Can a spiritual mismatch interfere with psychotherapy?

Journal of Psychiatry Reform vol. 11 #12, November 1, 2024

Caroline Giroux, MD, FRCPC

Author information:

Professor of Psychiatry, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

During psychotherapy, the packaging of the content shared, such as questions and insights by both patient and therapist, is influenced by the lens with which they each try to make sense of the world. And the lens a person has is made of belief systems or schemas that provide some reassuring stability and predictability in a life characterized by impermanence. Such a belief system helps humans give meaning to and cope with adversity and suffering. For some, believing in an after-life can provide comfort while grieving a loved one. 

Spirituality is an integral aspect of human experience [1]. Like everyone else, I have my own belief system regarding spirituality. I try to be aware of it and at the same time remain open to other people’s belief systems. But recently, a patient I had just offered psychotherapy to after she told me she had had a hard time finding a therapist made a somewhat destabilizing comment after I talked about an example of holistic approach (I suggested the integration of polarities like yin and yang, or using the four elements found in nature during self-care). She told me she needed to make me aware that she had her beliefs, that she didn’t believe in “earth goddesses”; she warned me that it conflicted with her religion. I felt an unease rising as she was rigidly trying to protect what I couldn’t help but label as a construct (a specific denomination or religion), which is limited to begin with, instead of even keeping an open mind or a small dose of curiosity towards difference, which is what therapy should be about, right? 

She kept going. She didn’t believe in “New Agy” stuff either. I stopped myself before becoming too defensive, remembering another patient I had met years ago, also from her generation, who had labeled me as such to the resident after I had staffed the intake. Funny (and quite unfair, to be honest) how people so easily label others. With labels come biases. Sure, I consider myself curious and very inclined to merge various frameworks, whether it is Buddhism or feng-shui, the chakra system, forest-bathing, the cycles of nature, Celtic wisdom, symbolism of spirit animals, positive mantras, Gestalt, drumming, dream analysis, gratitude journaling… But I never particularly identified as “New Agy’”, ever (it’s another construct). Only spiritual. Wearing a stone pendant on any given day doesn’t make me anything in particular. Something that gives me energy, joy and helps build connections is merging various fields like philosophy, mythology to enlighten my understanding of people and it keeps my mind flexible and receptive as I expand my perspective. 

Maybe she sensed that my approach is aimed at rebalancing polarities, which includes expressing the divine feminine in all of us more, and she immediately stopped the conversation by mentioning the goddesses. But what’s wrong with the goddesses? I was already having some unpleasant counter-transference following the immediate shut down rather than “please tell me more”, which would have been more constructive. Maybe it is my job to model that rather than expect this from her immediately. 

Just like it is quite disconcerting to hear “I don’t believe in mental illness”, a complete dismissal or denial of some non-equivocal reality, like mental illness (sure, it can be a construct, but the suffering it generates is very real) can be more damaging than believing in something that we haven’t proven (like certain conspiracy theories). Also, a prerequisite to therapy is a willingness to tolerate difference, uncertainty and doubt. This patient comment felt like the equivalent of saying “I don’t believe in the color turquoise”.  

There is almost a futile component to this, as color, just like other beliefs, including the existence of certain mental disorders, has something to do with perception. But color-blind people cannot negate the reality of the colors they don’t perceive. Just like I cannot deny the reality of what I cannot perceive (someone might say “I felt God’s love or presence”. Who am I to tell them, “well, if you say that, we can’t have a discussion because I don’t believe in God” or “I cannot feel God’s presence like you do?”). 

I think what we mean by belief system in my case example is the specific framework or lens used to examine spirituality, which is not something we can so easily define in a cookie-cutter kind of way because it is implicit to our nature and interwoven into life. The more intangible a phenomenon (like the concept or experience of a God), the more diverse the spectrum of representations or beliefs to make sense of it. My work with people coming from a diversity of backgrounds, including the Native populations, has expanded that spectrum. Plus, since the evolution of the self is dynamic, so is therapy and, very likely, the beliefs examined during the process, might be shaken by adversity leading to existential crises. 

Although I will find difficult to not speak a language I had become accustomed to (the divine feminine and yes, Sacred Mothers and Goddesses etc), I still believe that psychotherapy will be beneficial if both participants are open-minded enough to learn from each other by listening to the other without judgment. Why I have the belief I have now (the natural cycles, the importance of our connection to Mother Earth) comes from how life experiences (including injustices, oppression, trauma, then empowerment etc) have shaped me. I guess it bothered me to feel like I had to challenge or mute my own frameworks mostly because I am generally quite accepting of people’s different views or conceptualization of spirituality. What is important to me is not to fall into the trap of moralism or dogma. All ideas and frameworks are just that: constructs, or pale representations or attempts to capture the intangible. 

If a belief system doesn’t create injustice or oppression, then we should let it be. What if I put a lot of significance on a grey fox showing up repeatedly on my property, closer and closer to me, or a vivid dream with strong symbolism? As long as I use my interpretations for the expansion and growth of my being, to fuel my creativity, to enrich my life, and therefore, the life of others, it should not offend or shock anyone. This is where my freedom is, and if you are to work with me in therapy, you can be assured I will protect your own meaning-making process. 

I think psychotherapy is a great opportunity to challenge one’s own assumptions about life with the goal of expanding awareness and promoting growth. After all, human development is a dynamic process throughout the lifespan. People tend to get attached to specific religious or other beliefs because they identify with thoughts or stories about the self, as if they were the foundation of identity. But what if identity was more a structure or a container witnessing the thoughts, feelings, identifications and self-representations passing by, coming and going as they are shaped and then transformed by a variety of factors, socio-cultural contexts, relationships, and life events? And isn’t the examination of these processes at play what psychotherapy is about? 

Tillman wrote that in some sectors of psychodynamic psychotherapy the primary task of the psychotherapy is not complete identification with the therapist, but developing a greater understanding of dynamic conflicts expressed in the evolving transference [2]. Maybe we should be more explicit about that at the outset of therapeutic alliance formation. Patients may bring religious concerns to treatment as a way of expressing transference phenomena, resistance, or unconscious content [2]. 

Guntrip contends that religion represents a form of personal relationship between humans and the universe and that the nature of religious experience is to integrate humans into the world in the deepest fashion [2]. The God representation is seen as a transitional object. That is an interesting conceptualization, and another layer of belief that should not dissuade the patient or therapist from engaging in therapy if they have divergent views on this. 

I think what destabilized me the most about this recent encounter was less this patient’s rejection of my framework than the immediate doubt about compatibility in therapy based on speculation or premature conclusion. What I am used to (and prefer) is when patients ask me personal questions because they are curious, and not so much an immediate announcement of their guaranteed dismissal if I say, think or do this or that. 

But what appears to be an initial divergence could lead to a fruitful dialogue. It seems more useful to inquire about these beliefs, their origin and current expression rather than comparing them and deciding which one should prevail.  Restating the task of psychotherapy could provide reassurance to our patients that different views are not incompatible with evolution through therapy. Moreover, the therapist might also find relevance in learning how the patient negotiates conflicts in regard to religious beliefs [2]. 

Whether it is religion, culture, diet, profession, sexual orientation, or any preferences, we have to see each person beyond their opinions, identities or any other social “cloak”. Each patient I work with and learn from is certainly more than any belief they hold dear. What appears to be a mismatch of opinions doesn’t have to be an obstacle to therapy. It can in fact enliven it. Maybe we should shift from a comparison of beliefs to a make-believe session like in symbolic play, as we learn to try to imagine what it would be like to believe what our patients believe, and if they wish so, vice versa. That would constitute the cornerstone of mentalization, mutual understanding and therefore, evolution of the self within the psychotherapeutic frame. 

References: 

1. Giroux C, Song I, Patron D. Transcending trauma: exploring the tole of spirituality in psychiatry. Journal of Psychiatry Reform. 2024 June 10. Transcending Trauma: Exploring the Role of Spirituality in Psychiatry – Journal of Psychiatry Reform
2. Tillman JG. Psychodynamic psychotherapy, religious beliefs, and self-disclosure. American Journal of Psychotherapy. 1998 Jul;52(3):273-86.