earliest origins of identity formation in the first two years of life {so called pre – oedipal development}. Says Guntrip:
 

                     {Since 1920}, …when Freud began to formulate the emerging concepts

                      of his most important theoretical advance, an ever-widening research

                      into ego-psychology, and the deepest depths of the unconscious and

                      the earliest stages of infantile growth has become the outstanding

                      feature of psychoanalysis. (Guntrip, p.243)

<>Among researchers who have made important and stimulating contributions in this fruitful area are Guntrip (1969), Eagle (1984) Erikson (1950), Freiberg (1959), Eigen (1986), Jacobson (1964), Kaplan (1978), Mahler, l971, H.B. Lewis (1978), Piaget (1960), Spitz (1965), Winnicott (1958), Wittenberg (1968), Seinfeld (1991), (Silverman and Lachman (l971).

C
<>ollectively these researchers explore the roots of the self as developing out of “an undifferentiated matrix.” The self is not considered to be a tabula rasa but an already complicated structure in the making that differentially responds to stimuli in intrapsychic and interpersonal reality. A child apparently has to experience enough of being unconditionally accepted {loved} to grow a solid self structure. 

To the degree to which the baby is helped and encouraged to tolerate that which is unpleasant {negative affects chiefly that of frustration} it spontaneously grows a cohesive self. Correspondingly, bearing too much or too little frustration leads to global ego weakness.

Global ego weakness, in combination with an under structured self generates the whole gamut of complaints listed above. Chief among these symptoms is depletion of basic vitality – or in AA terminology – deflation consciousness. 

Connecting Spirituality and Psychology and Locating it in Early Childhood Development

A.H. Almaas, (2000) a physicist who became dedicated to exploring the nature of spirituality and pathways to accessing it, believes that the roots of spirituality are to be located in the vicissitudes of the developing child.  Although not a psychologist he appreciates the contributions made by various approaches to depth psychology. In a book called: The Point of Existence: Transformations of Narcissism in Self-Realizations Almaas indicates why he favors the psychology of the  psychoanalytic approach in understanding the nature of spirituality rather than the Jungian although he gives credit to the Jungian approach as, unlike the psychoanalytic approach, it “integrates the spiritual dimension.”

Almaas states:

                   … rather than trying to square our understanding with Jung’s {perspective},

                     we have come to use psychological knowledge that is available in other schools

                    of depth psychology which do not include the spiritual dimension. In this way,

                    we can remain with the purity of our understanding and experience of the

                    spiritual dimension and create concepts that connect them to the psychological

                    knowledge that are appropriate to such understanding of experience. So we use

                    the findings of Freudian psychoanalysis, ego psychology, object relations theory,

                    and self psychology, amongst others integrated with our view of development.

                    At the same time we appreciate Jung’s work as more complete than the Freudian

                    perspective, primarily because it integrates the spiritual dimension. (Almaas,  

                    p.463)

Specifically, Almaas speaks about psychological structures as the key to understanding spirituality from a naturalistic perspective. Says Almaas: “Our work includes the concept of structures of essential reality, which can easily be confused with Jung’s archetypes….” (Almaas, P.464) 

Assuming that faith, hope, trust, persistence, and love (core spiritual concepts and experiences) have their origin in early childhood development gives us a pathway to integrating “spirituality” with classical psychodynamics. {Psychodynamics studies ‘the subjective experience of the human being as a person.”(Guntrip,1969, p.329} Such a view of spirituality can be scientifically investigated without robbing it of its extra scientific benefits to patients. Guntrip’s (l969) words are instructive:

                         … {Psychoanalytic} psychotherapy must use psychodynamic

                         knowledge, which has its own objectivity and is the only truly

                         ‘psychological science’ , as a tool in the service of human

                         personality and its rights to be given personal relationships of

                         a kind which will permit and ‘facilitate’ (vide Winnicott) growth

                         to maturity of personality. (Guntrip, p.326)

Borrowing from many points of view derived from the “collective consciousness” I propose a theory of spirituality and psychoanalytic psychotherapy that has nothing to do with the supernatural. Its emphasis is strictly on what is perceived as immanent and personal rather than that which is thought of as transcendent and collective.

<>What has just been said is perhaps true but is largely abstract – from the outside in – so to speak. It gives the impression that psychoanalytic psychotherapists were {or should be} primarily disembodied intellects who have or perhaps can attain power to be totally objective. This standard is, as we painfully become aware in our often frustrated attempts to help our patients, - particularly in working with “spiritual” material - not the case. However, it does not mean that we should be dismissive of the potential power of shared minds to be as objective as we can in trying to rationally do therapeutic justice to the complex “spiritual” material we encounter.

In this connection, we are saved from utter doubt and confusion {hyper subjectivity /hypo rationality/ and, an “anything goes” relativity} by consulting our best ally as to the key to the patient’s “spiritual” difficulties, this ally being the patient him/herself.

Consulting the patient as the best guide for intervention, Williams viewed each of his six patient’s “spiritual” symptoms as unresolved psychological conflicts beginning with their earliest experiences of “reality.”  For each person, reality appeared totally irrational and cruel – utterly devoid of a personal good God who was reasonable and caring.

Summarizing the major characteristics of these patients in their first few sessions of individual psychoanalytic psychotherapy, Williams (2000) states:     

                       Each of the patients is analytic and psychologically minded. Each feels that

                       something fundamental concerning the self is either missing or is defective.

                       Further, that what is missing or defective is related to issues thought of as

                       spiritual. …Each is searching consciously or unconsciously for absolute

                       answers to ultimate questions such as who am I, what do I want, and what is

                       my purpose. Each has tried but ultimately failed to utilize the Higher Power to

                       break free of what has seemed to be an intractable therapeutic impasse. Nevertheless,

                      despite their overt rejection of the Higher Power as conceptualized by A.A., they have

                      each retained an almost obsessive preoccupation with spiritual matters. Clearly these

                      agnostic patients have been searching for an effective spiritual psychology to

                      transform themselves. (Williams, pp. 5-6)

Despite valiant attempts to negotiate the Twelve Steps, five of the patients wound up irretrievably “blocked” at some point in the steps process. Williams (2000) identified four problems associated with each of the patient’s psychological/spiritual impasses. These four psycho/spiritual impasses were experienced as roadblocks, or stuck points, primarily affecting the patient’s primary motivation. These four impasses are:

(l) The problem of empty expressed by the patient who felt there was something missing at his core-

with nothing substantial to hold onto and if by chance there occasionally was, he couldn't sustain it. (2) The

problem of negativity expressed as an allergy to intense negative and sometimes positive affects including those

of frustration, anxiety, fear, depression, shame, guilt, rage, revenge, excitement and pleasure. (3) The problem

of self esteem deregulation expressed as an inability to cope with internal and/or external stressors (realistic limitations) which results in a deflation of self esteem. (4) The problem of final authority expressed as the patient's inability to trust others or himself as the final authority for his experience.

 It is important to take note that these four impasses are all associated with what Whitfield would identify as the area

 of Being. It is also to be noted that the psychotherapist and his patient working on resolving these treatment impasses

 invite shared intellectual discussion into the sessions. Thus the thrust is to begin by identifying and naming sensations,

 intuitions, and feelings that are associated with “spiritual” material but converting what is experienced as only

 existential {ego dystonic} into that which is problematic{ego syntonic}. Two examples of how this is carried out in

 treatment is as follows:

                 The Problem of Empty and the Personal Unconscious

                       If the Higher Power be thought of as the Personal Unconscious, the problem of

                       empty may be understood in one of two ways: (l) either as a by product of

                       insufficient structural development of the self, or (2) as motivated emptiness.

                       Peter was unable to connect with and therefore unable to use his personal  

                       unconscious due to early unintentional 'brain washing'. His overly protective

                       parents gave him the message not to separate but to stay home and take care of

                       them. Thus because he learned that urges and actions towards the direction of

                       autonomy were experienced as forbidden experienced as unconscious guilt, he

                       lacked permission and encouragement to grow a cohesive self. Quite predictably,

                       he developed a habit of systematically overriding his truest instincts that issue from

                       his personal unconscious. Disowning his most authentic natural desires was

                       experienced as emptying himself out. Thus his issue of empty was understood by

                       his therapist as motivated emptiness.

                       As this automatic self sabotaging process was gradually made increasingly more

                       conscious, Peter, had, for the first time in his life a rational framework for

                       clarifying the battle yet to be fought for the control of his soul. This was

                       accomplished in eight months.

                       The Problem of Self Esteem Regulation and the Personal Unconscious

                       Mills began Psychoanalytic Psychotherapy hyper sensitive to his feelings of

                       frustrated unrealistic expectations {a disappointment allergy} unaware that he was

                       convinced that perfection is a fact and that he should be able to both attain and

                       sustain it. Predictably falling short of his goal evoked a periodic despised feelings

                       of weakness, confusion, fear, depression, accompanied by a precipitous drop in his

                       self-esteem. His therapy consisted of (1) of continually challenging his first

                       assumptions about his {unrealistic}fantasies of perfection (making him consciously

                       aware of  what up to that point was largely unconscious}. (2) He was taught how to

                       identify and to tolerate increasing dosages of  dreaded intensely painful ‘negative’

                       and 'positive' affects. This led to a spontaneous strengthening of his ego and the

                       formation of a cohesive self. As a result of his gradual shifting of unrealistic to

                       realistic attitudes about his goals coupled with a guided effort in working towards

                       them he began to get in touch with his considerable 'middle level' powers and

                       began effectively utilizing them. This therapeutic intervention broke a life long

                       self-esteem deregulation impasse in only three months, three times a week

<>                       psychoanalytic psychotherapy.  (Williams, pp. 10-13)

It is my view that what we psychoanalytic psychotherapists must do to be  maximally effective in working with spiritual material is to identify, explore, and understand in depth and breadth the idiosyncratic psycho/spiritual ‘fingerprint’ of each one of the unique patients we work with.

                 … The highly individual nature of every separate analysis calls for

                 understanding, since no two patients are ever exactly alike. Every

<>                       human being  {is} a unique individual person. (Guntrip, p. 316)              


I have concluded that identifying the four issues above and making them center stage, until they are sufficiently worked through, constitutes a necessary step in satisfying a patient’s need to attain and sustain a meaningful “spiritual” connection.

Extensions of these ideas aimed at integrating spirituality into mainstream psychoanalytic psychotherapy are found in papers I have written, including: “A Theory and Use of Meaningful Coincidences” (l999); “The Psychodynamics of Spirituality: The Personal Unconscious and the Higher Power (2000); On Learning to Tolerate My Own Frustration (2000); and Something Out of Nothing:  The Problem of Empty – Creating Psychological Structure (2001) - gibbsonline.com

Utilizing their findings and my own research I propose a theory of spirituality and psychotherapy independent of the supernatural.

My composite conclusions are:

                   (1) What we refer to as spirituality has its origins in pre-oedipal {the first two years of

                          life} consciousness.

                   (2) Spirituality is experienced as a preoccupation with contents, attitudes, and conflicts

<>                         concerning the presence or absence of basic trust, faith, hope, persistence, and love.


                   (3) Effective spiritual psychotherapy will focus on creating the optimum conditions for 

                         identifying, exploring, and working through these five core issues.

                   (4) The first issue in working towards therapeutic success is building psychological

                         structure {a cohesive self, a strong ego, and necessary psychological boundaries in

                         space, time, and contents of consciousness).

                   (5) The key to effectively building psychological structure {see Spitz (1965 ) is in teaching 

                          a person to tolerate increasing dosages of negative affect including: anxiety,   

                         depression, frustration, ambiguity, complexity, not knowing, and the like.

                   (6) It is of paramount concern to concretize for the patient how he/she automatically react

                         to disappointment {missed expectations}in predictably leading to depressed states

                         and blocked forward movement greatly affecting primary motivation.

                    (7) Those person’s identified as needing spiritual psychotherapy vary along a continuum

                          ranging from “true” believers to those that have either lost or never had any belief in a

                          transcendent deity.

                    (8) Those persons identified as needing spiritual psychotherapy vary in attained

                           consciousness. The attained consciousness of a given patient acts as a filter through

                           which the raw material of internal and external reality is processed. The states of

                           consciousness, so far identified, are kaleidoscopic consciousness; symbiotic

                           consciousness; transcendent consciousness, transitional consciousness,

                           transformational consciousness, ego consciousness, psychodynamic consciousness

                           and unity {synthetic}consciousness.

The combination of an under-developed self structure {experienced as an inability to remain solid and focused in the midst of internal or external pressure} and global ego weakness results in a devitalization of the spirit. Such a person feels dispirited. Spirit is equivalent to primary motivation. Primary motivation ranges from positive inertia experienced as kinetic energy or negative inertia experienced as anhedonia - a decathexis of self and object libido. 

Revising the Operational Definitions of Core “Spiritual” Concepts in the Framework of Psychoanalytic Psychotherapy

Just as a revision of the self yields a significantly different way of conceptualizing the nature of and working with spiritual material in alternative therapeutic approaches so too will the revision of other core spiritual concepts. Among the core spiritual concepts that need to be redefined are:  at-one-ment, faith, trust, hope, love, persistence, transcendence, and transformation.

Alternative Perspectives of the Concept and Experience of At-one-ment

Because words have multiple meanings depending on the contexts in which they are embedded, it requires us to think critically and openly about the concepts that we use and the uses to which they are put. Case in point is the repeated ‘group think’ near unanimous agreement concerning attitudes about at-one-ment experiences characteristically associated with “spiritual” material.

In this connection it is common place that much of the literature of spirituality {particularly that which focuses on spiritual events} emphasizes the element of at-one-ment expressed as an assumption of the {positive}interconnectedness of everything with everything else.

F
or example, T. Hora (1983) in a booklet called “Healing Through Spiritual Understanding”, states:

                      We are not separate units of life; we are one with the creative principle of

                      our existence. Infinite mind is our creator and spirit is our substance. We

                      are made of the same stuff as God is made of, and we cannot really

                      be independent. Existence apart from God is an illusion which we all have to

                      be healed of eventually. Wonderful things happen when we reach a point

                      of understanding wholeness; wholeness is oneness, undividedness, and that

                      is very important to realize. (Hora, p. 6)                                  

Whereas experiences of at-one-ment are often experienced as quite wondrous, and psychologically warm, inducing hopefulness and a sense of interconnectedness with the self and the object world, it is also important to note that such numinous events can be exploration stoppers. Some therapists can be so enthralled by the numinous aura emitted by these experiences that both patient and therapist may just bathe in the glow of the wonder of it all without using the opportunity to explore thereby short changing the therapy.

“Spiritual” events, such as Jesus giving my patient a gift tend to be accompanied by feelings of awe and the uncanny referred to by Jung and others as “numinosity”. Progoff (1973) talking about synchronicities {especially meaningful coincidences} describes numinosity as {radiating}:

                       An aura of great light and great warmth… Expressions of psychic

                       intensity … accompanied by a great emotional affect, {bringing an

                       awareness of a special light, a numinosity carrying a sense of

                       transcendent validity, authenticity, and essential divinity.

Such uncanny {spiritual} events are often considered to be nothing short of the mystic’s experience of a felt connection with a realm of transcendent spirituality evoking a powerful feeling of at-one-ment and a sense of the interconnectedness of everyone with everything.

Jean Shinoda Bolen, M.D. (1979) – a Jungian psychiatrist – commenting on her experience of synchronicities considered to be ‘spiritual’ occurrences, describes her non psychoanalytic psychotherapy attitude to such events as follows:

                       {Under the right conditions such as meditating or praying} the

                        intuitive knowledge that there is a patterned universe, or an

                        underlying meaning to all experience, or a primal source, to which

                        “I” am connected, always evoke a feeling of reverence. It is

                        something known rather than thought about, so that explanatory words

                        are inadequate. (Bolen, p.2)

A patient suffering from a defensive isolation of affect so as to appear as if they are unable to feel, once experiencing a numinous “spiritual” event and the “loosened’ affect typically accompanying it may be so shockingly positive that it is judged to be an authentic “spiritual” breakthrough. However my experience is that most patients who come into therapy for the first time suffer less from too little feeling than from too little thinking. 

“Breakthrough” not with standing, relatively inexperienced psychoanalytic psychotherapists should be warned that significant change is always difficult and hard to come by as conscious and unconscious resistance dogs the way. That is why we allow for a great deal of time to “work through” the material appreciating that seemingly major breakthroughs are subject to just as rapid regression.

An issue that has both transferential and counter-transferential implications is that the psychotherapist who strives to be objective has to guard against making too much out of what at first glance – appears to be a true “miraculous” spiritual transformation following a so called “spiritual breakthrough.”

While there is no doubt that a patient can and often does believe that they have had  a  “spiritual breakthrough” experienced as feeling meaningfully connected, more energized, perhaps even saved, there is a danger that such feelings will last only as long as internal and external reality present tolerable pressure. Once intolerable pressure is encountered regression frequently and rapidly reappears.

                        J was my first patient of all time. She cried for 45 minutes of her first session

                        in deep despair. Her central complaint was that she had never been consulted

                        as to whether or not she wanted to be born and unfortunately for her she

                        got stuck with two insensitive parents. After three years of psychoanalytic

                        psychotherapy we were able to identify some of the roots of her seemingly

                        intractable depression . But her hopes for a brighter, creative life were not too

                        strong. Then a few hours before her next session she called to tell me that she

                        would be late because she and her parents had been in a car accident on the New

                        Jersey turnpike. They had skidded on some oil streaked pavement and

                        completely flipped over {but landed upright with no injuries.} Her upbeat joyful

                        voice was uncharacteristic to say the very least. She said that there must be a

                        God and that she felt she was saved by a miracle. Her depression lifted, she felt

                        hopeful, and made plans to move out of her hated dank apartment. Her

                       {uncharacteristic} burst of  good feeling and positive attitude lasted exactly two

                        weeks (4 sessions) before she sank into an even deeper depression {triggered}

                        by some {unexpected}  new loss experienced by her as traumatic.

  At the time I was too untrained and unanalyzed to have known what would have been

  most helpful to my patient.   Had I known then what I know now I would have spent

  less time talking about feelings {i.e. her litany of complaints with respect to her

  numerous frustrations, disappointments and even her rapturous short lived conversion}

  and; instead, focused on her lack of psychological structure blocked from developing

  due to her  virulent negative affect allergy.     

  Another potentially valuable line of inquiry might have been to trace her mixed

  relationship with God and spirituality. This would no doubt have located the probable

  onset of her life long depression associated with the death of a beloved Grandfather

  when she was three years old. Despite her hatred of her parents, she loved and was

  loved by her  grandfather. When he died any belief in a caring God ‘died’ as well.

  She subsequently became cynical and cold with respect to anything remotely resembling

  “spirituality.”

 The “miracle” of being saved from a near death experience was equivalent to a persistent

 fantasy of hers that her dead  grandfather would wake up and come back to rescue her.

 When life pressures got to big for her weak ego to master she psychologically

 “collapsed”. Thus, what was initially experienced as a true spiritual breakthrough,

  directly leading to a short but significant change of attitude {negative to positive

  motivation} collapsed and led to a deepening of  her despair, bitterness, and cynicism

  with J  concluding that her spiritual breakthrough was a grand illusion. 
 

A Revision of the Operating Definition of Faith in the Context of Psychoanalytic Psychotherapy

In addition to the self, and at-one-ment, concepts such as faith, hope, trust, transformation and transcendence are generally discussed as if we all are quite certain as to their meanings. The truth of it is that they have multiple meanings depending on the lenses through which we view them.

The psychodynamics of spirituality invites a revision of the operational definitions of these and additional core concepts associated with spirituality to fit into the framework of psychoanalytic psychotherapy theory and practice. 

Thus, faith viewed in the context of naturalistic psychodynamics is operationally defined quite differently than faith defined in the context of a reality assumed to be transcendent and spiritualized. “A psychoanalytic and self psychological perspective would view faith in psychodynamic terms.” (Williams, 2000 p. 6)

A pertinent example of this is Klauber’s (1974) psychodynamic translation of the concept and experience of faith.

                        Klauber, quoting Tolstoy describes faith as 'the force whereby we live' -

                        that sense by virtue of which man does not destroy himself, but continues to

                        live on.'   Klauber continues: This description of faith does not refer, however,

                        to belief in any religious myth or formulation. It refers to the inner consciousness

                        of a force that, whatever its origins, is now experienced as acting from within. It

                        may, I think, be translated into psychoanalytical terms as the force which ensures

                        that the individual will withstand instinctual frustration and tolerate tension

                        between ego and ego-ideal without the danger of a murderous attack upon the

                        ego by the superego. Put another way, it is the faith in the indestructibility of good

                        internalized objects. (Williams, p.8 quoting  Klauber )

The standard definition of faith is “a firm belief in something of which there is no proof.”  Faith in this perspective depends upon a passice connection with a transcendent "spiritual" force. By contrast, faith, translated into the langauge of  the psychodynamics of spirituality is an active process whereby an individual persisting in struggling with
struggle retains a solid self in the midst of internal and external pressure by tolerating and thereby mastering negative affects.

            

Some Transference and Counter-transference Issues Associated in Working with Spirituality

As for counter-transference, my experience in working with “spiritual” concerns is that it is among the most complex, multi leveled, nuanced material one will ever encounter in this work. If the therapist is open to the direct experience of the patient he sooner or later will be “pushed” to confront his most basic ontological and epistemological assumptions about the nature and knowledge of reality.

<>For example, the often encountered belief of new patients {reinforced by the big lie perpetrated by many managed care “operations”} that the therapist has magical powers to effect a rapid and sustained transformation in the suffering patient in twelve sessions or less, most assuredly challenges the therapist to come to terms with what his true powers really are and are not. 

As to transference, significant change is possible but is always dogged by resistance. The major resistance is repetition compulsion – the need {habit} of repeating the familiar. Significant change in those who suffer from spiritual disease tends to proceed not with a series of major breakthroughs, straight up and onwards, but more like trench warfare – twelve trenches forward and seven trenches backwards. Thus the therapist’s personal and professional narcissism is constantly being tested with respect to his/her own solidity in the face of what often appears to be  intractable failure in the patient’s circular attempts to acquire and sustain meaningful therapeutic progress.

As will be seen S was “betrayed” by a therapist who I believe got angry at him for daring to challenge her personal and professional competence. I believe her anger at him was motivated by underlying anxiety in being frightened by his complex – seemingly intractable – existential despair. Such material is not uncommon among those new patients who I believe are fit candidates for spiritual psychoanalytic psychotherapy.

There are numerous interventions that might be made that work to some extent.  However it is obviously to the patient’s benefit that we have some criterion for determining not what works but what works best. This means, contrary to a growing trend among a number of psychotherapists, that diagnosing the core issue hypothesized to underlie complaints of the patient is of paramount importance because it determines the choice of the therapist’s specific interventions both globally and session by session.

This is a crossroads issue having crucial transference and counter transference implications for the treatment of a patient needing spiritual psychotherapy. As to transference it is crucial for the therapist to appreciate that he will see only that which he sees. Freud’s words are apt: “The problem with self analysis is the counter-transference.”  Therefore it is crucial for the therapist working with these issues to know what his prejudices are, careful not to force his patient to swallow whole that which does not resonate with the patient’s direct experience. This goes for any position as to whether a patient {or therapist} believes or disbelieves in the existence of God, a God, Gods, or no God.

A Trip into Inner Space:  Detail by Detail – Connection by Connection

A key principle in psychoanalytic psychotherapy is to convert what appears to be existential {a just so story} into that which is problematic guided by some theory of symptom formation {model of the psyche}. A theory is operationally defined as “the analysis of a set of facts in relationship to one another.” {Merriam Webster’s Collegiate Dictionary, 10th edition)

One such model of the mind is Freud’s largely overlooked metapsychological principles consisting of six overlapping conceptual filters for organizing the raw data of our intrapyschic experience. When used this way the metapsychology is an extremely valuable guide for doing conceptual justice to the complexity of inner reality. For those interested in more detail about these six principles see my paper on “Something Out of Nothing” gibbsonline.com

The six metapsychological principles {dynamic, structural, topographic, genetic, adaptive, economic points of view} powerfully resonate with the lived experience of patients, enabling them to feel connected, and potentially understandable as whole persons seeking relief from their intense emotional pain.

The metapsychology works as a set of organizing concepts to yield contextual knowledge about the way a given person generates personal meanings. Psychodynamics can be seen as the way by which information is processed through structures {id, ego, super ego and the self} generating personal meanings for the purpose of effectively identifying and resolving psychological problems. This means that the most successful therapeutic relationships are most likely to be ones in which the therapist is most resonant (attuned) to the complex lived experience of his patient, connecting with what is truly most vital to the patient.

In this connection, each of the six organizing constructs, collectively making up the metapsychology, highlights an assumed essential context in mapping the complexity of each person' unique process. Thus the dynamic principle highlights the context of basic conflict. The structural principle highlights the context of organizing structures that process the contents of consciousness. These structures include the id, ego, super ego and some add the self. The topographic principle highlights a continuum of awareness of contents of consciousness ranging from unconscious to pre conscious to consciousness. The genetic principle highlights the historical and developmental origins of present conflicts. The adaptive principle highlights the essential problem solving - goal directed context of inner reality. The economic principle highlights a continuum of available/free versus unavailable/limited libido {basic energy}.

It is my contention that a potentially fruitful pathway of viewing the realm of spirituality in the context of traditional psychoanalytic psychotherapy is to view it through the composite lens of these six metapsychological principles.

Realistic limitations prevent a thorough attempt to fulfill this needed task. However I will view spirituality through the lens of the genetic (developmental /psychic origins) point of view and the structural point of view.

Extending the research on the development of the self (both the healthy and the pathological self)  many of my  papers view the realm of spirituality in the context of a grounded psychodynamic perspective. For example, in one paper called “Something out of Nothing,” the origins of spirituality are located in the preoedipal consciousness of the new born.

This contention is supported by research studies of identity formation in early childhood development. These studies suggest that the consciousness of the one year old child is dominated with “psychic material” intimately associated with issues of basic trust, faith, hope, love, and persistence. These are all concepts and experiences generally thought to be the essence of what is referred to as the realm {dimension} of spirituality.

It is interesting to note that Lloyd Silverman’s (1982) experimental work on the consciousness of the baby yields the following significant finding. If a new born could answer the question as to what was most meaningful to them about being alive – the answer would universally be: “My mother and I are one” {symbiotic at-one-ment consciousness}. (Silverman, Lachman, Milich, p.167)

Silverman’s conclusion implies that a prerequisite for the child to develop a solid self structure, the baby must first experience quality connectedness {attunement} with its “mother.” Blocked attunement interferes with the baby having a necessary at-one-ment fusion experience. The failure to experience enough of a quality at-one-ment with the “mother” sets up a life long yearning for such experiences to fill what, in its absence, is experienced as a profound sense of hole at the core of ones being.

In this connection, it is no coincidence that the core symptom of those patients in need of spiritual psychoanalytic psychotherapy is that of “emptiness.” {Williams: “Something Out of Nothing.”

Highlighting the symptom of “empty” as the core complaint of people suffering from a failure to have grown a self structure – I have proposed that effective treatment focuses on creating conditions conducive to the spontaneous growth and development of a cohesive self.

It is important to note that new patients suffering from the core symptom of emptiness typically enter treatment in a state of multiple crises. They present themselves as in desperate need of being rescued.

Given the pressing urgency to act quickly, it is crucial that the therapist who works with patients in crisis be able to intervene in such a way that there is a maximum probability of the 'biggest bang for the therapeutic buck.' William James refers to this principle as 'the cash value' of ideas. Cash value means "its impact for the fulfillment of a purpose." Thus, while the patient in crisis is simultaneously presenting multiple problems, the therapist/counselor has only limited time to select that problem meriting the distinction of highest priority.

The statement above means that the psychoanalytic psychotherapist pays a great deal of attention to identifying and exploring the details associated with the specific “spiritual” material of the case at hand. {It has been said that the operational definition of love is systematic attention to fine detail} {Personal communication: Rudolf Wittenberg, (l980)

Specifically, the psychoanalytic psychotherapeutic task is to convert “spiritual” events, conflicts, concerns that at first glance appear to be simply existential ‘just so stories’ into analytic material that identifies unresolved problems with the self originating in the patient’s first year of life.  In so doing, it follows, that with respect to focusing on the realm of spirituality, it is the task of psychoanalytic psychotherapeutic theorists to keep their focus on translating spiritual material into the perspective of mainstream psychoanalytic psychodynamics.

The Self as One’s Final Authority

A crucial question for psychoanalytic psychotherapists working with patients about any material is that of final authority. In working with spiritual matters, the choices either are

(l) an allegiance to a projected  transcendent authority whose words and ideas are uncritically accepted as gospel; or (2) assuming responsibility for one’s own choices based on drawing conclusions about the truth and significance of events derived from one’s personal struggling with struggle in the crucible of one’s lived experience. {God helps them who help themselves}

Surveying the literature of both psychoanalytic analytic and non psychoanalytic studies of spirituality what appears to be of most significance is the core concept of the “self”. The self is either viewed as whole or is divided, it is preformed or it has to be constructed. It is in a constant state of both being and becoming. It seeks vital knowledge to be able to grow and to develop. Growth and development of selves varies along  overlapping continuums that range from passive dependency to actively interdependency; from “empty insubstantial” to “full and solid”; from relatively divided to relatively unified and the like.

I believe that a psychoanalytic psychotherapeutic theory of spirituality must necessarily be based on the bed rock assertion that each person {including patients and psychotherapists} are ultimately responsible for their own final authority. Or as President Truman once said: “The buck stops here.”

However, this assertion is based on the critical assumption that a person has enough of a solid self to adequately care for them selves to be able to make informed judgments that are in their best interest. 

What is notable in the beginning of psychoanalytic psychotherapy with such people as the five drop outs from AA is the undeniable fact that each was struggling to hold on to any small vestige of a self they were able to muster. Thus, at the onset of treatment, each was desperately seeking rescue {salvation?}

Helping patients lacking a cohesive self to confront – often for the first time in their lives - the issue of final authority, there are a number of basic organizing questions that should hover over their therapy. These are: Who am I and what do I really want and need? What is really real and how do I know it? What is myself and where is it located? {Wittenberg (1975) Personal Communication} 

All of these organizing questions force the therapist and the patient down to the roots, the foundation, of the patient’s awareness of being alive and conscious.  A serious attempt to answer these questions truthfully, shines a search light on what is most basic, essential, and meaningful in the direct experience of the patient in question. Thus the most meaningful spiritual psychoanalytic psychotherapeutic experience stimulates the patient and the therapist to engage in the subject matter of speculative philosophy. It is as if Plato and Socrates were dialoguing about the meaning of life but instead of it being a dialogue of relatively disembodied intellects, the quality of the therapeutic exchange would be a dialogue of experience (primarily focusing on the experience of the patient.)

Additionally, it is valuable for the psychoanalytic psychotherapist to bear in mind that in a well defined problem there lies an embedded solution. Adherence to this principle focuses the psychotherapist’s awareness towards striving to identify the most accurate operational diagnosis of the core problem. This principle assumes that every person has a core issue around which the rest of the personality coheres. Thus it follows, that if the core problem is accurately defined then laser–like interventions should be aimed towards resolving the identified issue. If a part is missing or defective in a machine replace or make a new part. 

For example: If a person wakes up with an excruciating pain in his mouth it is one thing to “diagnose” the cause as just one of those things, a cavity or an exposed root. The nature of the intervention will directly follow from the identification and choice of a particular hypothesized diagnosis. Either there will be no action, or action will consist of filling a cavity and or instituting a root canal procedure. Maximum effectiveness will be determined by the accuracy of the diagnosis. If the problem is identified as decay but it is really an exposed root necessitating a root canal obviously the intervention will fail to do justice to the true necessity of the matter.

Similarly, if a person’s core problem is a lack of basic trust {often the core problem in people in need of spiritual psychotherapy} then the thrust of the therapist’s attention should be directed to (a) making the patient aware that this is his key issue and (b) creating the maximum conditions that promote an atmosphere in which trust is most likely to evolve. Components of this just right atmosphere necessarily include: (1) a trustworthy psychotherapist; (2) a genuine experience of attunement between the therapist and the patient from the very start of the therapy; and, (3) a psychotherapist who is equipped to select the just right concepts geared to teach the patient how to trust. 

An educational situation combining these two principles described above is: A boy wants to fish. Is it better for an authority to give him some fish or teach him how to fish? In the realm of spirituality this represents a choice for (1) assumed spiritual knowledge considered to be revealed absolute truth passively received {channeled} bypassing the “critical ego” {unmediated - felt and or intuited only} in the service of healing the divided self restoring the “spiritually ‘diseased’ soul” back to a reconnection with an assumed transcendent realm of absolute spirituality; or, (2) assumed spiritual knowledge that is considered to be realized relative truth actively experienced (making meaningful connections with the self and the object world) derived out of  the real relationship with the caring and knowledgeable psychotherapist persisting through the inevitable ups and downs of the therapeutic journey towards the attainment of self and object constancy.

Returning to S’ ‘Spiritual’ Dream: A Descent into S’ Inner Space

We might first ask ourselves, what is the story line of the dream and the context in which S’ spiritual experience is embedded? What immediately strikes us are the conditions associated with Christ’s’ {the savior} “miraculous” appearance. S is portrayed as being dangerously near total exhaustion, feeling overwhelmed by shouldering the entire burden of caring for his wife and himself. His experience of his sorry state is one of helplessness, and hopelessness. For S the outlook for better times is grim.

The location of the dream – the Bronx where he grew up – connects his present with his past which will be seen to be experientially parallel.  He is indicating that the feelings he is having at present had their origin in his childhood. Both then and now are dominated with familiar feelings of being overwhelmed, alone, totally responsible for himself and others {i.e. his overwhelmed wife and two children}, all but crushed by internal and external forces, desperately needing someone or something to rescue him and them. 

Just as the darkest moment descends on him a mystical/magical moment occurs taking the form of Jesus’ appearing.  This highly improbable occurrence thus appears to be a miracle having the quality of a wondrous something happening seemingly out of nothing. The apparent ‘divine’ intervention occurs just as S is dangerously approaching a zero point of psychological empty {total intractable despair/death}.

His strongman image makes Jesus appear to be like an aggressive used car salesman. He   confronts S head on – speaking to him as if he has known him all of his life. His tone conveys a sense of absolute authority and certainty that his “gift” and his instructions are a guaranteed prescription for curing S’ of his Job like spiritual disease.

A Grounded View of S’ Spiritual Material

It is seductive to conjecture that the patient might well experience this “divine intervention” as the prelude to a dream come true ‘rebirthing’. Such a rebirth for him would likely be experienced as nothing short of a one hundred and eighty degree turn, constituting a revolutionary transformation of his soul.

For the therapist who is a “true believer” it is reasonable to conjecture that he/she might well treat this “spiritual material” as a literal occurrence concluding that this patient at this time had indeed experienced a true major “spiritual” breakthrough. If so one would reasonably expect the patient’s outlook to be significantly altered.

Significantly altered outlooks accompanying transformations and transcendent experiences would include a shift from passive inertia to positive kinetic energy. With more energy we would expect S to experience an ascent from his deep despair, a lifting of his depression, feeling more generally secure and possibly special, a renewal of faith, hope, trust, a sense of meaningful connectedness, and a sense of worthiness. And indeed as will be seen that is exactly the turn of events that occurred summarized below.  <>However, it will additionally be shown that in exploring this “spiritual” material, uncovering its details, reveals S’ spiritual dimension to be far more complex than the relatively simple notion that what he experienced in the dream was only a passive connection with the realm of a transcendent spirituality. 

In this connection it is interesting to note that Jung, steeped in the basic presuppositions of classical psychoanalysis failed or purposefully overlooked exploring any indications of resistance, and or transference implications associated with a pivotal “spiritual” occurrence – his reaction to the famous “scarab” synchronicity.  Jung’s (1965) reaction was to accept the ‘spiritual’ event at face value, treating it as an existential occurrence

only, having the power of effecting a truly wondrous transformative experience {both in his patient and in himself}. What he did not do was to explore the meanings of this event relating them to his patient’s personal contexts (situational, psychological, historical and the likes}. Jung’s conscious or unconscious “failure” to explore this “spiritual” material obviated a deepening understanding of both the transference and counter-transference issues associated with his patient’s complex psychodynamics.

I understand the essence of Jung’s conception of spirituality to be motivated by a wish for quintessential change, purpose, and transformation. In Jung’s view, the quest for meaningful connections begins with the self but ultimately connects with absolute knowledge that transcends the self. When such connections are reestablished they are considered to be markers of major turning points in a given patient’s psychotherapy. In the present case, S would presumably have effected a connection with an activated archetype of salvation reconnecting him to his lost transcendent or religious function.

Viewing S’s spiritual event from the perspective above I might have let S and me simply bask in the glow of his having felt saved. I might have judged the dramatic changes that shortly followed - reverberations of his feeling “saved” - as evidence of his apparent reconnection with a transcendent realm of spirituality.{My apologies to any Jungian therapists if my understanding of how they might view this material is too simply stated}.

My point is that therapists who are reading this paper may choose to do the same when confronted by such spiritual material in their own practice. However, let them not be deluded that there are no more valid options in illuminating the significance of this material.

Pressing for Details and Distinctions

The traditional psychoanalytic approach to “spiritual” content should be no different than approaching any other non spiritual content. The rule of thumb is to let the patient be the best guide as to where to take the material. In short – ask the patient for his/her associations. More often than not that which initially appears obvious and transparent when viewed in the context of the patient’s associations turns out to be much more nuanced and complicated than at first glance.

Freud’s comments on Dream Interpretation are apt. In l925 in the paper “Some Additional Notes on Dream-Interpretation as a Whole, Freud wrote: “Dream interpretation … without reference to the dreamer’s associations would remain a piece of unscientific virtuosity of the most doubtful value.” (Freud, quoted in Bettelheim,  p.34 )  

Whereas most of the literature of spirituality emphasizes the questing for wholeness, unity, interconnectedness and at–one-ment precious little emphasis is focused on the side of individual differences, distinctions, nuances, and complexities. In extensive work with patients who are deemed fit candidates for spiritual psychoanalytic psychotherapy, while indeed yearning to merge, at the same time, equally yearn to have a distinct sense of them selves.

Distinctions are identified by paying close attention to detail. Applying this fundamental principle of pressing for fine detail in attempting to understand S’ spiritual material in the context of his psychoanalytic psychotherapy – his personal trip into inner space – the following detailed summary of four sessions follows.  <>These process notes highlight one way that a psychoanalytic psychotherapist might identify, explore, and begin to work through “spiritual” material in the framework of psychoanalytic theory and practice.  <>The first session precedes S’ “spiritual” dream; the second is the dream session; the third is his reaction to his “spiritual” experience; and the forth is a reverberation of his spiritual experience resulting in a “transformation” of attitudes {from negative to positive} affecting his primary motivation. 

Session Notes:

This Session Immediately Precedes the Jesus Dream Session

 S begins by telling me he thinks he has a mood disorder. He then recounts a pleasant dream. {This is a notable shift in mood from his usual vivid nightmares.} The Dream: He is prospecting with some people in a mine for silver and gold. S was happy to prospect only for silver. He sees his daughter sit up. He sees other people are alive. He says to himself that he doesn’t know how to live. He feels depressed.

The dream confirms the accuracy of his self diagnosis. He demonstrates that his moods shift because he has an inability to regulate his self esteem. He makes a distinction between the “new me” – his present hated self, experienced as all over the place, pessimistic, and enervated; from the “old me”, which was more stable, optimistic, and energetic. He indicated that since l992 (thirteen years ago) he began hating his work, felt overwhelmed, took to his room never wanting to get out of bed. He is feeling too strained to constantly carry the load for himself and his family. He has no other support.

He experiences his life as if he was the prototype for the Myth of Sisyphus. He pushes his load up a hill but as soon as it gets to the top it all tumbles down. Then he begins the climb once again. {He is apparently in the grips of a severe “fate” neurosis.} 

He detailed his shabby conditions all around him. Everything is deteriorating needing repair but too unaffordable.  He has denied his deteriorating condition for years but the stark reality has been bursting forth resulting in his feeling overwhelmed with panic anxiety, depression, helplessness, hopelessness, and despair.

I indicated that from my perspective he desperately needs psychotherapy that focuses on the spiritual dimension.  He is suffering from a loss of faith. He occasionally experiences good feelings but since bad always follows good (loss always accompanies gain) he is despondent. He would like to be able to sustain the good feelings but they are always eroded like sandcastles constructed on a beach inexorably overwhelmed by the relentless incoming tides.

As S has no faith in God he must seek it in himself. But as he has no solid self to hang on to he doesn’t know where else to look.

I said to him that in my experience a loss of faith often occurs as early as year one. It is associated with one or more traumatic experiences – most probably a major loss. I further indicated that bad things often happen to good people. This tragedy, in and of itself, is not going to make New York Times headlines. That which happens is sociology, what a person makes of what happens is psychology. We are interested in what he has made of his terrible experiences including what his attitude is about his miserable feelings as well as his attitude to feeling quintessentially stuck.

He heartedly agreed with everything I said to him expressing some small ray of hope that he might be able to eventually understand what was wrong with him. 

Six Days Later: The Session When S Tells Me His Jesus Dream

This last day of July, is like an exposed electrical wire for S. as August is the month that most psychotherapists are thought to take their vacations. August, for S, is associated with betrayal by his last therapist who insensitively failed to help him with his abandonment anxiety thereby reopening a thinly crusted wound that had never healed, triggering a severe breakdown in S – occurring two years before his coming into therapy with me.

S finds little that is good about his life. The past is depressing {the only good part was being with his beloved grandfather and a nurturing psychiatrist both of whom died}, the future looks bleak and he is living in an intolerable present The day before the dream he screamed at his wife venting all of his pent up fury.. He feels pinned down like a besieged soldier at Bastogne. He feels he has no support: “there are no good people at crucial times.” Thus he feels totally alone, desperately in need of an ally.

<>To make matters worse he finds himself also pinned down at work caught between two warring factions. He was approached by one of them to “trick” the other to gain control. He uncharacteristically took a principled stand and turned down the offer.  <>He shifted to having failed in his two previous therapies.  His first therapy was a waste of time. The second started out perfectly. He felt he was in a warm bath in the midst of perfection. But, as usual, for him, good things end in disaster. Possessing a keen intellect he said: “I yearn for primitive love. I had it and I lost it… I had it with her {his second psychotherapist} again … and I lost it again.” 

I have from the beginning of the therapy with S identified his core issue as learning how to trust both one real person (me) as a bridge to learning how to trust himself. In technical terms we are working to obtain and sustain a state of object and self constancy. He  identifies with super heroes like Captain Blood – romantic, swash buckling – who win the day with mental agility and physical strength. More importantly, they are integrated, and are exceedingly courageous, possessing a solid sense of who they are.

<>He said that he saw Kerry’s acceptance speech and was impressed with what seems to be authenticity and articulated power. Hearing the speech instilled a shot of hope. Feeling substantially better he said it was good to talk with me.  <>He continued to make a comparison between his last therapist and myself. While he believes he is receiving the real stuff with me he is bothered by the fact that he experiences a gap in his feelings. “The words bounce off… some of it clicks but most often they don’t resonate.”

I interpreted his lack of not quite feeling the quality connectedness as most probably due to a fear of being burned yet once again.

It was at this point in the session when he told me his “Jesus” dream.

I asked him, what did you feel when Jesus came out of the car? He answered “I felt saved”. This surprised him as he had given up on God. I suggested that in his state of travail it was quite understandable that he would have a powerful need to be saved (rescued). However since it was his dream {meaning he is the author, director, set designer etc. of these movie shows of the mind} then logically he arranged to be saved by himself.

He understood what I said but focused on Jesus not as a projection of himself but as a real entity. Yet it surprised him that he should pick of all people Jesus as his appointed savior.  To him Jesus is ok – but as far as S is concerned “just neutral.”

On his best days he refused to talk to God, on his worst he wished him dead. When he did think about God he
 identified with Job wondering how a supposedly loving God could permit such terrible suffering to both himself and others. He shifted back to his own suffering.

When he was overwhelmed with negative feelings like depression, helplessness, hopelessness, and panic anxiety, he would reluctantly telephone his last therapist. She did speak with him but always began with the statement that “I can only talk for a “couple of minutes.”

He acknowledged that he always finds me available and he feels good about it. Yet he doubles back to his being bothered by the feeling that something is missing in our connection. “I can’t seem to connect with you on an emotional level.”

I said: But you seemed to have made a real connection with Jesus in the dream. He answered: “I don’t really think so. “ We then discussed his experience of not being able to experience that which he thinks he should be able to experience? Specifically, what is your reaction to not being able either to connect with Jesus or me the way you think you would like to be able to do?  <>He answered that not being able to do that which he feels he should be able to do is horribly frustrating which then leads to anger and eventually depression. Once that happens he sinks into apathy and negative inertia. Whatever good feelings he has evaporate when ever he gets disappointed.
 

I refocused on the concept of self esteem regulation starting with the idea that bad things can happen to good people. I indicated that it would be to his benefit to learn how to bear frustration without always taking it so personally. I also reintroduced the concept of making psychological boundaries. In this case he has to keep telling himself that he, himself, is more than one or a collection of ‘negative’ feelings.

He ended the session by thanking me.

(Six Days Later): This Session Follows the Dream of Jesus

S began the session with a dream: He is working on multiple jobs. He is uncomfortable. One of them involves going into a backyard somewhere. A man threatens him. To protect himself S offers him money. The man says “save your money I want to whip you”. As S feels he desperately needs the money he lets the man whip him. S eventually crawls away and goes into a house.

Seeing blood pouring out from his body S fears he is dying. He goes looking for his wife. Another woman appears. She has to help, he says, it’s because of her need for money that he took the beating. 

As this woman talks with other women she is fingering her hair. S feels abandoned. I asked what happened to Jesus? What about his broach? He says that the broach with Jesus ’picture was to protect him by being able to summon up the strength to stand up to bullies (his enemies). He also has to protect himself from unpredictable women as they are responsible for sending in the bullies to beat him.

I said it sounds like you believe it’s a women’s world. Men are utilized to do their dirty work. S commented on the Jesus Dream. He said he had been shaken by it. His initial reaction to feeling shaken was to feel scared and vulnerable. He thought of calling me on the weekend to help him “get out of the bad feeling.” But he decided to tough it out. S was pleasantly surprised to discover that his “bad” feelings soon went away. He was glad he didn’t have to call me. S also felt his calling would be experienced by me as imposing and intrusive. I indicated to him that he has the right to call whenever he feels the need. If it becomes “excessive” to either one of us, we can talk about it as an issue.” 

I associated to an image of us being a team of two pinned down behind enemy lines at the siege of Bastogne in World War II. In a previous session he had turned me on to the TV series Band of Brothers. I said we could easily identify with those soldiers, who, although dangerously low on ammunition, freezing cold, with little hope for immediate support still had some important choices. Like them, we could surrender, commit suicide, run like hell and desert, or hold our own, making a stand and perhaps even make a battle plan. The later would require facing primitive fears and summoning courage.

Any choice under the extreme duress would be understandable. I further said that I think he is particularly raw because we have penetrated his defensive denial and he is experiencing a hornet’s nest of negative feelings that he had all but numbed out with his alcohol and drugs starting many years ago.  <>It is normal – not pathological for him, to be feeling and fearing panic anxiety, dread, confusion, despair, coupled with massive ego weakness.

 The key to success is learning to bear these crummy feelings by making boundaries in space, time, and contents of consciousness. He has to tell himself that he, S, is more than any one or all of these negative feelings. This is the secret to spontaneously growing a cohesive self. 

I challenged him. Don’t take my word for it. Run a psychological experiment. The next few times you feel negative feelings try to name them. Then make a space for them and step away. Tell yourself that you are more than any of the ‘bad’ feelings. See how long you can tolerate them – not like them – just tolerate them. Then watch what happens.

I refocused on Jesus appearing and giving him a gift. I said even if Jesus was real and actually was to give you an actual gift you would still have to take the responsibility of making the lucky charm work. Even if God were to issue instructions that he insists are just what you need to make you feel whole you would still have to lend him your projected authority. You can’t give it away.

S said that projected authority is not what he wants. He prefers to feel organically strong. He wants to experience himself as a solid self with a strong ego. I assured him that in my personal and professional opinion he has all the necessary ingredients to attain and sustain this goal.

He thanked me and hung up. 

(Six Days Later): Two sessions Following the Dream of Jesus

S said “it was an interesting day.” He was able to hold his ground at work and then some. Determining to get out of the cross hairs he dared face two of his biggest life long fears (l) taking a stand with his enemies, and (2) walking away from a bad atmosphere.  He felt as if he has awakened from his long standing negative inertia, rousing himself into action. This  unexpected surge of “positive” energy has enabled him to (l) stand up to a bully/boss; and (2) tender his resignation which was refused.

Noting that his behavior reflected the appearance of a person who had undergone a major transformation I asked him to re look at the Jesus dream in more detail. He talked about identifying with the hero in the British TV series called The Prisoner. He then commented on how he has renewed closeness with his son who he loves very much. If any one was to harm him he would kill them.  <>He then indicated that he has been actively wondering why God permitted his only son, Jesus, to suffer on the cross. This led to a chain of associations about God saying to Abraham to make an excruciating decision about proving his trust of God by his willingness to sacrifice Isaac his first born son. Even though God prevents the murder at the last moment – S adds that Isaac never forgave his father. S somehow did not recall the fact that Jesus, on the cross cries out, “Father, why hast thou forsaken me?” S did recall that Jesus winds up saying “Forgive them Father for they know not what they do?”

We discussed the fact that there is apparently no mention in the Bible as to whether or not Jesus forgave his father for putting him through hell.} S returned to his major point: Why did God abandon his only son?  

I asked him again how he felt when Jesus came to him in his dream. S said “it was like discovering you have a real ally – a lucky charm – an antidote to the vampires. I was given a real gift.” {Seen in another light – he arranged to give this gift of solid trustworthy support to himself perhaps signaling that in his unconscious S is feeling more worthy of being helped.}

S then summarized the “horrible seven year ride” he has been on. “I honestly haven’t been able to venture out of the house except for going to work and seeing Gibbs. Now we speak twice a week on the phone.” I said that in a very real way its as if he was  buried alive.

He then remarked that he was asked by a coworker to objectify his brother’s problem - an ex drug addict who beat heroin but has now become a compulsive gambler. S spoke for a long while sounding as if he was giving a brilliant psychological report of a very complex patient.

At the end he was pleasantly surprised that he was so coherent and open with me about his summary. He acknowledged that “I still have a fairly good mind.” {This is a significant occurrence as he had been feeling as if he had all but totally lost his powers as a therapist and thinker.}

I asked him to associate to the gift that Christ had given him. S said “it was a transitional object – something solid to hold onto.” He recounted feelings of vulnerability, not connecting, literally being beaten by his father for no good reason, unable to express his feelings – resulting in experiencing himself as isolated and alone. He learned to tolerate his frustration – alone - {in fact he learned to tolerate too much frustration}.

H
e understands that he has been unable to stop grieving for his lost self, the self that never was - generating a preoccupation with all of his understandable resentments. He  realizes that he has never completely mourned these critical losses… that he has been stuck in his miserable past unable to free himself from his self imposed isolation characterized by states of morbid self pity. Shifting back to the dream I said if you wanted to be saved and it was your dream why did you have Jesus be the savior? As you don’t really have any particular feelings for him, why not a superhero such as the prisoner?   What, I asked, are the major qualities of the savior? He quickly answered: “authenticity” immediately followed by “That’s Gibbs.” If Gibbs is like an authentic savior for you then why not have Gibbs in the dream instead of Jesus with whom you feel neutral?

He then had what was for me a stunning association to Jesus that reinforces my confidence that one of the most significant benefits of the psychoanalytic psychotherapeutic approach to spirituality is its focus on being sensitive to identifying and then understanding fine details. In so doing it emphasizes the need to identify, explore, and understand idiosyncratic meanings {individual differences} complimenting the powerful need for an experience of at-one-ment.

His 
association was: Even though Jesus and his father seemed to have had a very close connection, “Jesus was betrayed by his father.”  S noted that we are on the phone a lot. {As he had been too debilitated to drive to our sessions I agreed to temporarily have phone sessions. They have worked well. They don’t work for everyone but they do for S.}S made a connection between himself and Jesus on the cross. He and Jesus were both “betrayed” by their father. S recounted multiple beatings he received as a child administered by his frustrated father.

S told me that he loves to call me as he needs the therapy and always feels helped. He said that he realizes that the problem with connecting is that he hates to leave. To leave a good connection means that he has to experience overwhelming painful feelings of missing that have often left him near incapacitated.

I said that there is a positive side to missing as well as a negative one – you can look forward to reconnecting. He picked up on the point.

S said he was going through both a ‘breakdown’ and a ‘breakthrough’ simultaneously. I  asked him to comment on his experience of  ambiguity, not knowing, confusion, uncertainty, and the often double nature of experience. He said when he is aware of them he often can't think straight.

I said then when you feel in the midst of these kinds of ambiguous confusing experiences you get scared and panicky because you are not in control. If asked who are you – you would probably answer I am panic anxiety and confusion. Then you must feel as if you are going crazy believing that you have literally lost your mind. <>He concurred. I said the antidote to feeling mindless is mindfulness. You need to integrate your very keen analytic mind with your passionate feelings. That’s our therapeutic task.

He ended by saying: “You know I think I really love you. You are someone who understands and cares and is dependable.”

Commentary:

Accepting the composite definition of spirituality implies that spiritual psychoanalytic

psychotherapy focuses the material on identifying ones essential meaning with respect to life. In so doing it treats the patient’s preoccupation with the big life questions as worthy of prime importance. These questions are: Who Am I, and, What is really worth doing.  This emphasis promotes an analytic {reflective} attitude to ones experience of experience by encouraging critical, independent, original thinking about the patient’s most vital and pressing concerns. For S, his most vital and pressing concern is to be whole, real, powerful, integrated, alive, reliable, consistent, balanced, and stable over time. This is the area of the self that Whitfield identifies as pure being.

Working with the spiritual dimension focuses awareness on the whole patient’s quest for enlightenment, and peace of mind, by increasing the patient’s capacity to attain, to experience, and to sustain meaningful connections in the realms of being and becoming.

In this connection, I think it important to note that in the pursuit of enlightenment and peace of mind, one conclusion drawn from my work is – as the introductory quotation states – that spirituality is multi faceted and multi dimensional. People (including psychotherapists and their patients) will each have their own experience of spirituality depending upon the lens through which they view internal and external realty. Thus spirituality is perhaps best thought of as different facets of a diamond each reflecting a nuanced matrix rather than viewed only as a single undifferentiated gem stone. 

One ramification of the statement above is that a spiritual psychoanalytic psychotherapy  should be open to identifying and exploring the meanings of the important role that extraordinary events such as fate, luck, destiny, {karma?} serendipity, satori, epiphanies,  synchronicities, and ‘miracles’ have for the patient. Extraordinary events do happen that appear suddenly, seemingly without a logical explanation, that for some people are life defining. How they are experienced, the meanings they generate, the conclusions reached, and what role these conclusions play in the psychic economy of the patient {and therapist} are valuable grist for the spiritual psychoanalytic psychotherapist’s mill.

Translated into the framework of psychodynamics – spirituality highlights both the existential and often self induced suffering commonly reported by patients receiving spiritual psychotherapy. This attitude is not strikingly new in and of itself as any one who has worked with patients in deep despair will attest. This means that the therapist maintains an unwavering attitude of staying with the relentless ‘negative’ material that is characteristically presented by the patient often for long stretches of time. Progress is typically circular or stalled, seldom, if ever, straight up.

In the case of S, for the full thirteen months of his treatment thus far, he had been in the throes of deep despair. Except for a few “good” days, his understandable suffering has been unremitting. Platitudes, simple explanations, exhortations to snap out of it, would be to no avail. Avoiding directly acknowledging his hopelessness, helplessness, and pessimism would have been experienced as betrayal and fear. I know these statements are true because of S’s negative experiences with his two past therapists, as well as from my own two out of three therapeutic failures. 

One way of being that has been exceedingly helpful to this patient, in enduring the protracted psychological gloom of his inner landscape, has been to be free, light, playful, and humorous when authentically felt. For example we somehow got into a discussion of his identification with minerals as in the oft used phrase: everything existing is an animal, a vegetable, or a mineral.  This led to a shared identification of the two of us being the rightful bearers of the initials ‘SM.’ SM in our language stands for “smart minerals.” Whereas humor feels good it also has the therapeutic benefit of adding perspective and dimensionality into the mix.

The aim of exploring the spiritual dimension in a psychoanalytic psychotherapeutic framework aims at promoting wholeness in patients stuck in pre oedipal consciousness {constructing and integrating a global self) enabling a patient to plug in the necessary pre conditions to facilitate his quest for purpose and meaningful connectedness.  <>This implies that spirituality focuses on inducing significant psychological change, transformation, revelation, transcendence, and enlightenment. These concepts suggest something more, greater, higher than the change associated with success in conventional psychoanalytic psychotherapy. Note Freud’s criterion for the outcome of a successful therapeutic experience is to be able to convert neurotic suffering into an acceptance of every day common misery.

I think that Freud is basically accurate in his assessment of the realistic goals of any therapeutic experience. Nevertheless I think that he fails to capture and convey the authentic pleasure of patients being able to finally experience freedom from the stultifying constrictions of having felt chained to their personal wheels of repetition compulsion.  <>Nothing is sweeter and more personally and professionally gratifying than to hear a patient, who after literally decades of suffering, indicates that she now looks forward to getting up the next day rather than morbidly brooding about her sorry lot wishing she could find a painless way to die a certain death with an absolute guarantee of no karmic return. 

Such a positive wholesale transformation of attitudes and behavior – literally creating something positive out of a seemingly negative nothing – would seem to be concrete evidence of a quintessential spiritual breakthrough commonly referred to as being “reborn.” From the perspective of a grounded spirituality I think what is referred to a reborn for patients like S should more accurately be conceptualized as “born” for the first time.

This distinction between transformation as reborn or as born for the first time suggests redefining the concept of transformation when viewed in the context of psychodynamics. <>For Whitfield (1984) transformation is a process of “transforming our awareness or consciousness {which involves} a switch from one domain of  reality to another.” (Whitfield, Part 111, p.1). I accept  his operating definition of transformation. However we disagree about the direction of  the shift.<>  

Whitfield contends that the direction of the shift is from linear consciousness {ego or secondary process thinking characterized as processing reality by means of links of cause and effect relationships} to “non linear (non verbal – transpersonal – experiential) knowing and Being.” (Whitfield, p.17).

My position concerning the direction of the process of transformation is just the reverse. As previously stated persons judged to be good candidates for spiritual psychoanalytic psychotherapy necessitating a transformation of their whole selves typically begin their psycho/spiritual journey in a state of kaleidoscopic/symbiotic consciousness gradually ascending  upwards {if the therapy is working} with the aim of integrating  increasingly more complex states of consciousness. 

In my paper (Williams, 2000) on “The Psychodynamics of Spirituality”-The Personal Unconscious and the Higher Power” I compare and contrast the approach to spiritual counseling in the Twelve Steps Program with  what I propose to be spiritual psychoanalytic psychotherapy. My conclusion states:

                     The result of transitional success in the Twelve Steps program is the attainment

                     of a state of spiritual consciousness. This has been described as being reborn.

                     The patient feels like an authority but is identified with the final authority in his

                     life {being} God.

                    The result of transitional success in Psychoanalytic Psychotherapy is the

                    attainment of psychodynamic consciousness. This has been described as being

                    not reborn but born. A patient who concluded his successful psychotherapy

                    experience, summed it up stating:   ''I feel as if I have had to create myself all

                    over again for the first time.'' This patient, while often experiencing a clearly

                    defined state of identified spirituality, nevertheless simultaneously experienced

                    himself as his own final authority. (Williams, p.13)

This conclusion has important implications in measuring S’ progress in his own “spiritual” journey. What, from a non psychoanalytic psychotherapy perspective, might appear to be the beginning of the successful completion of his “spiritual” journey having seemingly reconnected with a transcendent source of spirituality, is, from a psychoanalytic psychotherapy perspective a  marker of  the beginning of the beginning of S’ “spiritual” journey.

I believe this statement to be well founded because I have been able to discern two relatively distinct phases of treatment associated with spiritual psychoanalytic psychotherapy. These two phases are described below:

Phase I  focuses on being – i.e. helping a patient grow a cohesive self and a strong ego making clear psychological boundaries in space, time, and contents of consciousness. This phase might be referred to as a spirituality of survival, with associated issues of death, resurrection, transformation and the potential of realizing transcendence.

Phase II focuses on becoming – i.e. helping a patient to harness their energies and focus them towards meaningful activities deemed most valuable and purposeful. This phase of spiritual treatment might be referred to as a spirituality of thrival – with associated issues of taking one’s self seriously, daring to push into the unknown “not me” realms of ones here to fore dissociated self, actively looking for psychological trouble in all those ways that prevent one from connecting with that which is most meaningful; and disciplining the self to be able to persist in the mastery of those tasks which propel a person into the realm of a dedicated meaningful connectedness {transcendence}.

In this connection I propose that the spiritual term transcendence be redefined. From a psychoanalytic psychotherapeutic perspective transcendence need not be associated with a heavenly divinity but rather, viewed as a naturalistic, immanent, mundane process.

Thus, with phase one in view:  I believe the concept of transcendence is best used to identify a patients’ slow struggle with struggle in making connections with his inner creative process enabling him to find the path to free himself from his personal wheel of repetition compulsion. Transcendence in phase one would be the successful attainment and maintenance of a solid self that would be experienced by the patient as creating {constructing} a solid something out of an amorphous nothing. Further this construction would be the byproduct of a creative collaboration – the fruits of a truly meaningful therapeutic alliance of the patient and the therapist. Vital knowledge of the patient’s process needed to construct his self would be both “revealed knowledge” {as in the patient’s becoming acquainted with potentially powerful transforming organizing concepts delivered by the therapist derived from the “collective consciousness”} and “realized knowledge” wherein the patient cathects {breathes life into} abstract organizing concepts into his own directly lived experience.

With respect to phase two, I believe the concept of transcendence most aptly applies to traversing all of the necessary steps to harness ones energies and direct them to a meaningful goal(s). Transcendence in this view is cathecting ones own idiosyncratic process pushing the boundaries of the self by undertaking, and persisting (struggling with struggle) to master whatever task is at hand. Transcendence in this view aims at helping the patient to aspire and actively search for those pursuits which are felt to be most worthy of dedicating ones time and energy.

Combining phases I and II – as stages in negotiating a spiritual journey in inner space, suggests a new operational definition of spirituality.  Spirituality, in this combined perspective, is both cathectingones idiosyncratic creative process and directing it towards the fulfillment of those goals that are deemed to be of utmost value.                        

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Gibbs A. Williams Ph.D.                          NY, NY                                     December, 2006






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