Psychotherapists Urged to Counsel Patients on Spirituality

SAN FRANCISCO – Contrary to decades of tradition – and Sigmund Freud – psychotherapists working with frail elders should offer counseling on spirituality, according to three experts who have straddled the therapy-spirituality line in their own practices.

"I’m convinced you can take process psychology and marry it to theology," Jim Ellor, Ph.D., a professor of social work at Baylor University in Waco, Tex., said at the conference.

One reason that psychotherapists have avoided discussing their patients’ spirituality is that they confuse spirituality with religion, said Donald Koepke, director emeritus of the California Lutheran Homes Center for Spirituality and Aging, in Anaheim, Calif. Since the days of Sigmund Freud, who saw religion as a kind of neurosis, psychotherapists have been taught to avoid religion.

"While everyone may not have a religion, or be what we call religious, everyone has spirituality," said Mr. Koepke. "It’s core beliefs. It’s what drives them and helps them to experience the world."

He gave the example of Audrey, a communist atheist he met in the nursing home where he worked as chaplain. When she was diagnosed with a terminal illness, Mr. Koepke visited her and asked how she felt about having little time left.

"I move over and make room for someone else," she answered. But she went on. "The purpose in life is to leave the world better than you found it," she said. "I have done that." She went on to describe her activism in the labor movement.

Mr. Koepke said he left Audrey’s room feeling that "she felt connected to that which was greater than herself."

He said that everyone has four spiritual needs: to find meaning; to give love; to receive love; and to feel forgiveness, hope, and creativity. Something about the experience of living in a nursing home gives people an opportunity to face these needs, he added. "The spiritually healthy people I know are almost all in skilled care. They are marvelous people to know."

Barry Kendall, Psy.D., a private-practice existential psychologist in Beverly Hills, Calif., said that what is called existential psychotherapy can help such patients answer spiritual questions. This approach, as described by Stanford (Calif.) University psychiatrist Dr. Irvin Yalom, deals with psychological conflicts as stemming from the inevitability of death, the responsibility of freedom, isolation, and the inherent meaninglessness of life.

"Inside psychotherapy, people for the first time begin to have a relationship with someone who understands them," he said. With some patients, the conversation may turn specifically to religion, for others it may stay more generally on the meaning of life, Dr. Kendall said. "For some patients who are theists, the explicit questions are helpful. For other patients, the implicit questions are helpful."

How can a therapist help patients with their spiritual problems? Listen to their experiences, advised Dr. Ellor. "Look for the threads that are consistent in their story. If they are talking about the spiritual, listen." When patients ask for a spiritual professional, for example to conduct rites specific to a religion, psychotherapists should step aside.

But when the question at hand is really about feelings, then psychotherapists should continue trying to meet their patients’ needs because the therapists know how to work with feelings. In that case, bringing in a religious professional can force the patient to start over again building a new relationship.

"Look at the whole person," Dr. Ellor advised.

SAN FRANCISCO – Contrary to decades of tradition – and Sigmund Freud – psychotherapists working with frail elders should offer counseling on spirituality, according to three experts who have straddled the therapy-spirituality line in their own practices.

"I’m convinced you can take process psychology and marry it to theology," Jim Ellor, Ph.D., a professor of social work at Baylor University in Waco, Tex., said at the conference.

One reason that psychotherapists have avoided discussing their patients’ spirituality is that they confuse spirituality with religion, said Donald Koepke, director emeritus of the California Lutheran Homes Center for Spirituality and Aging, in Anaheim, Calif. Since the days of Sigmund Freud, who saw religion as a kind of neurosis, psychotherapists have been taught to avoid religion.

"While everyone may not have a religion, or be what we call religious, everyone has spirituality," said Mr. Koepke. "It’s core beliefs. It’s what drives them and helps them to experience the world."

He gave the example of Audrey, a communist atheist he met in the nursing home where he worked as chaplain. When she was diagnosed with a terminal illness, Mr. Koepke visited her and asked how she felt about having little time left.

"I move over and make room for someone else," she answered. But she went on. "The purpose in life is to leave the world better than you found it," she said. "I have done that." She went on to describe her activism in the labor movement.

Mr. Koepke said he left Audrey’s room feeling that "she felt connected to that which was greater than herself."

He said that everyone has four spiritual needs: to find meaning; to give love; to receive love; and to feel forgiveness, hope, and creativity. Something about the experience of living in a nursing home gives people an opportunity to face these needs, he added. "The spiritually healthy people I know are almost all in skilled care. They are marvelous people to know."

Barry Kendall, Psy.D., a private-practice existential psychologist in Beverly Hills, Calif., said that what is called existential psychotherapy can help such patients answer spiritual questions. This approach, as described by Stanford (Calif.) University psychiatrist Dr. Irvin Yalom, deals with psychological conflicts as stemming from the inevitability of death, the responsibility of freedom, isolation, and the inherent meaninglessness of life.

"Inside psychotherapy, people for the first time begin to have a relationship with someone who understands them," he said. With some patients, the conversation may turn specifically to religion, for others it may stay more generally on the meaning of life, Dr. Kendall said. "For some patients who are theists, the explicit questions are helpful. For other patients, the implicit questions are helpful."

How can a therapist help patients with their spiritual problems? Listen to their experiences, advised Dr. Ellor. "Look for the threads that are consistent in their story. If they are talking about the spiritual, listen." When patients ask for a spiritual professional, for example to conduct rites specific to a religion, psychotherapists should step aside.

But when the question at hand is really about feelings, then psychotherapists should continue trying to meet their patients’ needs because the therapists know how to work with feelings. In that case, bringing in a religious professional can force the patient to start over again building a new relationship.

"Look at the whole person," Dr. Ellor advised.

SAN FRANCISCO – Contrary to decades of tradition – and Sigmund Freud – psychotherapists working with frail elders should offer counseling on spirituality, according to three experts who have straddled the therapy-spirituality line in their own practices.

"I’m convinced you can take process psychology and marry it to theology," Jim Ellor, Ph.D., a professor of social work at Baylor University in Waco, Tex., said at the conference.

One reason that psychotherapists have avoided discussing their patients’ spirituality is that they confuse spirituality with religion, said Donald Koepke, director emeritus of the California Lutheran Homes Center for Spirituality and Aging, in Anaheim, Calif. Since the days of Sigmund Freud, who saw religion as a kind of neurosis, psychotherapists have been taught to avoid religion.

"While everyone may not have a religion, or be what we call religious, everyone has spirituality," said Mr. Koepke. "It’s core beliefs. It’s what drives them and helps them to experience the world."

He gave the example of Audrey, a communist atheist he met in the nursing home where he worked as chaplain. When she was diagnosed with a terminal illness, Mr. Koepke visited her and asked how she felt about having little time left.

"I move over and make room for someone else," she answered. But she went on. "The purpose in life is to leave the world better than you found it," she said. "I have done that." She went on to describe her activism in the labor movement.

Mr. Koepke said he left Audrey’s room feeling that "she felt connected to that which was greater than herself."

He said that everyone has four spiritual needs: to find meaning; to give love; to receive love; and to feel forgiveness, hope, and creativity. Something about the experience of living in a nursing home gives people an opportunity to face these needs, he added. "The spiritually healthy people I know are almost all in skilled care. They are marvelous people to know."

Barry Kendall, Psy.D., a private-practice existential psychologist in Beverly Hills, Calif., said that what is called existential psychotherapy can help such patients answer spiritual questions. This approach, as described by Stanford (Calif.) University psychiatrist Dr. Irvin Yalom, deals with psychological conflicts as stemming from the inevitability of death, the responsibility of freedom, isolation, and the inherent meaninglessness of life.

"Inside psychotherapy, people for the first time begin to have a relationship with someone who understands them," he said. With some patients, the conversation may turn specifically to religion, for others it may stay more generally on the meaning of life, Dr. Kendall said. "For some patients who are theists, the explicit questions are helpful. For other patients, the implicit questions are helpful."

How can a therapist help patients with their spiritual problems? Listen to their experiences, advised Dr. Ellor. "Look for the threads that are consistent in their story. If they are talking about the spiritual, listen." When patients ask for a spiritual professional, for example to conduct rites specific to a religion, psychotherapists should step aside.

But when the question at hand is really about feelings, then psychotherapists should continue trying to meet their patients’ needs because the therapists know how to work with feelings. In that case, bringing in a religious professional can force the patient to start over again building a new relationship.

"Look at the whole person," Dr. Ellor advised.