Addressing spiritual and religious issues in counselling and psychotherapy
Thresholds, Winter 2012

Writing about religion and spirituality with a counselling audience can feel a bit like ‘fools rush in where angels fear to tread’¹, but mindful of my own continuing need for counsel around these topics, I think it is especially important that we counsellors and psychotherapists hold open a space where our clients can explore these issues if they so wish.

I am often asked, ‘what do you mean by “religion” and by “spirituality”?’ My preferred answer is: what do these words mean to you and to your clients? This does not usually seem to satisfy my questioners, so my next response is to draw on common dictionary definitions, which often talk of religion as the framework – buildings, pastors, books, beliefs – under which people gather, whilst reserving spirituality for the individual’s own beliefs and experiences (also usefully discussed in Harborne, 2008²).

Many people do seem to resonate with this distinction between religion and spirituality. However, it does not always meet with universal acceptance. So I notice that even the words we use to talk about these issues are under challenge and often the subject of passionate dispute. These words – ‘spirituality’ and ‘religion’ – really matter to many people. I think the polarisation and controversies around religious beliefs in recent years have increased the amount that they matter. In the therapeutic context it is useful to think about spirituality in terms of:

(a) experiences that people have which they refer to as ‘spiritual’;
(b) the beliefs that they have in relation to their spirituality;
(c) the value system, explicit or implicit, they have in relation to their spirituality; and
(d) where this all fits in (or does not fit in) with organised religion.

We can usefully expand this notion of spirituality and spiritual experiences within a therapeutic context, and say that:

• It is rooted in human experiencing rather than abstract theology. 
• It is embodied. 
• It involves linking with other people and the universe at large. 
• It involves non-ordinary consciousness. 
• Active engagement with spirituality tends to make people more altruistic, less materialistic and more environmentally aware. 
• It deals with the meaning that people make of their lives. 
• It faces suffering and its causes. 
• It relates to God/goddesses/ultimate reality. 
• It often uses the word ‘soul’ or ‘higher self’. 
• It uses techniques such as prayer, meditation, contemplation, mindfulness, yoga and t’ai chi³.

Who we are

As therapists I would suggest that our personal understandings and experiences of who we are, and what we think, are part of our being in the room with our clients; whether we share this information with them or not. I imagine that many readers of Thresholds would take the viewpoint that our counselling work with clients is in some way an expression of our faith in practice. This does not mean that we impose our faith or even talk about our faith and spirituality with our clients. However, it is part of who we are; part of our being in the room. And, I would maintain that this does communicate itself in some way to our clients.

I would maintain that the religious viewpoint of the therapist does impact on her clients. Any one therapist may be:

1. Religious: although we may carry our religious faith and belonging lightly, it will however impact on the values that underpin our work with clients. I imagine many within APSCC would fall into this group. For those who think ‘so what?’ Peter Gubi’s research^4,5 into the use of prayer in counselling might give some pause for thought. He surveyed just over half of BACP accredited practitioners and 43 per cent (247) replied. Fifty-nine per cent of his respondents had used prayer covertly with clients and 12 per cent had used it overtly with Christian clients. Only 24 per cent of those who used prayer had ever discussed it in supervision.
2. Spiritual but not religious: this is quite a common position for people within Britain today – what Davie⁶ calls ‘believing but not belonging’. This is also a very common position for counsellor trainees to have, in my experience. I notice how often the word ‘soul’ is used among this group, and the popularity of religious practices such as mindfulness, yoga and meditation, which are often used outside of a religious context.
3. Not spiritual: some people do not get it and do not want it and wonder what the fuss is about! I have recently had the pleasure of reading a book chapter by Dave Mearns in which he insists that he is a nihilistic atheist who never uses the word ‘spirituality’ to describe the experience of meeting a client at relational depth⁷. What I found intriguing was that I could relate deeply and indeed spiritually to what Mearns says even though he does not use the language of spirituality. This cured me of the belief that something is necessarily lost when we only use secular language. However, my personal preference is to use spiritual and religious language.
4. Anti religious (a subset of 3): this grouping has been strengthened by recent polarisation of opinions for and against religion, reflected in the writings of the natural scientist Dawkins⁸, the journalist Hitchens⁹ and the philosopher De Botton¹⁰. People in this group will sometimes carry hurt and anger in relation to their experiences of organised religion.

I would hope that, whatever the therapist’s view on spirituality and religion, the client would get the therapy they need; but we know from Chris Jenkins’ research¹¹ that this is not always the case: ‘When I was ill, I certainly learned very quickly to keep the spiritual side of myself separate from the rest of myself whenever I met with any of the “professionals”’ (counselling client cited in Jenkins 2006¹²).

This challenge around the impact of the therapist’s apparent religious beliefs on their clients was brought home to me very forcefully three or four years ago when, one day, with my own therapist, I noticed that she was wearing a Christian cross. I thought to myself, ‘Oh my God, what on earth does she think of me? Is she a Christian, and if so, what kind of Christian is she?’ I feared her condemnation. I had taken her to be vaguely New Age in her spiritual outlook and seemingly accepting of my spirituality and faith, but what if I had got it wrong about her? During the week between sessions I said to myself, ‘Come on William, you’re a specialist on therapy and spirituality; surely you of all people could address such a spiritual issue with your therapist?’ So I did and asked her about why she was wearing the cross. She replied that it was worn as a fashion item and not as an expression of belief! My relief was immense but it had taken me some courage to raise this issue. How hard, then, might it be for a client to raise questions around spirituality. I held back on telling her she needed to explore this in supervision!

Challenges

There are three broad challenges that may arise when working with clients around spirituality and spiritual issues and religion:

1. Client presenting issues relating to their spirituality and/or religious faith; 
2. Experiences within the counselling session that either client or therapist or both regard as spiritual; 
3. When working with a client’s spirituality leads to spiritual or religious issues arising for the therapist.

It is possible that more than one of the above factors may be active and possibly problematic for the therapist. I have always felt that working with clients has the potential to change me, hopefully for the better. And that by being witness to, and reflecting on, my clients’ struggles, it changes who I am over time. Considering each of these three challenges in terms of the counsellor’s experience, meaning-making and values, we get the table shown below:

Table 1: Challenges

I will now briefly consider each column of challenges in turn. 

Client issues around spirituality and religion

Clients’ descriptions and discussion of their spiritual experiences and beliefs can be challenging and disturbing. We need to be able to help our clients explore their doubts and concerns. We may or may not have similar issues ourselves. For example, it can be very painful for a client whose spouse is no longer willing to share their religious faith. There can be deep-rooted religious and psychological issues involved, including: ‘will my partner go to heaven?’ It might be easy, all too easy, to reject the concern of such a client, but it may well be very real to her.

I quite often find that people have cruel attitudes to themselves that are in sharp contradiction to their religious faith. For example, Buddhists who feel unworthy of compassion or Christians who feel themselves to be unforgiven.

It can prove difficult working with clients who believe they are under a spiritual attack. This can be very tricky. It usually helps to find out what their religious framework is and to locate the necessary work within that frame, with referral if necessary. Indeed, the question of referral may arise:

1. When we feel the therapeutic work they need to do is beyond our expertise or we feel ‘out of our depth’; 
2. When we feel they need to work with someone from their own faith tradition; 
3. When we feel a referral for a mental health assessment is necessary, hopefully with their consent.

Spirituality in sessions

Brian Thorne, in describing his notion of tenderness within the therapeutic encounter, writes:

‘It seems as if for a space, however brief, two human beings are fully alive because they have given themselves and each other permission to be fully alive. At such a moment I have no hesitation in saying that my client and I are caught up in a stream of love. Within this stream there comes an effortless or intuitive understanding and what is astonishing is how complex this understanding can be’¹³.

There is a lot to be unpicked here, which is beyond the scope of this article (further explored in pages 63-64 of Spiritual Issues in Therapy). However, it seems clear to me that Thorne is describing a spiritual experience seemingly shared by both therapist and client.

In being open to spirituality and spiritual experiences in therapy sessions there are some very real boundary issues to consider:

1. Potential loss of boundaries for client. How do we make and keep it safe for our clients? 
2. Potential loss of boundaries between client and therapist. I had a client once¹⁴ who spoke of his fear of the ‘spiritual intimacy’ that existed between us. This was an expression of a boundary issue for him and also for me. It raised the question for me of whether our therapeutic work together had shifted from being therapy to being spiritual direction and what this ‘spiritual intimacy’ he was referring to was? Part of resolving this matter was inviting him to clarify what this intimacy and the nature of our relationship had then become. 
3. Sometimes either therapist or client may feel they experience God or other presences in the room. This can get very real and very challenging. It demands a real honesty to engage in such work and a willingness to stay with the unknown and the uncertain. 
4. Where does therapy end and spirituality or religion begin? Or rather, when does a therapeutic encounter begin to feel more like spiritual direction or accompaniment, and who decides? Clearly this question needs exploring in the moment with the client but also subsequently within supervision.

Therapist’s own spirituality and religious beliefs

My work as a therapist has changed me and my life in so many ways. It feels that witnessing my clients’ life struggles has made me ever more aware of my own issues that need addressing. This has included the need to look after myself at a deep level including spiritual practices that keep me on an even keel.

My clients over the years have thrown up a whole host of spiritual and religious issues that I have had to wrestle with, within and outside of supervision. Some examples:

1. Why them? In other words, why did such horrible things happen to this client and how does my faith stay intact? I feel it is important for me not to duck this issue but to give it the time it deserves, (largely) outside of the session. 
2. How do I deal with the sense of others present in the therapy room? I certainly feel ‘helped’ at times, especially in difficult moments in my clients’ therapy processes. I am intrigued by the images and words that can turn up at just the right moment when working deeply with clients. Sometimes, when working with bereavement, the deceased will appear very present to both myself and the client. 
3. My therapy and academic work cause me to be aware of my regular need for spiritual solitude and contemplation.

Conclusion

It is quite common to talk in therapy of being on a journey as a client or therapist, and I find this a useful metaphor for my spirituality, ie being on a spiritual or faith journey. A related idea I often use is that of ‘unfolding’: that there are friendly processes wanting to happen, to unfold, and counselling and what we might call ‘spiritual friendship’ can facilitate such unfolding.

However, I have no need for my clients to be on a spiritual path or have a religious faith; that is up to them. I don’t need my clients to share my understanding of what spirituality is. In any case I am open to learning from them and from the experience of us working together. There can be great joy in working with someone who does not share the same faith as me, or even has no faith at all. My own spiritual journeying continues, and Jonathan Wyatt makes sense to me when he urges us to have awareness of our own faith position in the moment: ‘When I am clear about my faith and comfortable with it – whatever it looks like – then that is good. I know what I think. I know what I believe and I know what I do not believe. I know what my values are, or I know that I don’t know. Then, when I am like that, I can listen to clients’¹⁵.

Dr William West is a Reader in Counselling Studies at the University of Manchester where he is most noted for his interest in counselling and spirituality and for his work with doctorate and PhD students. His most recent book is Exploring Counselling, Spirituality and Healing (Palgrave 2011). William is a keen cyclist, amateur poet and beginner piano player.

References

1. Pope A. An essay on criticism; 1709. http://www.poetryfoundation.org/learning/essay/237826
2. Harborne L. Working with issues of spirituality, faith or religion. BACP Information Sheet G13. Lutterworth: British Association for Counselling and Psychotherapy; 2008.
3. West W (ed). Exploring therapy, spirituality and healing. Basingstoke: Palgrave; 2011.
4. Gubi P. Practice behind closed doors: challenging the taboo of prayer in mainstream counselling culture. Journal of Critical Psychology, Counselling and Psychotherapy; 2002; 2(2):97-104.
5. Gubi P. Integrating prayer in counselling. In West W (ed). Exploring therapy, spirituality and healing. Basingstoke: Palgrave; 2011.
6. Davie G. Religion in Britain since 1945. Oxford: Blackwell; 1994.
7. Mearns D. On faith and nihilism: a considerable relationship. In Leonardi J (ed). The human being fully alive: writings in celebration of Brian Thorne. Ross-on-Wye: PCCS Books; 2010.
8. Dawkins R. The God Delusion. London: Black Swan; 2007.
9. Hitchens C. God is not great: how religion poisons everything. New York: Hachette Book Group; 2007.
10. De Botton A. Religion for atheists: a non-believer’s guide to the uses of religion. London: Hamish Hamilton; 2012.
11. Jenkins C. When clients’ spirituality is denied in therapy. In West W (ed). Exploring therapy, spirituality and healing. Basingstoke: Palgrave; 2011.
12. Jenkins C. A Voice denied: clients’ experience of the exclusion of spirituality in counselling and psychotherapy. PhD Thesis. University of Manchester; 2006.
13. Thorne B. Person-centred counselling: therapeutic and spiritual dimensions. London: Whurr; 1991.
14. West W. Spiritual issues in therapy: relating experience to practice. Basingstoke: Palgrave; 2004.
15. Wyatt J. ‘Confronting the almighty God’? A study of how psychodynamic counsellors respond to clients’ expressions of religious faith. Counselling and Psychotherapy Research. 2002; 2(3):177-184.

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