Department of Psychology, Cleveland State University
Cleveland, Ohio 44115
From the Comprehensive Handbook of Psychotherapy Integration, edited by George Stricker and Jerold R. Gold. Plenum Press, New York, 1993. Reprinted here by permission of the author and Plenum Press.
The institution of verbal psychotherapy, as such, is a relatively recent historical development and one that first occurred in industrialized, Western societies. The precursor of contemporary verbal psychotherapy was a model that attributed the causes and cures of psychological problems to the levels of biology and physiology. Both models replaced millenia of traditional spiritual approaches to a variety of forms of malaise.
The term successionism refers to the negative attitude that religions have often evidenced toward their predecessors. For example, Judaism evidenced a negative view toward pagan religions. A type of successionism also may be found in the antagonism of the institutions of psychotherapy toward spiritual models of reality (Vitz, 1977) and toward associated healing traditions. Contemporary psychotherapy has thus lost sight of important aspects of the human experience as well as of ways of helping people encumbered by life's difficulties.
Such a de-spiritualized psychotherapeutic endeavor overlooks the spiritual dimensions of life and of experience. A wide range of spiritual healing1 traditions emphasizes the central importance of the connection of all life to spiritual or cosmic realities. In these views, healing is usually seen as restoring a condition of wholeness or harmony (Carlson & Shield, 1989). Contemporary psychology and many contemporary psychotherapeutic approaches express the perception of human beings as cut off and isolated, not only from nature and from other individuals, but more significantly from activities of cosmic purpose. Copernican, Newtonian and Freudian conceptual revolutions have led to the notion of human beings as purposeless, determined organisms acted upon by physical and biological laws. Even in humanistic approaches, meaning is usually seen as a subjective and arbitrary creation (Tart, 1975). Beyond any specific techniques that may be derived from spiritual traditions, contemporary psychotherapy has much to gain from a worldview that reconnects human beings with one another and with universal and spiritual purposes (Bergin, 1980).
[1 The term spiritual healing is not always clearly distinguishable from psychic healing or from shamanism. All three of these approaches share certain characteristics but may differ in major respects. Many healing traditions combine all three elements into a unitary form. In this chapter the term spiritual healing is used in a general way to refer to such traditions.]
Frank (1973) has indicated that contemporary psychotherapies do have many features in common with traditional healing approaches. The underlying structure of psychotherapy itself, that is, of a person seeking help (healee) going to a specifically trained or qualified individual (healer) for the purpose of seeking some type of solace or remediation of a problem, appears to be derived either from healing traditions themselves or from aspects of human nature appreciated both by healing traditions and by contemporary practice.
Traditional spiritual forms of healing do consist, in part, of suggestion and placebo, but upon further examination it becomes apparent that active therapeutic ingredients2 also must be present (Colijn & Sollod, 1990). Many such active ingredients which contribute to demonstrable changes in thinking, feeling, and behavior have been identified and utilized within various healing traditions during the millenia in which spiritual healing approaches have developed.
[2 Pharmacologists have analogously discovered that traditional remedies are often potent cures and may consist of biologically active ingredients.]
In addition, the significance of motives associated with the archetype of healer in the psychotherapist is an important factor that suggests the value of the integration of spiritual healing approaches and methods within psychotherapy. Many therapists appear to be motivated by all inner directionality similar to that experienced by healers in traditional societies (Guggenbuhl-Craig, 1971; Wilmer, 1987). Such an archetype involves service and the development of the power to change the lives of others as a result of specific training and experiences; privileged access to the often hidden experiential world of others and awareness of one's own problems (the "wounded healer") also are aspects of this archetypal pattern.
Some therapeutic training programs, most clearly psychoanalytic institutes, have already incorporated elements of all initiatory school. From the standpoint of spiritual traditions, such programs represent pseudognostic initiations (Sollod, 1982); nonetheless, they engage the archetypal energies of would-be psychoanalysts. A more direct acknowledgment of the connection between the roles of psychotherapist and healer in the training of psychotherapists generally could foster their development.
The example of spiritual healing approaches also suggests that it is possible to work more sensitively and effectively with a variety of experiences that most contemporary psychotherapeutic approaches avoid or pathologize. Anomalous or paranormal experiences are often inexplicable in terms of current scientific views and are incompatible with normative perceptions and expectations about reality (Alcock, 1981; Braude, 1978; Tobacyk & Milford, 1983). Nonetheless, many reports indicate that such experiences are surprisingly prevalent. Greeley (1975, 1987) summarized his survey research to conclude that 29% of American adults reported visions, 67% reported ESP experiences, 67% indicated deja vu, and 31% had experienced clairvoyance. According to a 1985 Gallup poll, 43% of American adults surveyed have reported an unusual spiritual experience and 15% have reported a near-death experience. Lukoff (1985) has written about the possibility of authentic mystical experiences and the frequent overlap of such experiences with psychotic disturbances. The spiritual healing traditions evidence a familiarity with and acceptance of a wide range of spiritual and anomalous experiences. This is, therefore, a domain in which contemporary psychotherapy could have much to gain by selectively incorporating aspects of spiritual healing approaches (Sollod, 1992).
THEORETICAL AND CONCEPTUAL POSITION
This chapter focuses upon the relevance of techniques, approaches, and concepts derived from spiritual healing traditions for the contemporary practice of psychotherapy. It also will present some guidelines and approaches to a possible psychotherapeutic integration of some insights and practices from spiritual healing traditions. As there are many different types of spiritual healing and a variety of viewpoints concerning them, there is no single available integration of such approaches within the practice of psychotherapy. The appraisal of frequent practices within spiritual healing approaches leads to the possibility of their integration within psychotherapeutic practice (Sollod, 1988). Some elements commonly found in spiritual healing may serve to reinforce or highlight aspects of current psychotherapeutic practice. Other elements may suggest that innovative techniques and approaches may be beneficial.
A sampling of current healing methods in a variety of traditions reveals major aspects of spiritual healing practices (Bloomfield, 1984; Carlson & Shield, 1989; Cooke, 1980; Goldsmith, 1959; Hamer, 1980; LeSban, 1966; Markides, 1985, 1988). Principles and approaches considered important in many of these healing traditions include the following: (1) There is an alteration of the healer's state of consciousness. The healer has expertise in entering a variety of states of consciousness that differ from ordinary waking consciousness. These different states of consciousness are used to facilitate a variety of therapeutic processes. In such alternate states of consciousness, the healer relies on factors outside his or her ordinary ego to facilitate healing. The ego and its functions are kept in check during the process as they may interfere with the healing process. (2) The healer's view or manner of perceiving and conceptualizing the person seeking help is an important factor in spiritual healing. Seeing the person as deficient or impaired usually hinders the healing process, whereas seeing the person as freed of limitations is usually very therapeutic. The complementary client processes are disidentification and transcendence. (3) The healer accesses and uses intuitive understanding. (4) There is no clear separation between the processes of the healer and those of the person seeking healing. In some cases, a sense of fusion between the healer and the person seeking healing constitutes a basic element of the healing process. Healing may involve the healer successfully resolving certain personal issues. (5) There is considerable use of visualization by the therapist and by the healee. (6) Alteration of the healee's state of consciousness through trance induction is often used. (7) A spiritual or transpersonal model is used to explain illness and therapeutic recovery. (8) All implicit personality theory accompanying the spiritual tradition emphasizes the potential for change. Within Western monotheistic spiritual traditions, the individual is seen as a child of God and, as such, possessing rationality and free will. (9) Reestablishing a conscious relationship with spiritual life and developing an appreciation of divine or universal laws are often seen as resulting in the restoration of health. (10) Prayer or meditation are frequently viewed as therapeutic activities.
Although it is not feasible to illustrate the entire range of healing approaches here, space does allow a brief summary of the approaches of two healers--Joel Goldsmith and Styllanos Atteshlis. These examples illustrate some of the principles indicated above.
Joel Goldsmith (1958, 1959, 1983) was an American healer who led meditation, healing, and spiritual development circles throughout the world. Writing within a Judeo-Christian framework, Goldsmith emphasized the importance of the state of consciousness of the healer. He stressed that, in healing, it was important to enter a different state of consciousness in which one felt an inner wholeness or oneness with God. Goldsmith considered it unnecessary and even detrimental to focus on the type of illness or problem of the healee. The healing approach seemed to involve an effort to achieve "at-one-ment" and the healing thus was caused by spiritual forces beyond the activity of the ego. The healer's activity involved a suspension of normal ego functioning and an attempt to reach an inner stillness. The healing was said to take place within that stillness. Goldsmith did not do hands-on healing and indicated that healing could be done either in the presence of the healee or at a distance.
Styllanos Atteshlis3 is a native of Cyprus who has engaged in spiritual healing and teaching for much of his life. He is commonly referred to as "Daskalos", which is the Greek word for teacher. His activities have been the subject of two books by the sociologist Kyriacos Markides (1985, 1988), and he has also contributed his own teachings and writings about spirituality and healing (Atteshlis, 1990a,b, 1991). Working within an esoteric Christian framework, Daskalos also emphasizes the importance of the state of consciousness of the healer. Unlike Goldsmith, he believes that the healer may try to affect the condition of the client through conscious control of the healer's own thoughts and feelings. He suggests that the energy of the healer can be intentionally directed, often through imagery, in such a way as to enhance the well-being of the healee on a variety of dimensions. He also states that the healer should be motivated by love and by a desire to be of service. He agrees with Goldsmith that healing is potentiated by spiritual forces beyond the ordinary ego functioning of the healer but teaches that such forces may be invoked and enhanced by the intention and directed consciousness of the healer. He also indicates that focusing on negative or limiting thoughts (either by the healer or the healee) limits and impairs the efficacy of healing but, unlike Goldsmith, does not think that the diagnostic process or recognition of the nature of a problem is inherently detrimental. Daskalos maintains that healing may be done in the presence of the healee or at a distance, and he also uses physical touch as one means of healing.
[3 Styllanos Atteshlis is referred to pseudonymously as Spyros Sathi in Markides' books.]
Daskalos has also devoted considerable attention to the art of psychotherapy (Atteshlis, personal communication, 1988, 1989, 1990a; Markides, 1985,1988). He has stated that conventional psychotherapy does not get to the root causes of psychological problems. He often views such root causes as the thought-desire forms or patterns that a person has developed and energized over the years. He labels such patterns "elementals." Conventional approaches, through the process of catharsis, often prematurely bring to the surface some deeply hidden elementals with which a person may be unable to contend. Daskalos teaches that the process of psychotherapy however, should instead include helping a person to develop more benign patterns of thought and feeling and to depotentiate destructive and negative patterns. This process may be aided, in Daskalos' view, through the creation of therapeutic elementals as well as by example and persuasion.
LeShan, who has developed conceptual models of alternate states of consciousness and meditation (1966,1974), also presented a typology of healing approaches (Goodrich, 1978). In Type I healing, the healer enters an altered state of consciousness characterized by experiential fusion with the healee and a state of deep, caring love. Type I healing may be done in the presence of the client or at a distance. In Type II healing, there is an attempt to direct the healing process. Therapeutic touch or the "laying on of hands" characterizes this approach. Applying this typology, it appears that the Type I approach best describes Goldsmith's approach to healing, whereas Daskalos' activities include both Type I and Type II processes as well as other aspects that do not fit into either pattern.
CLINICAL AND THEORETICAL ANTECEDENTS
The generally accepted assumption that psychotherapeutic approaches have been unequivocally derived from scientific roots has been challenged (Perfez, 1989; Sollod, 1982). The origins of psychotherapeutic forms are complex and consist, in part, of sociohistorical and biographical factors. Originators of psychotherapeutic approaches have drawn from a variety of extrascientific sources. Spiritual traditions and associated healing techniques have long been one major but largely hidden and poorly acknowledged source of psychotherapeutic innovation. A large portion of current psychotherapeutic practice appears either to have been derived from spiritual traditions and teachings or to consist of approaches and practices similar to those found in spiritual healing traditions.
From the development of psychotherapeutic uses for dreams to hypnosis, biofeedback, and relaxation techniques, Western psychotherapeutic innovators have been antedated by traditional sources and have drawn upon them. Rogers (1980) has indicated that Taoism was an influence on his development of client-centered therapy; secularized aspects of Protestantism also are present in his therapeutic approach (Sollod, 1978). Gnostic elements were prominent in aspects of Freudian psychotherapeutic techniques (Sollod, 1982). Freud traced his emphasis on the importance of dreams to Biblical writings; the idea of the subconscious mind was known to Cabalistic mystics (Bakan, 1958; Fodor, 1971).
Even when contemporary schools of thought may not have their origins in spiritual and healing traditions, surprising similarities are often present. For example, Adler's (1959) view of the individual as an active creator may be considered an exoteric version of Cabalistic thinking. Skinner's4 model of individual behavior as completely conditioned and shaped by the environment was antedated by Uspenskii (1929), a Russian mystic and student of Gurdjieff. Albert Ellis (1970) has cited the insights of Epictetus, the ancient Greek spiritual master, to support the validity of his rational-emotive approach. A major tenet of rational-emotive therapy--that an individual's thought shapes experience--although presumably based upon empirical scientific considerations, is consistent with Stoicism as well as with some Christian, Buddhist, and Cabalistic teachings.
[4 Skinner (1976) indicates that he had read Uspenskii's Tertium Organum (1929) before beginning graduate school in psychology. Thus, there is a possibility that his thinking may have been influenced by Uspenskii's ideas.]
Another type of clinical antecedent is the fact that healers in a variety of traditions have not restricted themselves to physical illnesses but have also typically addressed problems and concerns that are commonly considered the exclusive province of psychotherapeutic intervention (Berthold, 1989; Edgerton, 1971). Traditional cultural and spiritual teachings have developed approaches to a variety of conditions that also could be described within the framework of psychiatric and psychological diagnosis (Buhrmann, 1984; Holdstock, 1979; Wilson, 1989). The integration of traditional healing approaches with more conventional practice has also been noted or suggested (Gordon, 1990; Rappaport & Rappaport, 1981).
Besides such considerations, several current forms of psychotherapy are based on specific spiritual or healing traditions. Such approaches may operate within the framework of a specific theology or spiritual tradition and consist of the application of principles and methods consistent with that worldview. Psychotherapies involving body work and therapeutic touch (Kepner, 1987; Krieger, 1975) also involve ideas and processes drawn from or similar to those found in spiritual healing traditions.
THE TECHNIQUE AND PROCESS OF PSYCHOTHERAPY
There is no one specific approach to psychotherapy that involves the integration of spiritual healing. Instead, there are some major types of emphases and a repertoire of techniques that may be adopted. In the spiritual traditions, the healer is the conduit of healing, and it is through the healer's inner activities that healing is enabled to take place. Such inner activities include the healer's state of consciousness and contents of consciousness.
Thus, a major emphasis in a psychotherapeutic approach incorporating the principles of spiritual healing is upon the inner activities of the therapist. The therapist in such an approach is ideally able to move into altered, often transcendent, states of consciousness that may be beneficial for the therapeutic process. Some such states may be similar though deeper than the empathic and the objective, almost meditative awareness of the therapist in various approaches of psychotherapy. Other states of receptivity, awareness, and non-ordinary altered states of consciousness also may be accessed. Such states may involve a deep feeling of unselfish love, enhanced sensitivity to the other, contact with inner resources of compassion and understanding, and perception of the client as whole or potentially whole. Within Western monotheistic healing traditions, and in a psychotherapy incorporating these concepts, the therapist believes that the client is a loved and valued being--made in the image of God. He or she also can access states of consciousness in which the client's spiritual essence is perceived or directly experienced.
Conventional approaches to therapy also focus to a certain extent on the level of consciousness utilized by the therapist. Psychoanalysts, for example, are trained to develop a certain type of even-hovering attention. Therapists with a client-centered orientation evidence a special type of empathic awareness. Experiential psychotherapists access their embodied feeling states as an essential part of the therapeutic process (Mahrer, 1989). Conventional therapeutic approaches also emphasize the importance of therapists' specific thoughts and feelings, although in a different way for the most part than do spiritual traditions.
The therapist, as a result of training and experience, should be able to enter a variety of distinct states of consciousness. An ideal primary state is called self-observation, self-remembering (Tart, 1987), or witness-consciousness (Wilbur, 1977). In this state, the therapist is able both to attend to the communications of the client and to monitor reactions as they occur. This process goes beyond intellectual appreciation of one's own reactions and consists of a conscious, non-judgmental awareness of thoughts and emotions as they occur. This state may be accompanied by an associated emotional state that consists of access of deeply loving and compassionate feelings toward the client. For some therapists, self-remembering may be accessed only temporarily; for others, it can become a more pervasive or central state.
Besides this primary state, the psychotherapist should be able to shift to several additional states of consciousness. One is a state in which he or she accesses intuitive knowledge; another is a state of empathic fusion with the client. Additional states of consciousness also may branch off from the primary state of self-remembering. Some may represent a deepening of this state and a reflection of the influence of the therapist's own personality upon perception and thought. Others may combine benign intentions with the primary state of consciousness. Still other states may represent a deepening and transformation of the therapist's perceptions and experience of the client.
If possible, such states of consciousness may represent forms of split consciousness in which the therapist continues to interact on an ordinary level with the client. There is no need for the therapist who is trained and experienced in accessing such states of consciousness to go into a trance or to behave in any unusual fashion. The ability of therapists to enter such meditative states varies, and a therapist may find that he or she cannot reach one or more of the meditative states described. Participation in training programs as well as meditation and prayer may be of assistance.
The specific contents of the therapist's consciousness also are of particular relevance to a psychotherapeutic form integrating insights from healing traditions. Wilbur (1977, 1980, 1981) has written extensively about consciousness and has compared consciousness with a building. The levels of consciousness constitute a type of deep structure and are analogous to the different floors. Specific contents of consciousness are compared with the floor plans and the furniture. These contents of consciousness, although more superficial than the deep structure of levels of consciousness, are nonetheless significant.
Specifically, as in the healing traditions, seeing the client as deficient, defective, and diseased is viewed as detrimental, but seeing the client as potentially empowered, happy, healthy, and whole is beneficial. In such a psychotherapeutic approach, the diagnostic process is approached with caution. The therapist may utilize diagnostic constructs to assist in describing a case, but only if he or she realizes that the current pathological condition is not supported by the deepest level of reality of the client or of the cosmos. Such an insight should be conveyed to the client. As Daskalos (Atteshlis, personal communication, 1988) has said, "Help them [people seeking help] to see that their problems in time and space are just illusions." It is vital for the therapist not to become caught up in a sense of the client's limitations as it is precisely the therapist who is responsible for helping the client to relinquish views and activities that are causing difficulties.
Some techniques that emerge front these considerations emphasize pleasant, life-enhancing activities. For example, the client may be asked what activities he or she engages in or has engaged in that bring the most satisfaction and is encouraged to participate in one or more of those activities. This approach is very similar to that developed by LeShan (1990) for psychotherapy with cancer patients. He has indicated that another useful beginning point is to ask the client what he or she would most like to do with the gift of a year of life that could be shaped in any manner the client desired. LeShan has also indicated many additional techniques that can be used. The client also may be encouraged to undertake more helpful, altruistic activities in daily life. Such participation in new, life-enhancing activities should be deeply grounded in the therapist's belief that people have the power to change, that they are capable of rational choice, and that they are fundamentally responsible for the quality of their experiences and for the quality of their relationships with others.
Another technical consideration is the relative lack of emphasis on the problems, conflicts, and negative emotions of clients. The therapist is open to the expression of such concerns but does not want to potentiate them through undue attention or through repetition. Catharsis is not necessarily viewed as therapeutic--nor is trying to recover hidden, painful memories and concerns. The effort is to help the client create areas of experience and associated thoughts and feelings that are satisfying and life-enhancing. Much of the therapeutic process is devoted to helping the client find out what would be most fulfilling and to encouraging inner and outer activities that correspond to selected goals.
Techniques that may be used to facilitate the building of new patterns of thought, feeling and behavior, in addition to those commonly used by cognitive therapists, are affirmations, prayers, and visualization techniques. These may be used by the therapist and by the client as well. In spiritual healing traditions, such techniques are thought to potentiate specific contents of thoughts and feelings. Thus, autosuggestion and suggestion are considered as potentially therapeutic processes. Both utilize the mind's ability to shape experience and even to affect physiological responses. Suggestion, in this approach, is not viewed as a placebo. It is an active ingredient of therapy (Barber, 1978). Hypnosis also may be used to enhance the impact of affirmations, visualization, suggestion, and autosuggestion.
An additional technique that may be incorporated into psychotherapy is that of hands-on healing. Therapeutic touch (Krieger, 1975) and a variety of other healing traditions employ a technique of touch or near-touch in which healing energy is assumed to pass from the healer to the healee (Brennan, 1987). Such an approach has been used for both physical and psychological problems. The psychotherapist incorporating techniques from healing traditions may develop expertise in hands-on healing and include such work as part of psychotherapy. This hands-on approach may be used to help a client become relaxed, to feel more energized, or even to resolve specific problems that might have a somatic representation. Empirical research has documented the impact of therapeutic touch and related approaches (Grad, 1965; Krieger, 1975; Krippner, 1980; Wirth, 1989). Therapists trained in therapeutic touch, reiki, or other related healing modalities can integrate such types of work with a variety of verbal psychotherapies. Kepner (1987) has presented a thorough integration of body work with gestalt therapy.
Meditation and prayer also may be used in a variety of ways to facilitate therapeutic change. Meditation, for example, has been found to result in greater relaxation, disidentification, alertness, awareness, empathy, sensitivity, and openness to change (Carrington, 1977; LeShan, 1974; Shafii, 1985). Both therapist and client may benefit from meditative practice. Meditation may be practiced both within and outside the therapist's office. Different types of prayer have been vital to many spiritual traditions (Bloom, 1980; Laubach, 1946). Prayer also may be part of spiritually oriented psychotherapy. The therapist may pray for and/or with the client as do a significant minority of therapists (Nix, 1978). The client's prayer life also may be supported in therapy.
Alongside the more conventional appreciation of the possible effects of such techniques, Jamesian parapsychic (Fuller, 1986) and transpersonal explanations also may be considered. A tenet of transpersonal psychology, consistent with spiritual healing traditions, is that the directed inner activities of a person may impact upon others. In addition to praying for the client, the therapist may direct visualizations or thoughts to facilitate beneficial changes in the client. Imagery that presumably results in changes in another person is termed transpersonal imagery (Braud & Schlitz, 1989; Samuels, 1990).
Some empirical support exists for the assertion of transpersonal influence. Over 35 studies have indicated that prayers and meditations can be beneficial for individuals at a distance (Byrd, 1988). The results of hundreds of studies have strongly suggested the possible influence of attention on electronic functioning as well as on living organisms. Changes in EEG patterns were recorded when persons tried to communicate with others at a distance (Orne-Johnson, Dilbeck, Wallace, & Landrith, 1982). Braud and Schlitz (1989) conducted a study in which transpersonal visualization was used to alter autonomic nervous system activities of others remotely. It appears that adequate methodological procedures were utilized in many of these studies.
Another characteristic of the therapeutic activity is a psychotherapeutic form that integrates spiritual healing techniques into psychotherapy is the reliance of the therapist on an intuitive process to guide therapeutic activities. Intuition, "listening with the third ear," involves the ability to access thoughts and feelings which reflect an inner knowing or understanding (Agor, 1984; Vaughan, 1979). Each person develops a particular means of contacting intuitive information. For many people, the ability to attain a relaxed, meditative state, to focus on a question for which an intuitive answer is desired, and to wait for relevant thoughts, feelings, or images to arise in answer constitute the intuitive process. Intuitive psychotherapists often experience ongoing access to a flow of intuitive information. Intuitively derived information should be examined rationally before being fully utilized.
In this psychotherapeutic approach, a close connection between the client and the therapist exists. At times, a sense of therapist/client experiential fusion is an important ingredient that facilitates therapeutic change. Also, the therapist seeks to find an underlying meaning for the therapeutic encounter and to understand what he or she is to learn through working with a specific client. Contact with a client may challenge the therapist to reexamine certain preconceptions, to learn to be more accepting of various aspects of experience, and to change his or her approach to life. Sometimes, this "work on oneself" is necessary for the therapist to be able to provide a truly therapeutic relationship.
Another feature of this approach is a collaborative, egalitarian relationship. There is a partnership between client and therapist. As in holistic approaches generally (Gordon, 1990), the client participates actively in recovery and can beneficially engage in a variety of activities. These might include instituting dietary changes, beginning an exercise program, engaging in meditation, visualization, relaxation exercises, self-analysis, or diary work. The specific content of exercises is usually developed collaboratively.
The process of therapy varies considerably from one client to another. Often, however, alleviation of symptoms occurs early in therapy. It is followed by the client learning to develop new patterns of living in order to "lock in" any symptomatic changes.
The utilization of such techniques drawn from spiritual healing approaches and their integration into psychotherapy depends upon both the readiness and openness of the client and upon the capacity of the therapist. Integration of these techniques occurs along a continuum ranging from a therapeutic approach virtually indistinguishable from the conventional (although affected by insights from spiritual healing traditions) to approaches consisting in large part of techniques derived from spiritual healing traditions. The therapist should be skilled and trained in the use of any such techniques, be familiar with their utilization, and be sure that clients are accepting of and comfortable with specific approaches that may be utilized. Prayer, for example, is usually inadvisable if the client is an atheist or agnostic or, for other reasons, does not believe in the efficacy of prayer. Visualization may not be suitable for clients who have a limited ability or disinclination to work with imagery. Specific visualizations and affirmations may be most suited to a given patient.
There are some potential pitfalls in the use of techniques drawn from spiritual approaches. It is important that such techniques and approaches be approached in a tactful and matter-of-fact way. Otherwise, the focus of therapy may center upon the apparent novelty of the techniques themselves and upon the effects that they may produce. More important than any specific techniques is the adherence to an underlying viewpoint based on an understanding and appreciation of spiritual principles. Emphasis on integrating spiritual healing techniques into psychotherapy does not invalidate the continuing application of other psychotherapeutic skills and methods or the importance of additional types of insights.
It is not possible to present a single case that typifies all the principles indicated above. Each case is different, and practitioners vary in type and degree of training and expertise in this form of integration. Also, therapists may have different spiritual outlooks and have familiarity with a different range of associated techniques. Two cases will be summarized briefly to provide some sense of the broad range that is possible.
A 38-year-old man with a history of failed jobs and an unhappy marriage reported that he was feeling hopeless and depressed. He said that he had many conflicts with his wife and did not see much of a future in his job, at which he was failing. After initially forming a working therapeutic relationship, the therapist suggested that the client begin to engage in pleasant or fulfilling activities--no matter how unimportant they might seem. The client began gardening, taking long walks, and going sailing with some acquaintances. He objected at first, saying, "I have too many problems to enjoy myself." The therapist responded, "If your problems are so real, you don't have to worry about them all of the time. They will still be there after you spend the afternoon sailing on the lake."
The therapist began to limit the amount of time that the client could talk about his past and present problems to less than half of each session. Much of the rest of the time was focused on allowing him to explore what he wanted in his life and how he would like to be. The therapist encouraged the client to develop visualizations according to his stated goals. For example, one exercise was to visualize driving to work in a new car and looking forward to a pleasant and fulfilling workday. The therapist encouraged the client to plan and engage in specific behaviors that could lead to the fulfillment of his goals.
Dreams were also utilized and, when appropriate, were seen as indicating the potential for a more fulfilling life. As in healing traditions, the therapist encouraged the client to appreciate his dreams. For example he suggested that the client draw sketches of particularly significant dreams. Another possibility was to purchase small objects reminiscent of dream figures. Such measures were designed to help bring the feelings and thoughts expressed in dreams into the client's daily awareness.
Throughout the process of therapy, the therapist worked at maintaining a prayerful vision of the client as a being freed of limitations who could choose the direction of his life. He prayed that the client would have the wisdom to choose a good direction and the strength to carry out such a choice. Outside the therapy session, the therapist would meditate and visualize the client as happy, relaxed, and bathed in light.
The client seemed pleased and surprised at the direction of therapy. He had felt that something was deeply "wrong" with him and that psychotherapy should spend years getting to the root of his problems before change would be possible. Nonetheless, with the aid of this approach, he to experience longer periods of positive moods and began making plans to move ahead in his career life. With an improvement in the client's mood, meditation training began. Meditation gradually led to an increased awareness of the issues in his current relationship and, using a technique of self-analysis, he reviewed his responses to daily events in a meditative fashion upon falling asleep. Such efforts enabled him to develop more insight into his unfulfilling marital relationship. His frequent angry outbursts had distanced his wife. With more awareness, he was better able to apprehend the causes of his angry responses and to gain more self-control.
In a second case, an executive in his mid-forties reported a period of intense spiritual experiences. He was ecstatic and felt full of light, love, and forgiveness. The revelations he was experiencing were changing his life, but he was also frightened by the power and intensity of what he was experiencing. He also felt isolated and was somewhat confused about the meaning of his experiences. In addition, he stated that, at times, he sensed the presence of what he feared might be evil spirits. He was afraid of possession and of becoming or being considered insane. In addition, he reported becoming clairvoyant and was both frightened and intrigued by the possibility of the development of psychic abilities.
The approach used here was one of support and acceptance. Therapy provided a decentering context (Sollod & Wachtel, 1980) and support for the client to sort out aspects of his experience and to explore his spiritual opening (Sollod, 1992). The therapist addressed the sense of isolation and fear by discussing processes of spiritual opening (Greenwell, 1990) and describing experiences that people reported in altered states. Mystical states and psychotic experiences were compared and contrasted. The client was to engage in directed bibliotherapy involving reading descriptions of mystical states. He was encouraged to engage in visualizations and affirmations of protection according to his Christian beliefs. Grounding exercises were also suggested to help the client stay connected with his physical existence and daily life.
During the therapeutic process, the client moved from an apprehensive and fearful stance to one of more confident exploration of the new dimension of life that was opening for him. He indicated that he was learning to control or avoid the unpleasant and frightening aspects of such experiences. He continued to function effectively in his professional life. He became more committed to his religious tradition and began to participate in a study group to explore the dimensions of spiritual life.
It is possible that techniques and approaches indicated in this paper will be increasingly incorporated into psychotherapeutic practice during the coming years. Such a process would represent the continuation of a process that began with the earliest stages of verbal psychotherapy--the borrowing and integration of techniques and insights from traditional spiritual and healing approaches.
Many questions remain concerning how such an integration might occur. One area of concern is whether such methods would be subject to adequate empirical testing and outcome research before they become widely used. Are given techniques effective? If so, what are their strengths and limitations, their pros and cons? Some empirical research has already been conducted regarding the therapeutic impact of imagery (Sheikh, Kunzendorf & Sheikh, 1989), hypnosis (Bertrand & Spanos, 1989), and meditation (Shafii, 1985). The effects of prayer and hands-on healing, although studied outside of psychotherapy, have, as yet, been the focus of very little investigation within psychotherapeutic practice.
Another area of concern is the training of therapists in such techniques. Is it possible for therapists to learn such techniques through courses alone? Perhaps extensive workshops might be necessary to teach meditation or visualization skills. Or it might even be beneficial for therapists to participate in spiritual disciplines that involve extensive commitment to learning about such skills and approaches. Another question about the integration of such approaches and techniques into psychotherapy is to what extent the integration could occur on the level of technique, alone, and leave the underlying view of the model of personality and of psychopathology unaffected. The effect of techniques with origins in spiritual traditions might be explained by concepts derived from more conventional psychotherapeutic approaches. It is possible to use even such techniques as meditation, prayer, visualization, and therapeutic touch without equivalent consideration of the ethical, moral, and spiritual teachings of humanity's healing traditions. Therapists might not be personally committed to a spiritual path and yet utilize these techniques. It is possible that some techniques could lose their effectiveness when separated from a spiritual tradition of which they were an integral part. Perhaps they would prove as effective even when practiced as part of a technically eclectic approach.
On the other hand, it is possible that the continuing integration of spiritually based healing techniques into psychotherapy will lead to a questioning and redefinition of the deepest levels of the psychotherapeutic enterprise. Such a modification of the psychotherapeutic enterprise would also bring along with it a series of additional questions and dilemmas. For which clients under which circumstances would it be ethically and professionally appropriate to utilize concepts and techniques drawn from spiritual traditions? Would it be possible to combine such approaches in a nonconfusing and effective way with elements of more conventional psychotherapies? Are not the views of reality implicit in spiritual approaches so divergent from those of prevalent psychodynamic, behavioral, and cognitive therapies as to prevent an adequate integration? Such considerations have been relevant in considering the integration of behavioral and psychodynamic psychotherapeutic approaches (Messer & Winokur, 1984). How would the role of the therapist change and how would the meaning of psychotherapy in a client's life become different? Could such an integration occur without radically changing the significance of psychotherapy? Or, if the meaning of psychotherapy did change radically could the necessary accompanying shifts in the roles of therapist and client be feasible?
Depending on how these and related concerns are resolved, it is possible that empirically validated, spiritually oriented integrative psychotherapeutic forms will emerge within a contemporary, Western framework.
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