I'm honored to present a trio of accomplished scholars from the Institute for the Psychological Sciences (IPS) to share their perspectives on Catholic psychotherapy. IPS is an orthodox Catholic graduate school in Arlington, Virginia where students integrate science with "theological and philosophical underpinnings of psychology from the perspective of a Catholic anthropology." Gladys Sweeney (Ph.D. Pennsylvania State Univeristy), is the founder and Academic Dean of IPS and co-editor of Human Nature in Its Wholeness: A Roman Catholic Perspective. William Nordling (Ph.D. University of Maryland) is one of the founding faculty members of IPS and current president of the Catholic Psychotherapy Association. Craig Steven Titus (S.T.D., Ph.D., University of Freibourg) lectures and researches on virtue and moral development at IPS and is the author of Resilience and the Virtue of Fortitude: Aquinas in Dialogue with the Psychosocial Sciences. Please enjoy their contribution to the VRT series.
What is the role of religion or spirituality in your clinical practice?
When put in the context of the Catholic Christian practitioner, whether in the clinic or private practice, it is understood that the patient, through an informed consent agreement, is aware that the clinician is informed by a Catholic understanding of the human person and relationships and abides by Catholic moral principles.
From a Roman Catholic approach to psychotherapy, religion and spirituality can provide a powerful resource for the healing process. For Catholics, religious belief and practice promote growth in the life of faith, hope, and love (and the other virtues). This is a personal and communal journey towards flourishing that is both subjective in personal transformation and objective in its source and its goal, who is God. The role of religion and spirituality in our clinical practice helps to inform both the therapist and the client of the interconnection of human flourishing, truth, and goodness. This reminds us of Pope Pius XII (1953), who spoke of the necessity for "theoretical and practical psychology (...) to lose sight of neither the truths established by reason and faith, nor obligatory moral principles."
This view demands that we respect the basic dignity of each person, who enters the clinic. Furthermore, it is not in spite of, but rather, because of this view that we would respect the client's personal religious beliefs without imposing our own.
On the side of the clinician, we acknowledge that religion and spirituality transform our practice and can aid to promote the client's freedom to instill change in his or her life. John Paul II (1993), in this regard, says that "authentic freedom and truth go hand in hand, they cannot be separated." In all humility, we attempt to see and accept the client as God would, with love and care. We understand that being called to the mental health profession involves a way of serving our neighbors in need. In so doing, however, we also are transformed.
How does your technique or theory differ from mainstream psychotherapy?
First, we employ a Catholic understanding of the human person and relationships. At the theological level, we see the person as being created in the image of God, with the everyday and eternal vocation to love and be loved. We see the person as wounded by sin, yet redeemed by Jesus Christ. At the philosophical level, we understand that the human person is a unity of body and spiritual soul, who is interpersonally relational from conception. The whole person is called to grow not only physically, but also psychologically, morally, and spiritually in personal self-gift (love) and wisdom (knowledge), as well as in freedom and responsibility.
Second, we employ the same empirically-supported psychotherapeutic techniques as mainstream psychotherapy. We also use other empirically-supported psychotherapeutic techniques that have been developed from Christian insights, such as forgiveness therapy, which also recognizes that human nature can be healed and transformed with God's help (divine grace). In this regard, John Paul II (1993, par. 3) says: "no genuine therapy or treatment for psychic disturbances can ever conflict with the moral obligation of the patient to pursue the truth and to grow in virtue. This moral component of the therapeutic task makes great demands upon psychiatrists, who must be committed to attaining a more adequate grasp of the truth of their own lives and to showing profound respect for the dignity of their patients."
A new client comes to therapy reporting his main problem is feeling detached from God. How would you proceed?
In our experience, it is unusual that detachment from God should be reported as a client's main presenting problem. Nonetheless, if this were the case, we would begin by assessing whether there were any psychological issues of trauma (loss or grief) or any underlying psychopathology. If there were no properly psychological issues, we would refer the patient to a spiritual director.
If there was however psychopathology in addition to the said presenting problem, we would address the person's needs according to two levels of treatment. First, we would directly address his psychological issues, in a way that was respectful of his spiritual life. This will include instilling hope as an effective motivator in the client's life (Benedict XVI, On Christian Hope, 2007), for example, in overcoming addictions. Second, we would coordinate the psychological effort with the proper work of a spiritual director or guide, who was not only in the client's religious tradition, but also apt to aid the client with appropriate religious practices (involving prayer, scripture, and sacraments, for example, in the case of the Catholic tradition). A complement to the psychological treatment could consist of assigned spiritual readings.
What is the relationship between sin and psychopathology?
Often there is a relationship between spiritual and psychological issues. For example, the incapacity to forgive is both spiritually and psychologically unhealthy. Likewise, the inability to make deep human commitments and to form lasting relationships is also both spiritually and psychologically unhealthy. Indeed, both psychopathology and sin limit human freedom (as is apparent in the case of certain addictions or compulsions). In this case, the therapist addresses the unhappiness and suffering as well as their causes.
However, personal sin and psychopathology are not completely linked. Based on the teaching of Jesus Christ (see the Gospel of John chapter 9, verses 1-3), Roman Catholics hold that not all suffering comes from personal sin. In the face of the effects of sin and of psychopathology, psychotherapy from our perspective seeks to instill hope for healing and for strength in the midst of continuing struggles with sin and suffering at both spiritual and psychological levels.
As Pope John Paul II (1984, n. 15) affirms: "When one says that Christ by his mission strikes at evil at its very roots, we have in mind not only evil and definitive, eschatological suffering (so that man 'should not perish, but have eternal life,' John 3:16), but also-at least indirectly toil and suffering in their temporal and historical dimension. For evil remains bound to sin and death. And even if we must use great caution in judging man's suffering as a consequence of concrete sins (this is shown precisely by the example of the just man Job), nevertheless suffering cannot be divorced from the sin of the beginnings, from what Saint John calls 'the sin of the world' (John 1:29), from the sinful background of the personal actions and social processes in human history. Though it is not licit to apply here the narrow criterion of direct dependence (as Job's three friends did), it is equally true that one cannot reject the criterion that, at the basis of human suffering, there is a complex involvement with sin."
Who or what is the primary agent of change in therapy?
On the one hand, research has shown that the most important element of the psychotherapeutic treatment is the perception that the therapist truly cares. This factor seems at least as important as the actual psychotherapeutic technique that is used.
On the other hand, from a Christian Catholic perspective, we consider the practice of psychotherapy a response to the vocation to heal. Such a vocation to a life's work involves the therapist being called to care genuinely for the client and to develop skills to communicate this care and empathy as well as to employ empirically-supported psychotherapeutic techniques. As a whole then, the primary condition for change in therapy is the relationship between the client, who makes a decision to change, and the therapist, who therapeutically aids the client to make that change through competent care and treatment.
We in no way, moreover, exclude that in the midst of this therapeutic collaboration God gratuitously and effectively aids the client in healing. Toward this end, the therapist can and may pray for the client, although not necessarily in therapeutic sessions.
What is the most difficult part of practicing psychotherapy while maintaining your beliefs?
We recognize that in therapy there are two persons with their own beliefs. The psychotherapist must respect the beliefs of the client, while loving the client as a neighbor in need. At the same time, the therapist is called to speak the truth in love, even in difficult situations, for example, when there is negative pressure on the bond of marriage. The therapist will always work on behalf of the marital bond, regardless of the faith perspective of the client. With a Christian couple, the words of Pope Benedict XVI (2009) apply. He affirms the importance of "Existential, person-centered and relational considerations of the conjugal union [but] never be at the expense of indissolubility...which, in Christian marriage, obtains...a special firmness by reason of the sacrament."
It is always difficult to see a client make decisions that will negatively affect his or her own flourishing. Nonetheless, the therapist will work to establish, on the one hand, an unambiguous statement of informed consent that respects the two sets of beliefs and, on the other, clear and achievable treatment goals that both parties can support. In therapy, the clinician will then labor to help the client make good and free choices that contribute to his or her mental health and overall flourishing.
What is the most rewarding part?
The rewards of psychotherapy are twofold. First, on the side of the clients, it is rewarding to see them grow in freedom and truth, which is especially evident when they can recognize, accept, and give love to others, thus transcending their own painful pasts. We find it especially gratifying when clients diagnosed with psychopathology are healed and capable of flourishing in their own vocational commitments (to goodness and holiness, family and marriage , as well as formal and informal work). Clients thus become more capable of enriched relationships and meaningful life goals.
Second, on the side of therapists, we find untold recompense in being able to have expressed our own calling to love of neighbor through contributing to the healing of another person and their relationships.
Benedict XVI (2007). On Christian Hope. Encyclical Spe salve. Vatican: Libreria Editrice Vaticana.
Benedict XVI (2009). Address to Roman Rota. January 29, 2009. Vatican: Libreria Editrice Vaticana.
John Paul II (1984). On the Christian Meaning of Human Suffering. Apostolic Letter Salvifici Doloris. Vatican: Libreria Editrice Vaticana.
John Paul II (1993). Address to the Members of the American Psychiatric Association and World Psychiatric Association. January 4, 1993. Vatican: Libreria Editrice Vaticana.
Pius XII (1953). On Psychotherapy and Religion. Address to the Fifth International Congress on Psychotherapy and Clinical Psychology. April 13, 1953. Vatican: Libreria Editrice Vaticana.
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