A Humanistic Approach to Spiritually Psychotherapy

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A HUMANISTIC APPROACH TOSPIRITUALLY ORIENTEDPSYCHOTHERAPYDAVID N. ELKI NS

DESCRIPTION OF THE APPROACHMy approach to spiritu ality , presented in this chapter, has been influ-enced strongly by William James (1902 ), whom I regard as one of the major

forerunners of hum anistic psychology. Following James, I would characterizethe approach as follows: The human personality, at its further limits, opensinto the spiritual realm. Speaking metaphorically, one might say that thehum an personality is a river that, if navigated to its end, opens into the oceanof the mystical realm. Any psychotherapy that explores the deeper regions ofthe human psyche will eventually come to the brink of this spiritual realm,whe ther the client and therap ist recognize the place or not. It is my opinionthat human personality an d spirituality exist on the same continuum andthat a more com plete psychology would encompass that entire continuum interms of theory, research, training, and practice.Historical and Theoretical Basis

This section provides a historical overview of humanistic psychologyalong with a summ ary of the author's own spiritually oriented approach whichis based on huma nistic principles.The author wishes to thank Thomas Greening, L. James Hedstrom, Larry M. Leitner, Kirk J. Schneider,and E. Mark Stern for reading the manuscript while this chapter was in preparation and making helpfulsuggestions.

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Historical Overviewof Humanistic PsychologyAs Schneider, Bugental, and Fraser Pierson (2001) pointed out, the

historical roots of humanistic psychology are found in four major periods inwhich humanism flourished in Western culture: (a) the classical period ofancient Greece in the 5th century B.C.E. when philosophers such as Socratesand Plato turned their attention from the gods to that which concerns thehuman being; (b) the European Renaissance when scholars, returning to theclassics of ancient Greece, focused on the studia humanitatis in contrast to thestudio, divinitatis; (c) the Enlightenment of the 17th and 18th centuries whenrationalists and romanticistsboth participants in the movementdebatedwhether cognition or emotions distinguish the human being; and (d) theturn of the 20th century when humanism arose once again and in psychol-og y took the form of a reaction again the determinism of Freudianism andthe mechanistic assumptions of Watsonian behaviorism. William James(1902), Carl Jung (1933), Otto Rank (1958), and Ludwig Binswanger (1963)were among the early proponents of a less deterministic and mechanisticpsychology.

Although humanistic psychologyas we know it today drawson all thesehistorical periods, it is more immediately associated with the 1950s and 1960swhen Abraham Maslow, Carl Rogers, Rollo May, James Bugental, GordonAllport, Henry Murray, George Kelly, and others began to raise concernsabout mainstream American psychology, which was dominated at the timeby psychoanalysis in clinical training and behaviorism in academia (Elkins,2000; Taylor, 1999). Maslow and the other founders of what would becomehumanistic psychology wanted to create a psychology focused less on pathol-og y and the prediction and control of human behavior and more on the posi-tive potentials and distinctive attributes of the human being. The seeds ofthe new psychology were planted in various writings and meetings in the1940s and 1950s, and the movement blossomed and flourished in the 1960s.The Journal of Humanistic Psychology was launched in 1961, and a year laterthe American Association forHumanistic Psychology (AAHP), later renamedthe Association for Humanistic Psychology (AHP), was formed. In 1964,AAHP held its "First Invitational Conference on Humanistic Psychology"at Old Saybrook, Connecticut. Henry Murray gave the keynote address, andRogers, Maslow, and May were among those who presented papers. The OldSaybrook conference helped clarify the vision and set the future course ofhumanistic psychology in the United States. Within a fewyears, humanisticpsychology would become a major "third force" in American psychology. Itwould attract thousands of psychology students, spawn numerous humanisticorganizations, provide a penetrating critique of reductionistic science, ar-ticulate new methodologies and more qualitative "ways of knowing" in re-search, emphasize the healing power of the relationship and the intersubjective"between" in psychotherapy, and generate an array of new approaches to132 DAVID N. ELKINS


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psychotherapy and counseling that focused less on pathology and more onthe actualizing possibilities of the human being.

As Taylor and Martin (2001) pointed out, humanistic psychology wasstrengthened by the inclusion of European existentialism and phenomenol-ogy. In 1958, Rollo May, along with Angel and Ellenberger, edited Existence:A New Dimension in Psychiatry and Psychology (1958), a book that broughtthe psychological fruits of European existentialists and phenomenologists tothe attention of American psychology and under the umbrella of humanisticpsychology. Also, Viktor Frankl (1963), a Viennese psychiatrist and holo-caust survivor whose book Man's Search fo r Meaning was a best-seller afterWorld War II, contributed to the new movement through his logotherapy,an existential therapeutic approach based on what Frankl called the "will tomeaning." The Journal of Humanistic Psychology, housed at Brandeis Univer-sity where Maslow was chair of the psychology department, became the pri-mary organ of the new movement. The avant-garde thinking in its pageswastaken seriously in academia and other scholarly circles, and its editorial boardincluded some of the most respected an d influential figures in psychologyand related disciplines of that period. Humanistic psychology's focus on theself-actualizing possibilities of the human personality, its emphasis on au-thentic and emotionally mature relationships, and its nonreductionistic ap-proach to values, love, meaning, art, culture, religion, and spirituality had astrong impact on American psychology. Highly generative in nature, thenew psychology opened up vistas of human personality and experience thatmore reductionistic approaches had attempted to explain away or had leftunexplored. This more inclusive perspective that focused on the strengthsand potentials of the human being was, fo r many academicians and clini-cians, a breath of fresh air after 50 years of Freudian psychology an d animalexperiments in academic laboratories.

The humanistic movement did not, however, ultimately live up to itsearly promise. Eugene Taylor (1999, 2000), a William James scholar atHarvard and professional historian of the movement, has pointed out thathumanistic psychology thrived as a respected alternative perspective inacademia from 1941 to 1969, but at that time the scholarly focus of the move-ment was overshadowed by the political an d social ferment of the times.Humanistic ideals, which fit the revolutionary milieu of the day, were pre-empted by the American counterculture. Humanism, which had a distin-guished history stretching back to ancient Greece and serving as the mainforce behind th e European Renaissance, was trivialized by extremes withinthe counterculture so that humanistic ideals were used as an excuse for anyunusual personal or group experiment that members of the counterculturedecided to try. This is not to condemn the counterculture of the 1960s, whichaddressed major political an d social issues and helped change our nation inpositive directions, but it is to point out that when humanistic psychologywas used to support the anti-intellectualism and almost exclusive focus on

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the body and emotions that characterized certain parts of the counterculture,it had a chilling effect on the field's respectability in academic and otherscholarly circles where serious intellectual thought was the sine qua non.Even today, scholars and other thoughtful proponents of humanistic psy-chology continue to pay a price in terms of credibility because of the 1960sstereotypes that still hover about the movement. As Taylor and Martin (2001)put it, "Mainstream psychologists, if they have any name recognition at allwhen asked about the movement, think of humanistic psychology as unsci-entific, guilty of promoting the cult of narcissism, and a thing of the past"(p . 25).

The truth is, the stereotypes of the 1960s have little to do with thescholarly segment of the humanistic movement. In fact, some of the avant-garde thinking in psychology today focuses on topics that humanistic andexistential thinkers have been discussingfor many years, including Seligman'sposit ive psychology (1990, 1993; Seligman & Csikszentmihalyi, 2000),Stolorow's intersubjective field (Stolorow, Atwood, & Brandchaft, 1994),and Kohut's self psychology (1971,1977,1984). For example, Kohut's theoryof the self is widely known an d respected, bu t Carl Rogers's developmentaltheory relative to the self structure is seldom discussed, even though it isarguably as detailed an d clinically relevant as Kohut's. Also, the nature, dy-namics, and quality of the therapeutic relationship have been the centralfocus of humanistic psychotherapy, and Martin Buber (1965, 1970, 1988),who influenced Carl Rogers and other humanistic psychologists, wrote ex-tensively about the therapeutic power of the intersubjective "between" longbefore Stolorow and others made the topic famous. My intent here is not topit one theorist against another or to argue for the superiority of one perspec-tive over another. Rather, I am trying to show that humanistic psychologyhas always had a strong scholarly component and that it has made important,even groundbreaking, contributions to the field.In terms of contemporary scholarly activity, a major "re-visioning" ofhumanistic psychology is currently underway that involves dozens of schol-ars an d researchers, numerous humanistic organizations, an d hundreds ofhumanistically oriented professionals from the United States and around theworld (Elkins, 2000). Also, Schneider et al. (2001) recently published TheHandbook of Humanistic Psychology, a tome of 700 pages that contains contri-butions from more than 60 contemporary scholars associated with the hu-manistic movement. In addition, articles focused on humanistic research andtheory are regularly published in journals such as Th e Humanistic Psycholo-gist, Journal of Humanistic Psychology, Th e Psychotherapy Patient, Journal ofPhenomenological Psychology, Review of Existential Psychology and Psychiatry,The Journal of Constructivist Psychology, and others. Humanistic scholarswhich include humanists, existentialists, phenomenologists, constructivists,and transpersonalistshave much to contribute to the intellectual discourseno w taking place in psychology and related fields. Those of us associated134 DAVID N. ELKINS


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with humanistic psychology would encourage colleagues and psychology stu-dents to disregard the stereotypesand explore for themselves the philosophi-cal, theoretical, and research contributions of the humanistic movement.Spirituality in Humanistic Psychology

Humanistic psychology has always considered spirituality to be an inte-gral part of the human personality. Abraham Maslow, the main theoreticalarchitect of the humanistic movement, included spirituality as a major com-ponent of the humanistic vision. Instead of pathologizing religious needs,Maslow (1962) said, "The human being needs a framework of values, a phi-losophy of life, a religion or religion surrogate to live by and understand by,in about the same sense he needs sunlight, calcium, or love" (p. 206). Incontrast to Freud's view that religion was a sign of neurosis, Maslow (1976)said, "Humanistic psychologists would probably consider a person sick orabnormal in an existential way if he were not concerned with these religiousquestions' " (p. 18).Maslow was among the first to insist that spirituality should be broughtunder the umbrella of psychology and become the focus of psychological re-search. In Religions, Values, and Peak Experiences (1976), he wrote,

I want to demonstrate that spiritual values have naturalistic meaning,that they are not the exclusive possession of organized churches, thatthey do not need supernatural concepts to validate them, that they arewell within the jurisdiction of a suitably enlarged science, and that, there-fore, they are the general responsibilityof all mankind, (p. 33)Although Maslow believed that spirituality was a universal human phe-

nomenon that was not the exclusive possession of any religion, he was notopposed to organized religion per se, nor did he believe a nontheistic viewwas the only viable philosophical or theological perspective. In fact, Maslow(1976) said that "the essential core-religious experience may be embedded ineither a theistic, supernatural context or a nontheistic context" (p. 28).

Maslow's interest in spirituality eventually led him to launch anothermovement in American psychology devoted specifically to its exploration.As Taylor (1999) said, Maslow believed that mystical stateswhat he calledpeak experiencesrepresented a new frontier for psychology. In 1967, at thepeak ofhumanistic psychology's influence and popularity, Maslowannouncedthe emergence of transpersonal psychology, a "fourth force" in Americanpsychology. In 1969, the Journal o f Transpersonal Psychology was launchedand in 1971, the American Association of Transpersonal Psychology, laterrenamed the Association for Transpersonal Psychology (ATP), was formed.For the past 30 years, transpersonal psychology has continued to grow, at-tracting scholars such as Charles Tart (1975a, 1975b, 1989), Ken Wilber(1977,1980,1981,1995), Frances Vaughan( 1979,1986), Roger Walsh (1993,1995, 1999), and others.



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As Hastings (1999) pointed out, one of the ongoing debates in human'istic and transpersonal circles is whether transpersonal psychology is truly anindependent "fourth force" or should be included under the umbrella of hu-manistic psychology. My own view is that transpersonal psychology, whichoriginally sprouted and grew in humanistic soil, has gone on to develop itsown theories and perspectives. Whereas some humanistic psychologists haveembraced transpersonal theories to describe their own spiritual outlook, oth-ers do not necessarily view transpersonal psychology as representing theirown spiritual perspective. It does seem, however, that humanistic psycholo-gists have allowed transpersonalists do most of the "spirituality work" forboth movements and have not developed and articulated a specifically hu-manistic vision of spirituality.

A recent survey conducted by Elkins, Lipari, and Kozora (1999) con-firmed that contemporary humanistic psychologists remain interested in spiri-tuality. A 71-item questionnaire, which included a section of items on spiri-tuality, wasmailed to all 615 membersofDivision32 (Humanistic Psychology)of the American Psychological Association. Of the 230 (37%) who com-pleted and returned the questionnaire, 77% said that they considered spiritu-ality "important" or "very important" in their lives. When asked how impor-tant organized religion is in their lives, 22% said it is "important" or "veryimportant." Another 26% said it is "somewhat important," and 49% said it is"not important at all," When asked to select the statement that best repre-sents their spiritual orientation, 55% chose "I am spiritual but not religious,"32% chose "I am both religious and spiritual," and only 6% chose "I amneither religious nor spiritual." Finally, 75% affirmed belief in some type ofhigher power or transcendent force, and 43% professed faith in a personalgod. These findings suggest that the great majority of humanistic psycholo-gists view spirituality as an important dimension of their lives. Even moreinteresting is the fact that 43% profess faith in a personal God, a finding thatchallenges the myth that humanistic psychologists are nontheistic (for ex-ample, see Richards & Bergin, 1997).A Humanistic Model of Spirituality: Theory , Constructs,an d Clinical Application

In my own work as a humanistic psychologist, I have attempted to de-velop a model of spirituality that is accessible, clinically useful, and based onhumanistic principles. I respect the contributions of transpersonal writers,but my own approach is based more on the writings of scholars such as Wil-liam James (1902), Carl Jung (1933,1964), Rudolph Otto (1923), PaulTillich(1948, 1952, 1957), Mircea Eliade (1959), Martin Buber (1970), GordonAllport (1961), Viktor Frankl (1963), Erich Fromm (1950), James Hillman(1975) , and Abraham Maslow (1954, 1962, 1971, 1976).

I was originally trained as a minister in a conservative church, but inthe late 1960s, because I could no longer support some of its fundamentalist

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teachings, I was fired an d excommunicated fo r being too liberal in my theo-logical views. Nevertheless, my interest in spirituality continued, and in the1970s, when I was a doctoral student in psychology, I entered psychotherapywith a Jungian analyst who taught me about the care and feeding of thehuman soul. M y spiritually oriented therapy with this analyst, along with myow n studies of spirituality as a professor an d clinical psychologist, led meeventually to develop my own approach to spirituality.A summary is pre-sented in the following paragraphs. For a fuller discussion of this approach,readers are referred to my book, Beyond Religion (Elkins, 1998).Major Constructs

Th e Soul. The word soul comes from Old English an d Anglo-Saxonroots meaning "breath" or "life force." Soul is not easy to define, especially ina discipline that insists on operational definitions. In his lectures at YaleUniversity, Jungian scholar James Hillman (1975) pointed to the difficulty:"The soul is immeasurably deep and can only be illumined by insights, flashesin a great cavern of incomprehension" (p . xvi). Soul is not a tangible entitybut a construct that points to the spiritual dimension of the human being. AsThomas Moore (1992) put it, " 'Soul' is not a thing but a qualityor a dimen-sion of experiencing life and ourselves. It has to do with depth, value, relat-edness, heart, and personal substance" (p. 5).Ironically, the very fact that soul is so difficult to define provides animportant clue to its nature. The soul does not fit our Western need for ab-stract definitions. Soul reminds us that there is a deeper, more primordialworld than ou r logical processes. W e know the soul when we are stirred by apoem, moved by a piece of music, touched by a painting. Soul is the deepresonance that vibrates within us at such moments. Thus, the soul can betouched, felt, and known bu t never defined. Soul will slip through the barsofevery conceptual systemand defy all attempts to capture her in abstract terms.The soul is found in poetry, music, art, literature, ceremonies, symbols, ritu-als, intimate relationships, and other events and experiences sympathetic toher imaginal nature. In Western culture we tend to believe that thinking canopen every door, unlock every secret. Thus, we know little about the worldofthe soul where cognition is dethroned an d imaginal processes are more im -portant. As a result, we often mistake the menu for the meal and deludeourselves that we understand once we have an abstract definition in place.Yet unless our knowledge of the soul is rooted in personal experience, ourabstract definitions simply hang in space, devoid of meaning and rooted innothing.How then can we arrive at a common understanding of the soul? Com-mon understandings emerge from an epistemology that acknowledges theimportance of personal and experiential knowing. Without such an episte-mology, the soul cannot be known an d scholars will be forever discussing themenu instead of the meal. Yet among those who do their own spiritual work

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and become familiar with the spiritual domain, it becomes increasingly pos-sible to speak of these matters with a common vocabulary.Th e Sacred. When the sociologist Emile Durkheim studied native cul-

tures, he noticed that when members of the tribe went away to communewith the sacred, they returned to the village with a renewed power that theycalled mana. This led Durkheim (1915, p. 416) to write, "The believer whohas communicated with his god is ... stronger. He feels within him moreforce, either to endure the trials of existence, or to conquer them."Mircea Eliade,who for many years was chair of the Department of theHistory ofReligions at the University ofChicago, believed that humans havealways had encounters with the sacred. In his classic work, Th e Sacred and theProfane, Eliade (1959) defined the sacred and described the mysterious powerthat Durkheim had observed. He wrote,

The sacred is equivalent to a power, and, in the last analysis, to reality.The sacred is saturated with being. Sacred power means reality and at thesame time enduringness and efficacity. The polarity sacred-profane isoften expressed as an opposition between real an d unreal or pseudo-real.. . . Thus, it is easy to understand that religious man deeply desires tobe,to particulate in reality, to be saturated with power, (pp. 12-13)Although this language may sound strange to Western ears, Eliadewas

talking about something that is central to spirituality. Along with Durkheim,he was suggestingthat sacred experiences have a powerful an d fortifying ef -fect. Rudolph Otto (1923), the theologian who wrote Th e Idea of th e Holy,did a phenomenological analysis of sacred encounters and concluded thatthese experiences contain several elements including a sense of being over-whelmed, a feeling of fascination, a sense of mystical awe, and an experienceof intense energy. The "intense energy" that Otto mentions is similar toDurkheim's mana an d Eliade's power an d being.

What does this have to do with psychotherapy? I would suggest thatthere is a certain ontological power associated with spiritualitythat can helpheal and fortify our clients' lives. This power can help themin Durkheim'swords"to endure the trials of existence, or to conquer them." Some mayascribe the power to God or some other transcendent force, and others mayview it as simply the untapped spiritual resourcesof the human personality.Regardless of how one explains it, these scholars suggest that there is a spe-cial power associated with spirituality that can give grounding and strengthto human beings. One goal of spiritually oriented psychotherapy is to helpclients access this sacred power.

Spirituality. The word spirituality comes from the Latin root spiritus,which means "breath" an d refers to the animating principle of life. Spiritual-ity is based on the assumption that we live in two worldsa material worldwe know through the five senses and a nonmaterial world that is knownthrough intuition, inner reflection, and imagination. Spirituality has to do

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with the nonmaterial world, the world that mystics, poets, artists, shamans,prophets, and philosophers have told us about for thousands of years. Thisworld isvitally important to our existence as human beings, and in it we findour deepest values and most profound meanings.

In Beyond Religion (Elkins, 1998), I presented my own view of spiritual-ity in the following words:

First: Spiritualityis universal. B y this, I mean that spirituality isavailableto every human being. It is not limited to one religion, one culture, orone group of people. In every part of the world, one finds those who havecultivated their souls and developed their spiritual lives.

Second: Spirituality is a human phenomenon. This does not meanthat it has no divine component, but it does mean that spirituality is aninborn, natural potential of the human being. It also means that authen-tic spirituality is grounded in our humanity; it is not imposed from aboveor from without.

Third: The common core of spirituality is found at the inner phenom-enological level. Spirituality manifests in countless outer formsfromthe rain dances of Native Americans to the prayer services of SouthernB aptists, from the whirling dervishes of Islamto the meditating monksofZen Buddhism,from the ecstatic worship servicesofcharismatic churchesto the solemn silent meeting of the Quakers. But underneath these out-ward forms, there is a common longing for the sacred, a universal desireto touch and celebrate the mysteryof life. It is in the depths of the soulthat one discovers the essential and universal dimensions of spirituality.

Fourth: Spirituality has to do with our capacity to respond to thenuminous. The essential character of spirituality is mystical,a fact easilyoverlooked in a scientific and material age. Spirituality is rooted in thesoul and cultivated by experiences of the sacred; it feeds on poignancy,wonder, and awe. Its very nature is an expression of the mystery of lifeand the unfathomable depths of our own being.

Fifth: There is a certain mysterious energy associated with spiritual-ity. Every culture ha s recognizeda life force that moves through al l cre-ation. Mystics, poets, artists, shamans, and others are familiar with thisforce and have described it through the centuries. The soul comes alivewhen it is nurtured by this sacred energy, an d one's existence becomesinfused with passion, power, and depth.

Sixth: The aim of spirituality iscompassion. The word compassion lit-erally means "to suffer with." Spiritual life springs from the tenderness ofthe heart, and authentic spirituality expresses itself through loving ac-tion toward others. Compassion has always been the hallmark of authen-tic spirituality and the highest teaching of religion. Loveless spiritualityis an oxymoron and an ontological impossibility, (pp. 3233)

Statement of the TheoryI have described three major constructsthe soul, the sacred, and spiri-

tuality. These three constructs and their dynamic relationship to one an-



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other are the building blocks of my approach to spirituality. Simply stated,the theory is this: When the soul is nourished through regular contact withthe sacred dimension, the result is spiritual growth or spirituality. All humanbeings have a soul. All human beings have access to the sacred. Thus, allhuman beings, whether traditionally religiousor not, can learn to access thesacred, nourish their souls, and develop their spiritual lives.Clinical Application

The clinical application of this theory is based on two assumptions: thefirst is that the client is suffering at the level of the soul and the second is thatpsychotherapy is the process by which the client's soul is nurtured and healed.Because this kind of language sounds strange in a profession dominated bymedical and mechanistic models, I will provide a context for this approachbefore describing its clinical applications.

The word psychology comes from the Greek words psyche an d logos andliterally means "the study of the soul." The word therapist originally meant"servant" or "attendant." Thus, etymologically, a psychotherapist is a "ser-vant or attendant of the soul." This is why Jungian scholar James Hillman(1975) defined psychotherapy as "soul-making" and views the therapist as aservant of the soul-making process. Even the word psychopathology points tothe soul. It comes from the Greek wordspsyche and pathos and literally means"the suffering of the soul."

Throughout the history of psychology, there have been respected psy-chologists and psychiatrists who recognized that pathology is sometimes theresult of spiritual conflicts and deprivations. This distinguished list includesCarl Jung, William James, Viktor Frankl, Gordon Allport, Abraham Maslow,Irvin Yalom, and others. So the idea that psychopathology is sometimes rootedin the spiritual domain is not a new idea.Spiritually oriented psychotherapy is the process by which we attemptto assuage a client's suffering by nurturing and healing the soul. But how doesone do this in practical terms? First, the therapist's relationship with theclient iscrucial if one wishes to heal at the spiritual level. Formany years, wehave known that the quality of the therapeutic relationship is an importantfactor in psychotherapy. As Yalom (1980) pointed out, there are hundreds ofresearch studies demonstrating that the quality of the therapist-client rela-tionship is significantly related to therapeutic outcome. Yalom went on tosay that the most important lesson the psychotherapist must learn is that it isthe relationship that heals. Butwhat does it mean that the relationship heals?From a spiritual perspective, I believe this is another way of saying that thetherapist nurtures the client's soul, and through this nurturing the client ishealed. Love is the most powerful healer of the suffering soul, and in thetherapeutic relationship love takes the form of empathy, respect, honesty,caring, and acceptance. These factors make soul-to-soul contact possible andhave a profound effect on the client's inner life.

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Second, although a caring and spiritually sensitive therapist can nur-ture a client's soul, it is important fo r clients to realize that psychotherapy isnot simply a place where people come to have their souls nurtured by some-one else but that it is also a training ground where they learn how to care fortheir own souls. The client should be shown that there are many activitiesand experiences that can nourish the soul. Almost anything that touches,stirs, or speaks to the client's depths has this capacity, including music, lit-erature, poetry, plays, movies, paintings, religion, nature, and countless otherpossibilities. Like a shaman carefully choosing roots and herbs, the therapistmust help each client discover the activities and experiences that nurture hisor her unique soul. Some clients are nourished by listening to music or goingto art galleries and poetry readings. Others prefer going on camping trips orhiking in the mountains. What is important is that each client is helped toidentify what best nurtures his or her ow n spiritual life.

Third, the client should be encouraged to begin a regular program of soulnurturing. For one client this may mean taking daily walks on the beach oralong the river; fo r another it may mean setting aside time to read poetry orlisten to music;fo r still others it may mean planning regular retreats to a moun-tain cabin. Clients should choose several activities that nourish their souls andengage in these on a regular basis. The case example presented later in thischapter will demonstrate ho w this can be implemented in psychotherapy.The Nature of the Relationship Between Psychology andSpirituality

I believe psychology an d spirituality are intimately related. Historically,there was a rift between psychology and religion, but, as I stated in the intro-duction to this chapter, a broader, more inclusive psychology can and shouldencompass the spiritual dimension of the human being.Psychology often describes the human being in terms of four major di-mensions: body, mind, emotions, and behavior. Unfortunately, the soul, orthe spiritual dimension, is almost always left out. The soul is an importantconstruct because it points to a dimension not covered by these other con-structs. Such a construct gives us a way to discuss a client's spiritual capacityand to focus on its development in psychotherapy. Of course, once the soul,or the spiritual dimension by any other name, is brought under the umbrellaof psychology, this has implications fo r psychological research, training, andpractice. An immediate implication would be that psychologists and gradu-ate students would have to be trained in spiritual issuesof clients in the sameway they are currently trained in regard to the mind, body, emotions, andbehavior of clients.Therapist's Skills and Attributes

In his book I and Thou, Martin Buber (1970) said that there are twobasic ways of relating, which he called I-It and I-Thou. In the I-It mode, theHUMANISTIC APPROACH 141


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other is an object or a means to an end. In the I-Thou encounter, the otherceases to be an object and we are drawn into a deeper kind of relationship.Buber went on to say that when we relate to another as an It, we are alsoaffected because the I that goes forth to meet an It is very different from theI that goes forth to meet a Thou.

Buber's thinking is subtle but powerful. To translate this into termsrelevant to this discussion, one might saythat psychotherapists can only healat the level of the soul when they are in contact with their own souls. We cantouch our clients only as deeply as the place from which we come withinourselves. If we are intimately familiar with our own souls and can access thespiritual dimension of our own being, we will be able to make contact withour clients at a deeper, more profound level and create a relationship in whichcura animarum, "cure of the soul," becomes possible. This is not to say thattherapists who are have not developed their own spiritualitycannot addressreligious and spiritual issues in psychotherapy and provide some help to theclient suffering at the soul level, but it is to say that such therapists may beforced to deal with the client on an I-It basis and may have difficulty relatingto the client's spiritual struggleon a more personal and profound level. Whendealing with a client's spiritual life, the deeper w e have gone in our ownspiritual journey, the greater our chances of engaging the client on a soul-to-soul basis and being of help to the client. As existential theologian PaulTillich put it, "Depth speaks to depth" (Elkins, 1998, p. 177).Strengths and Limitations

Perhaps the major strength of this approach is that it is based on theassumption that spiritualityis a universal human phenomenon that does notbelong exclusively to any religion or spiritual system. Although psycholo-gists who hold orthodox views about the importance of a particular religionmay find this assumption unattractive, psychologists who are searching for anonsectarian and more universal approach to spirituality will find the ap-proach congruent with those values. Also, all clientswhether religious ornonreligiouscan use this approach to nourish their souls and develop theirspiritual lives.

The major limitation of the approach has to do with the difficulty ofdefining such constructs as spirituality, soul, an d sacred. Such "phenomeno-logical realities" do not easily lend themselves to operational definitions andscientific investigation using the traditional methods of psychological sci-ence. Thus, it is difficult to move these ideas out of the realm of theory intothe realm of scientifically verified facts. Most psychotherapies are "construct-laden," however, and researchers who are willing to define science in broader,less traditional "scientistic" terms ca n find ways to verify an d articulate knowl-edge in these areas. A broader view of scienceone that values subjectivityand phenomenological realitiesis needed along with research methods that142 DAVID N. ELKINS


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can more appropriately handle such subtle but important phenomena (Elkins,1998; Giorgi, 1970).Indications and Contraindications

This approach to spirituality is most useful to clients who have a well-developed capacity for self-reflectionand who are already familiar with thatdimension of their inner lives that the theory refers to as the soul or thespiritual dimension. Although these clients are the ones most likely to ben-efit from the approach, other clients may also find it useful. For example,many clients who do not think of themselves as spiritually inclined are nev-ertheless able to recall songs, movies, plays, concerts, poems, works of art,ceremonies, rituals, places in nature, relationships, and other experiencesthat touched them profoundly. Such experiences provide an opening inpsy-chotherapy, a place to begin to help clients become more aware of their spiri-tual dimension and more adept at nurturing that part of their inner lives.Clients who would not be appropriate for this approach include(a ) those who do not have the mental capacity for self-reflection and innerwork, (b ) those recovering from a psychotic episode or who may be especiallyvulnerable to psychosis, (c) those whose defenses are tenuous and who needsupportive therapy before moving to more inner-directed work, and (d) thosewho simply prefer not to make spirituality part of their psychotherapy.

Other clients who might not be appropriate for this approach (and thusshould be evaluated carefully) include (a) those who have been deeplywounded by religious or spiritual systems or by authorities associated withsuch systems and (b) those who are so committed to fundamentalist or con-servative religious beliefs that their psychological equilibrium might be seri-ously disturbed by alternative, more relativistic views of spirituality. A clini-cal interview that includes a detailed exploration of the client's psychologicaland religious history, along with traditional psychological testing, may beuseful in making these determinations.Cultural and Gender Considerations

Although this approach is based on a universal view of spirituality thatrecognizes the importance of spirituality in all cultures, it grew from the rootsof a Western historical tradition, that is, humanism, and has inherent andunavoidable cultural biases that ma y not fit the cultural background of someclients, particularly those from non-Western cultures.For example, Western spirituality, including this approach, tends tofocus on the spiritual growth of the individual, whereas many other culturesthink in terms of the communal group. Nevertheless, because this approachis based on a deep respect for all forms of spirituality, the therapist who iswilling to listen and learn about the unique cultural values of clients may be



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able to make adjustments in the theory and adapt parts of the approach toclients with non-Western cultural value systems.With regard to gender considerations, I am unaware of any major con-cerns relative to the applicability of the theory. My own observations indi-cate that men and women sometimes differ in terms of the kinds of experi-ences that nourish their souls, but the theory has enough built-in flexibility

to adapt to both individual and gender differences. Because the starting pointof the applied theory is to discover what nourishes this particular client'sunique soul, the theory is highly adaptable to both men and women.Expected Future Developments and Directions

It is unclear what th e future holds relative to spirituality in the human-istic movement and what new developments will take place in time. Ventur-ing a guess, I would say that humanistic psychologists will continue to placea high value on spirituality in both their personal lives and in their clinicalwork; they will continue to view spirituality as a universal human phenom-enon that is distinct from organized religion; they will continue to explorethe topic in an effort to find new and better ways of making spirituality partof psychotherapy; and they will incorporate more ideas from Eastern reli-gions and other spiritual systemswithout sacrificing the positive contribu-tions of Western humanismin an effort to create a spiritual approach thatis increasingly sensitive to people from non-Western cultures. Finally, I pre-dict that organized religion with its rituals and ceremonies will always re -main important to many humanistic psychologists but that they will tend torelativize all spiritual systems, including their own, as expressions of a morefundamental need of all human beings to look up in wonder and awe.

CASEEXAMPLEClient Demographics, Relevant Histories, and Presenting Concern

The following case is a composite constructed to demonstrate my ap-proach. Sheila, a 37-year-old divorced Caucasian woman, came to therapybecause she was feeling depressed. During the intake interview, when I askedabout her religious background, Sheila told me that she had grown up in aconservative Protestant family in the Midwest and that as a child and teen-ager she had attended church on a regular basis. When she left home toattend college, she began to have doubts about religion and eventually stoppedgoing to church. She said that she still believed in God but no longer prayedor engaged in any kind of religious activities.Sheila was physically healthy, had no history of psychological difficul-ties, and had experienced no unusual illnesses or trauma during her child-144 DAVID N. ELKINS


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hood. She had grown up in a small town where her father ran the local gro-cery store. Her mother had stayed home most of the time to take care ofSheila and her younger brother. Sheila said that she had always felt lovedand supported by her parents and that she continued to have a good relation-ship with them and also with her brother. Sheila's parents and brother allstill lived in the same town where Sheila had grown up, and she went homefor visits about twice per year.

After completing a bachelor's degree at a university in Ohio, Sheilaand a female friend moved to Southern California, where sh e found a job asan accounting clerk in a technology company. When she was 24, she fell inlove with a man, and a year later they were married. After 6 years of mar-riage, however, they both came to the conclusion that the marriage was notworking. In her words, they were both "good people but not good marriagepartners." A divorce ensued and was finalized when Sheila was 31. WhenSheila came to therapy, she had not dated anyone on a serious basis since herdivorce 6 years earlier. She said that her job required a lot of time and shewasn't that interested in dating. Sheila wascompetent and well liked atwork,where she had been promoted to accounting supervisor.She also had severalfriends outside of work whom she saw on a regular basis.Finding nothing unusual in Sheila's history or current situation, I askedher more specifically about her depressive feelings. She said that she had felt"blue" of f and on for yearsbut that in recent months the feelings had becomemore intense. "I don't think I'm depressed," she told me. "I have a good lifebut sometimes I look around an d say, 'Is this al l there is?' I'm unhappy and itfeels like something's missing." Further discussion revealed that Sheila hadfirst begun to have these depressive feelings during college, a few monthsafter she had quit going to church. As she thought about this more deeply,she said that as a child she had always gone to church and just assumed thatGod was watching over her. But when she stopped attending church duringcollege, she had begun to feel cut of f from God and, in her words, "very alonein the world." Her marriage had kept these feelings at bay, but they hadreturned with considerable force after the divorce. When I asked Sheila ifshe had considered returning to church, she told me that she no longer be-lieved many of the things Christianity taught and had no desire to return tochurch. She was still interested in spirituality, however, and had even at-tended a few workshops on Buddhist spirituality.Assessment and Clinical Case Formulation

Typically, I do a traditional clinical interview in the first session. I makeit a practice, as part of this interview, to ask about the client's religious andspiritual life. If I had not specifically asked Sheila about this, I might nothave discovered this important information. At the same time, if Sheila hadnot made the connection between her depressive feelings and her sense of



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being cut off from God and alone in the world, I probably would no t havepursued this further but would have explored other possible reasons for thetroubling emotions she was experiencing. Obviously, other explanations couldhave included the fact that she was in California, away from her originalfamily; that she had no husband or significant other in her life; that she wasunder stress at work; and so forth. In fact, I am sure that al l these factors didcontribute to her depressive feelings at times, but the core problem seemedto be spirituala perspective with which she agreed when we explored theissue. My hypothesis was that the rituals and ceremonies associated with herchurch had nourished her soul, at least to some degree, but when she stoppedattending church, sh e also stopped nourishing her spiritual life. After dis-cussing this with Sheila, I told he r that I thought she was feeling depressedbecause her soul needed to be nourished. Once I explained that this did notmean that she had to return to church but that we would look for other waysto nourish her spiritual life, she became intrigued and was ready to proceedin that direction. We agreed that this would be the focus of her therapy for afew weeks to see if this perspective proved helpful.Treatment Goals, Therapeutic Relationship Process, InterventionStrategies, and Course of Treatment

My primary goal was to help alleviate Sheila's depressive symptomsbyshowing her how to nourish her soul. My first task, however, was to establisha positive, supportive relationship by listening carefully with a type of "ac-tive empathy" or what Tillich called "listening love".1 Next, I determinedthe kind of activities and experiences that nourished her soul. I gave Sheila ahomework assignment that involved three exercises designed to help heranswer this question. One involved simply setting aside time to reflect onactivities and experiences that had nourished her soul in the past. The in-structions were as follows:

Think back over your life and ask yourself the following question: Whatexperiences have touched me most deeply? Think of the most poignantmoments you have experienced, events that touched and stirred yoursoul. You may have felt awe, reverence, wonder, humility, or gratitude.Tears may have come to your eyes.These experiences may have occurredwhen you were listening to music, making love, talking with a friend,reading a poem, attending a play. Make a list of all these experiences andbring them to therapy so we can discover common themes and get a

'Humanistic psychology views the quality of the therapist-client relationship as a central componentof therapeutic healing. Carl Rogers' ideas about the importance of empathy, positive regard, andcongruence have shaped my therapeutic style. While not denying the reality of transference,humanistic psychology emphasizes that when the focus is on modeling and developing a relationshipcharacterized by empathy, acceptance, and therapist authenticity, most clients will respond to thisinterpersonal milieu by gradually recognizing and discussing their own interpersonal limitations andmoving toward a more authentic way of being in both the therapy and in their lives outside thetherapy.

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clearer picture of the kinds of activities and experiences that nourishyour particular soul.The second exercise had the same goal but was more structured. I gave

Sheila a worksheet that had a list of categories of activities that many peoplefind spiritually nourishing. The categories included movies, music, poems,nature, religion, theater, art, literature, places, food an d dining, family, ro -mantic experiences, sexual experiences, and friendships. I asked Sheila toreflect on her life and write down all the soul-nourishing experiences shecould recall in each category. I asked her to bring these results to therapy sothat we could examine her answers to help determine the kinds of activitiesthat nourished her soul.

The third exercise focusedon her immediate spiritual needs. It involvedanother homework assignment that instructed her to relax and allow herimagination to come up with the kinds of activities or experiences that hersoul needed at the present time. The instructions, too extensive to includehere, involved sitting in a comfortable chair, closing her eyes, relaxing, andthen imagining that she was in a beautiful, soul-nourishing place of her ownchoosing. She was then to allow a fantasy to unfold in which she receivedwhat she most deeply needed at the spiritual level. She wascautioned not toforce the fantasy but to let it occur as though sh e were watching a video.When the fantasy came to a natural conclusion, she was to stop that part ofth e exercise, write down th e fantasy in detail using th e present tense, andthen examine the fantasy to see if it contained clues as to what her soulneeded at the present time.Based on the rather extensive information these homework assignmentsprovided, Sheila and I were able to determine numerous activities and expe-riences that nourished her soul. Using this information, we collaborativelydesigned a 3-month program that involved three "little" soul-nourishing ac-tivities each week and one "big" soul-nourishing experience each month. Forher weekly "little" activities she chose (a) to set aside time to listen to classi-cal music for at least 1 hour per week, (b) to take a walk along the beach atsunset 1 day per week, and (c) read and meditate on poetry for 1 hour perweek. Her once-per-month "big" activities were (a) to spend a weekend withan old friend in San Diego, (b) to attend the play Phantom of the Opera,which was in Los Angeles at the time, and (c) to spend a weekend in Taos,New Mexico, a place that nourished her soul.As part of her program, I also asked Sheila to begin what I call a "SoulJournal" in which she would record her spiritual experiences related to thesoul-nourishing activities as well as daily reflections about he r spiritual life. Iasked Sheila to find a quiet place where she could go each day to reflect onher spiritual life for at least 20 minutes and then enter her thoughts andfeelings in her journal. (I do not typically ask clients to engage in formalmeditation because of the inherent risks, for some clients, of doing this with-out a guide. If clients already practices meditation, they are free to substitute

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meditation for the 20-minute reflection period provided they also record theirexperiences in the journal.)Sheila followed her 3-month program conscientiously. She had consid-erable capacity for inner reflection and benefited significantly. It was quitecommon for her to use the first part of her therapy sessions describing thevarious poignant moments she had experienced as she followed the program.

The therapeutic interaction often focused on the emotions Sheila experi-enced during her soul-nourishing activities. Primarily, I attempted to listencarefully and help her to explore and clarify what she was experiencing. Attimes I brought in poems an d readings myself that I thought would illumineour explorations or speak to Sheila's situation. By the end of the first month,we both noted that her depressive symptoms were beginning to lift, and atthe end of the 3 months, she was experiencing new energy and was excitedabout a number of things in her life.Termination, Relapse Prevention, and Therapeutic Outcomes

After collaboratively designing another 3-month program of soul-nourishing activities, we mutually decided that the therapy should end, onthe condition that if she experienced a relapse, sh e would return for addi-tional therapy. I asked her to contact me once in awhile to let me know howshe was doing. She contacted me about twice a year for almost 4 years andeach time reported that she was still doing well. As time went on, she incor-porated various activities into her life in a more natural, less programmedway, so that nourishing he r soul became a regular part of her life.Final Comment

Obviously, not every client is as well suited for this spiritual approachas Sheila. In addition, to emphasize the spiritual dimensions of her therapy,I have not included the various discussions we had that focused on otherparts of her life, including her job, her family, and various conflicts thatarose in her daily life during the 3 months she was in therapy. I do notbelieve that my distinctly spiritual approach to Sheila should be viewed asa model for how to treat all depressive feelings or other forms of emotionalsuffering. I am quite traditional in terms of psychological interventionsand believe that spiritual interventions should be used only when there isclear reason to believe that they will address the problems with which theclient is struggling. In my opinion, those of us who use spiritual approachesmust be vigilant for alternative explanations of the client's psychologicaldifficulties and always open to discussing whatever the client needs to ad-dress, while at the same time continuing to focus on spiritual issues as longas this is relevant to the client's concerns and continues to generate thera-peutic progress.148 DAVID N. ELKINS


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CONCLUSIONFo r more than 40 y ears, hum anistic psychology has p rovided open are-

nas for discussions about spirituality , refusing to institutionalize an y particu-lar point of view. My own approach should be viewed as simply on e perspec-tive in this ongoing discussion of spirituality in the human istic mov ement.In this chapter, I have presented a vision of spirituality as a universal hum anphenomenon that is not the exclusive possession of traditional religions.Furthermore, I have presented a practical theory ofspirituality based on threemajor constructs and their dynamic relationship to one another. The soul isthe deepest core of our spiritual life; the sacred is a power that ca n nourishou r souls; and spirituality is the result of having our souls nourished by poi-gnant experiences of the sacred. Finally, I have presented a case to demon-strate how this approach can be used with clients to nourish the soul andrelieve emotional suffering. I hope this chapter proves useful to clinicianswho are searching for ways to integrate spirituality into their therapeuticpractices.

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A Humanistic Approach to Spiritually Psychotherapy