THE SILENCE OF GOD – the use of ”God” or ”god” in psychotherapy
The background of this paper consists of many informal discussions I have had, when I have given a number of clinical seminars in psychiatric settings on the role of religion in mental health/illness. More recently I have become increasingly aware of the role of the therapist´s religiosity and especially how countertransference influences the therapy, when the therapist him- or herself is a devout Christian yet working in and ”agnostic setting” – such as a general hospital.
In this paper I would like to make some clinical remarks as to the ambivalence of Christian therapists who are trained to understand a person´s religiosity in both psychodynamic and theological/pastoral terms. The aim of the paper is to elucidate the internal conflict that may emerge for a Christian therapist. The conflict is as follows: The therapist sees how a patient´s representation of God is linked to intrapsychic emotional forces, conflicts and needs, and therefore might intervene by means of a pychodynamic/object-relational theory of religion (God as god); but at the same time the therapist also would like to be a faithful Christian and therefore – in the psychotherapeutic process – also wants to support the patient´s experience of God as a living autonomous entity, not reducable to intrapsychic developmental or illusionistic needs (i. e. God as God).
In order to illustrate my remarks a short case vignette (here presented in a shortened version) was constructed and presentented to seven experienced therapists. All working as clinical psychologists in state-run clinics, not church-oriented institutions. They were also active members of the Swedish national church or a free-church. I asked them in a semi-structured interview what they understood was the best way to work with a pious individual who claimed that one of his main problems was the silence of God. I thereby stressed my interest in seeing how they coped – as therapists – with the patient´s experience of the (un-) reality character of God. Through the method of content analysis I researched the way the therapists used explicitly religious or faith related terms.
The first part of this article deals with some theoretical objectives of ”theology” and ”psychology”. The second part briefly describes a case history where a depressed man´s main problem is the silence of God. In the third part I present and discuss the questions if, how and to what extent the therapists ”use” their own or the patient´s faith and belief in a living God as a part of the therapy. Finally I make a few remarks regarding the wider problem of ”use” and ”abuse” of God in psychotherapy.
GOD AS ”GOD” OR GOD AS ”PSYCHOLOGICAL REPRESENTATION”
We all know the basics in early Freudian thinking – God is described as a function of intrapsychic forces and needs – a way to keep a psychological equilibrium by projecive, compensative and regressive manoeuvres. Later psychoanalytical thinking as well as the theory of sciences has questiond Freud´s unreflected Wissenschaftsaberglaube or scientism. There is an implicit evolutionary idea and an absolutistic materialism in his thinking, that at a first glance seems to be a result of his investigations. A more adequate description is rather that his view is an elaborated Vorverständnis projected onto the mental arena. For the clinical psychologist of religion, however, psychoanalytical thinking and especially the later development of object-relation theory (Rizutto 1979, McDargh 1984, Jones 1991, Spero 1992, Journal for Psychology and Theology 1994, vol 22, no.4) have become necessary tools in order to understand the dynamics of a belief system, now a little bit less ”loaded” with metaphysical claimings (see expecially Duvall 1994,429).
The individual does not create his representation of God out of nothing. The specific language as well as the social context are fundamental. The individual´s emotional make up interacts with culturally-given concepts. Some religious individuals seem to socialize rather unproblematically into culturally transmitted traditions where the role of God is represented in myths and rituals. Others seem to create a private god that sometimes is far removed from the official and institutionalized church´s version of God.
Out of a socialconstructivistic perspective, social and verbal legitimation are the moments by which the subjective internal world becomes ”objective” (Bruner 1991). The psychological conditions behind a religious experience therefore can be understood as an interplay between the person´s emotional/cognitive needs and the meta-narratives provided by religious institutions.
But this is exactly where we touch the very center of the internal conflict for a Christian psychologist or a pastor trained in psychodynamic theory. The dilemma can be formulated as a question: ”In a psychotherapeutic setting, how can the scientific/psychological way of describing the genesis and the function of a representation of God ( see above) be combined with a classical intra-religious perspective? An actor inside a religious structure or church is working in and giving advices out from a theistic world-view – God is understood and accepted as a living entity, a subject separate from or at least not reducable to a person´s own psychological or social construction.
In the theological, ontological a priori there is a latent criticism towards a ”pure” functional perspective, where God is (just) a symbolic representation for social, cognitive and emotional forces. Psychoanalysts, however, clearly can demonstrate that an individual´s experience of God actually is formed around emotional kernels and that this very inner representation – called God – is reinforced by cultural and social contexts. Now, in which way does a devoted Christian that belongs to both symbolic universes/plausibility structures – the church and the clinic – contain the two separate perspectives and use them in the therapeutic process?
IN WHICH WAY DOES ”GOD EXIST”?
The basic question is thus what one means by ”God exists and acts” and ”God is hiding himself” in the two traditions: the theology of spirituality and psychodynamic theory. Generally speaking the psychological theory claims that the concept ”God” is a code or a symbol that refers to a personal, psychological reality. Thus, it points to a reality that is at least subjectively true. But the pious individual and his religious culture attributes this inner object (god) an intentionality of its own (God) that is separated from – or at least fused with – the patient´s psychological composition. The question whether a God in reality exists or not, appears or disappears as an ontological reality – is not relevant for the psychologist per se. Psychology as a science can not claim that there is or is not anything beyond that which is experienced.
Classical theology, however, has not been very much interested in the way an individual´s faith is emerging in terms of its social and emotional determinants. The psychological buiding stones of an individual´s representation or image of God are irrelevant for the theologian. God – says the Christian – reveals him- (or her-) self to whomever he wants, independent of a person´s emotional or hidden needs. Theology is built upon a basic claim: God is not a human creation, he/she has an autonomy of being, in spite of or maybe due to the idea that God often is described as ”Semper major”, or hiding in the Cloud of Unknowing.
In a church or a parish the main goal for believers seems to be to help people to get access to an experience of the living character of this very autonomous God. But in psychotherapeutic work in clinics or private practices, it is often said that the objective is not to agree or disagree with the truthclaims of the patient´s theology. The ontological question is, at least in the therapeutic process, intentionally put in brackets. Instead, one explicitly limits the purpose to understand the functions of the representations of God in terms of mirroring, idealizing – all residues from early significant others. One tries to understand the developement and intrapsychic function of the claims that the patient attributes to God, how the classical defence mechanisms are intertwined in a person´s search for a sense of cognitive coherence.
In which way does God ”exist” in a psychological setting? He is living as an experience. But whether there is some ontological reality beyond this or not, is a question the psychologist – in his/her profession – has no mandate to answer. Among therapists dealing with religious issues there are Christians, Jews, Muslims as well as agnostics.
My point, however, is that this very detached, objective view often is idealized. It is at least problematic coming to the role of God in therapy. At least the rule of neutrality seems to be challenged to a certain degree when a religious therapist comes deeply into a process where the question of the silence of God is at stake and that this must be professionally met.
THE SILENCE OF GOD – A BRIEF CASE VIGNETTE
A man – 44 years old, active in a church, a teacher, with two children and devorced for seven years – comes for therapy. He has been in a new marriage for the past three years. His main problem is a deep feeling of boredom, emptiness and loneliness in spite of a happy marriage, good economy and many friends. After the divorce he had been in short-term psychotherapy. In the psychotherapeutic process he gradually talks more and more about the absence of God. In the exploration of his family situation it becomes clear that he has had a good relationship with his father and mother and he says that he is happy with his new family.
All his life he has had a very deep and secure trust that God is guiding his life. In his college years he thought about becoming a priest. He is an active religious man, making yearly faith retreats. All his life he has had a deep conviction of the reality and goodness of God. He has had a longstanding relation to his priest and to a spiritual guide – but they cannot help him now. The main problems are insomnia, anxiety and depression – all related to his loss of faith.
During the first the part of therapy the therapist attempts to locate the patient´s religious problem in terms of family structure and psychodynamics. But the main problem during the therapy more and more turns out to be concentrated an existential threat, the silence of God. The patient prays and attents the mass regularily. He reads the mystics especially apophatic theology. But the reading of St. John of the Cross or the thoughts of the theologia negativa does not help him. What remains is an increasing feeling of existential emptiness or alienation, an experience of having lost life´s basic meaning. He describes his problem as a type of life crisis. Above all he is disappointed with those therapists that hide themselves behind an objective mask. He wants himself to be taken serious, both as a psychological person and as a religious man. He wants his faith in a living God to be taken at face value and not only deconstructed as an inner object hiding in a safe transitional space.
His therapist is well trained in object- relation theory and especially familiary with the insights of Kohut and Winnicott. The more the therapy continues, the more confused the therapist becomes. He sees that he can neither accept the patient´s God talk at face value (God as God) nor deconstruct the patient´s God in terms of intra- or interpersonal hidden dynamics (God as god). He feels himself to be trapped in a cognitive, philosophical and professional dilemma.
RESONSE STRATEGIES OF PSYCHOTHERAPISTS
My question to the seven therapists responding to this vignette was: ”How do you feel about a patient like this, and in which way would you ”use” the patient´s own (lack of ) experience of God´s guidance in therapy?
Three of the therapists (A, D and E) claimed clearly that the faith of the patient should be taken psychologically seriously and be ”understood as an interpretative system and ”meaning-giving behaviour” that hitherto has given the patient support. The relation to God might mainly be explored ”in terms of weakening defence mechanisms” and ”lack of mirroring” . To a direct question at the end of the interview these therapists answered that they preferred to ignore the question of God as God in the therapy. They understood that kind of question as psychologically not relevant. On the contrary, they actively tried to not disclose their own belief. Every effort of the patient to talk about his God and draw in the therapist into his theological church-oriented terms was respected but interpreted psychodynamically. The reason for this detached position was that only in this position could the transference and countertransference be explored. These therapists worked strictly inside a psychodynamic understanding of a religious problem.
Two of the therapists (B and F) took another position. They also stressed that they actively should accept the patient´s belief . They talked about their own faith (before the sessions started), but they did not go into the theological questions in the therapy – the contract was strictly psychological. Both therapists claimed that they did not want to strengthen or question the patient´s religious worldview – instead they tried to elaborate the genesis and function of the man´s parental representations. After the therapeutic sessions they prayed for the patients but they never prayed together with them. The patients were aware of the therapist´s active Christian engagement. In that way these therapists professionally legitimated the patient´s experience that a real God existed, who out of his own will might hide himself in order to – by his ”absence” – negatively demonstrate his ”presence”. The therapist respected the patient´s worldview, but never used God-as-god as a means for diagnosing or in the working-through process.
And finally, two of the therapists (C and G) said that in working with religious patients the absence or presence of God must be understood both as a symbolic condensation of emotional and existential conflicts and possibilites (a psychological interpretation), and as an act of a living God (a theological legitimation). They switched without hesitation between an intra- and interpersonal understanding of the content and function of the patient´s loss of faith in God and a more church-oriented biblical understanding of God as an active intervening person. Both therapists also tried to be aware of the ”risks” with this double focus in terms of transference and countertransference, and focused these themes in their supervision sessions. In my remarks later, I will discuss how these two informants described their way of alternation between the two interpretative frameworks during the psychotherapy.
The Christian therapists described themselves as working inside two different perspectives: a confessional Christian world-view and a psychological world-view. Thus, they incorporated two partly contradictory interpretative schemes as to the silence of God. In one of these interpretative schemes the therapist understands the absence of God as a sign or symptom of a psychological problem. He then searches for reasonable causes for the depression that is coloring this man´s religious belief-system; i.e. the divorce, loneliness, guiltfeelings – all these problems are hiding behind what the patient describes as a religious problem. Instead of working through the loss of trust in terms of unconscious conflicts and desires to inner objects, he projects his feelings onto a celestial screen and therefore God is expererienced as absent.
Following the other interepretative scheme the therapist will support and legitimate the patient´s own religious interpretation and look actively for cognitive schemas in the Bible or the spiritual traditions of the patient´s church. He thereby tries to understand the man´s experience of God as a real Other, a living entity separate from the patient´s own psychological mak up. Through the therapeutic process this therapist makes God´s existence legitime for the patient, an existence which sometimes is silent. In struggling with this problem the therapist sometimes gives up his detached perspective and acts as a fellow Christian and refers to the Bible.
What happens in this latter case when the therapist on a surface level strenghtens and makes it legitime that the silence of God is a religious problem – yet where a further exploration actually could reveal that the absence of God indicates an intrapsychic dilemma dressed in theological garments ? A theological interpretation can thus weaken the patient´s ability to test reality – at least on the psychic level. Verses from the Bible, hymns and narratives from the Christian tradition can reinforce resistance. The theology and ”God-talk” of the therapist may contribute to a suppression of a conflict and enhance the chance that an immature solution is given to a hidden conflict.
But the opposite can also be the case. What happens if the therapist ignores the reality character of his patient´s God and deconstructs his loss of faith only in terms of hidden emotional or developemental residues? Then the therapist does not help the patient to reach a Christian interpretation of his cognitive dilemmma. The therapist neither helps a patient to a strengthening nor to a questioning of his very religious conviction on a secondary level.
If one looks further into spiritual theology, the church fathers and mothers have been very well aquainted with conflicts like these. In classical medieval ”pastoral medicine”, the spiritual guides were well aware for the need of ”differential diagnoses” between melancholy (understood in terms of biology or psychology) on the one hand, and the absence of God (in terms of apophatic theology) on the other.
Let me present three very simplified models for handling the conflict observed. Once again, my objective is limited, i.e. not whether the therapist should deal with religious material in general, but to be more exact: if and to what extent a religious therapist ought to help a patient to understand the psychological genesis and function of his representation of God.
The first mode is to legitimate the patient´s own intrareligious version. God is a reality that for one or another reason is hiding itself. There are a lot of church-based Christian spiritual traditions, especially in the mystical negative theology, which understand the longing for God as a sign of the reality of God. He is then described and accepted as an active agent of his own. In my view this way of legitimate the patients version of his faith is not the (Christian) therapist´s task, but that of the pastor or the spiritual director.
A second model is that the psychotherapist actively must avoid intervening in the Christian language-game on the secondary process level and its claimings of theological character. Instead he can de-construct the silence of God in terms of a hidden agenda, use the ”God-talk” as a fertile Rorschach test. The absence of God might be seen as a longing for mirroring, dressed in theological terms. The therapist then does not legitimate the drain of emotional support as a genuine religious experience, but as psychological and functional.
A third model is that the therapist balances between psychological and theological interpretations. The condition necessary for working with these ”double perspectives” is that the therapist has intellectually and personally been able to work through how psychoanalytical theory and theological narratives interact and are able to cooperate. The interviewed therapists, however, claimed that they need more professional thinking and discussions of clinical cases in order to become more aware of basic ontological hidden agendas, ”hiding” both in theological concepts and in psychological theories.
The switching from God as ”god” to God as ”God” was for some therapists made in terms of time. In the beginning of therapy they made a contract to focus at first on the psychological content, genesis and dynamics. After that working-through-process, they remade the contract in order to more explicitly elucidate the religious problem in terms of cognitive, theological and church oriented language. Together with the patient these therapists tries to find passages in the Bible or in the Christian tradition where feeling the absence of God is described.
An other type of parallel perspective is not in terms of time but in terms of themes. On the one hand one elaborates the emotional building stones of specific religious experiences, such as prayer, God´s presence, doubt etc.; and on the other hand, one tries to confront a patient´s experienced belief in God with classical maps of religious development, depending upon the religious context of the patient; St John of the Cross, John Bunyan the Russian Starets tradition etc. Such a alternation between a dynamic-psychological interpretation and a didactic-kerygmatic legitimation of the absence of God can actively provide an integration of the Christian belief-system. The risk then diminishes that the Christian faith just remains a cognitive dogmatic system without links to the person´s own inner life, or that it is just understood as a defence manoeuvre in order to maintain psychic equilibrium. The patient´s need to be taken seriously as believeras well as the psychologist´s need to question and seek the structures which lie behind what being overtly said, can in this way be professionally met.
A psychological way of understanding religion (God as god) is necessary for every (religious) psyhotherapist. By means of it he can critically elaborate the intra- and interpersonal function of his patient´s representation of God. A future need for therapists is the cross-cultural training for supervision strategies that are especially formed to handle the balance between two meaningsystems: theology and psychology. In the future it seems meaningful to elaborate the particular research arena we might label ”Transcultural Clinical Psychology of Religion”.
USE AND ABUSE – CONCLUDING REMARKS
I started with the question of how to ”use” religious terms in a therapeutic process. I will end with a few remarks related to the Uppsala 1993 preliminary discussion on abuse or use of religion in therapy.
To speak of something in terms of its ”use” and especially its ”abuse” has both normative and practical implications. This becomes especially evident if one turns the sentence ”uses and abuses of religion (i.e. God) in psychotherapy” around: the ”uses and abuses of psychotherapy in religion”. In both cases religion/psychotherapy is seen as a vehicle of something outside itself. As to the first, religion is a ”means” or an ”end” in a therapeutic process. The baseline is here mental health according to one or another definition. As to the the second, a psychotherapeutic method and relationship – both the psychodynamic and he cognitive approach – can be used or misused to deepen or weaken the religiosity of the individual. But the baseline is then related to whatever one means by religious, whole or mature. So, regardless of our position we will end up with more or less normative – or perhaps theological – questions.
My main argument is that neither theology nor psychology can be seen in purely functional terms. Psychoanalytically oriented therapy has as its main goal insight: to help someone get in touch with his/her unconscious motives and to bring them into awareness. As a side-effect the person´s autonomy heightens and sometimes the capacity to surrender to a faith or to leave a too regressive belief system.
In other situations an individual chooses to take an opinion that (from an unreflected psychological perspective) seems more or less neurotic/immature, but that in her own religious framework is perfectly logical. Is her religious conviction then an abuse or use, and out from whose baseline? Religion is (from an intra religious perspective) not mainly a meaning-giving pattern, a comforting or a social framework, a psychodynamic force to enhance identity etc. It is understood per se, not through its psychological effects but from its own inherited merits. So instead of discussing religion terms of ”use” or ”abuse”, I have tried to take another standpoint and to look ”inside” the Christian therapist who keeps together two different language-games through which one speaks of God, the ontological/theological on the one hand, and the functional/psychological on the other, the ontological as a religious person and the functional as a psychological professional.
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THE SILENCE OF GOD – the use of ”God” or ”god” in psychotherapy