Russell Siler Jones on Spiritually Integrated Psychotherapy

Russell Siler Jones: Thank you for having me, Lawrence, and we could think and talk all day just on that first question. But here’s a first thought, anyway, from a historical and developmental perspective. Psychotherapy is as old as humankind. Conversations to help people feel better have been happening for as long as we’ve been on the planet. And for centuries, many of these conversations happened in religious and spiritual contexts. The field of psychotherapy as we know it, as a professional discipline, is, what, 130 years old? That’s old for people, but against the backdrop of centuries, we’re still pretty young. But when psychotherapy came out of the gates in the late 19th and early 20th century, it had to differentiate itself from the healing conversations that had come before, to legitimate itself.

RJ:  Yes, to scientize itself. And so, psychotherapy claimed a position for itself inside a scientific frame—although that has always been a debatable point, to what extent psychiatry and psychotherapy really know what it is they’re doing—and the psychotherapy movement positioned religion and spirituality on the outside of this “scientific” frame.

Then, in the last 30 years or so, since mindfulness has entered the heart of most therapy practices, we see the field of psychotherapy reaching for help from the spiritual tradition. Not reaching for all the explicit trappings of the spiritual traditions but reaching for this core element of the spiritual tradition, which is the practice of consciousness and the understanding that to live well, you’ve got to wake up. You can’t sleepwalk your way through this life and do it well. There’s a gravitational pull to being asleep, but living well means that we’ve got to wake up. So, I think the field of psychotherapy reached out and grabbed that “wake-up” practice, which is part of almost every spiritual tradition I know of, and under the banner of mindfulness, has now made it a centerpiece.

There’s way more we could say about psychotherapy’s historical relationship to spirituality and religion. But I also think it’s important to add that it’s not just the field of psychotherapy that’s been resistant to spirituality. It’s people in general that are resistant to it. I know spirituality is appealing, and has all these benefits, and a majority of people say they value it. But many of the things spirituality asks us to do are actually quite challenging. Look inside yourself. Elevate yourself. What is it that you deeply know? What is wisdom calling you to do in this moment that might be difficult to do? Can you pick your head up out of your own self-absorption and let something larger than you be factored in? I think this is hard to do in psychotherapy or in any other context. And even though surveys say that clients want spirituality included in therapy, there is something in us that resists the kind of turnings that are part of spirituality. So we’re drawn to spirituality, yes, but we’re also drawn in lots of other directions, by the various lures of culture and of ego.

RJ: Yes! And it strikes me that we are already swimming deep in an understanding of spirituality in this conversation. Just your statement right there, about actualization being a spiritual process. And let’s add, since we were just talking about scientism, the need to legitimate our practices with proof, that when we say, “actualization is a spiritual process,” that’s neither a provable nor disprovable statement.

RJ: Yes. Absolutely. And wonderfully.

RJ: An explicit spiritual conversation is one that, if the average person on the street were to overhear it, they would say, “Oh, they’re talking about something spiritual. Somebody just said the word God, or meditation, or faith. They’re talking about something spiritual there.”

But implicit spiritual conversation, that’s when we aren’t using explicitly spiritual words, but spirituality is at the heart of what we’re thinking or feeling or saying. It’s a conversation about “What are you doing when you really come alive?,” or “What does all this mean?,” or “What’s my reason for being on this planet?” Or a conversation about guilt and forgiveness, or suffering, or joy. People don’t have to be using explicitly spiritual words or even thinking that what they’re saying is spiritual, for them to be tapping into the spiritual dimension.

I think most of the spiritual conversation that happens in therapy happens at the implicit level more than at the explicit level. It is explicit some of the time, but in my understanding of who human beings are, it’s implicit all the time. Every conversation is a spiritual conversation.

RJ: Therapists who don’t consider themselves particularly religious can definitely practice spiritually integrated psychotherapy. I know several who are really good at it. And with regard to your student’s question about Christian counseling, I’ll bet it means 50 different things to 50 different Christian counselors. But maybe at the heart of it, for all 50, is that both the therapist and the client have agreed that they are going to explicitly factor Christian beliefs, values, and practices into the conversation. That that’s going to be a part of what they do together.

RJ: Yes. And I would say there’s overlap between Christian counseling and spiritually integrated counseling. But you could also be doing spiritually integrated psychotherapy without declaring a particular religious or spiritual orientation. And this could occur without your and your client’s ever saying explicitly, “We want spirituality to be somehow part of the way we’re coming at this.” Spirituality is a way of seeing. It’s a way of listening. It’s a way of being. Our spiritual orientation is a way of seeing, listening, and being in the same way that being male is, being white is, being educated at a certain level is. You just can’t wash it out of yourself. It’s going to affect the way you sit in the room and interact with people.

RJ: A therapist who wants to honor that part of their client’s life and try to leverage it for some therapeutic gain—not one who wants to represent a particular spiritual tradition or try to advance a particular spiritual understanding, but one who wants to work with the spiritual understanding of their client—I would say they’ve got to be spiritually curious. They’ve got to have an interest in tracking it, noticing it, engaging with it. I think another key quality is humility. Humility in the sense of not assuming that the way you see things spiritually is the way the whole world sees it.

RJ: Yeah. Yeah, yeah. You and I, if people could see us in this interview, we both have two eyes and two ears and a nose and a mouth. If people saw us, they would say, “Those are two human beings.” But they’d also recognize that we’re physically distinct. People can tell that that’s Lawrence and this is Russell. And if that’s true physically, why would it be any less true spiritually? So a therapist who’s going to do spiritually integrated work well needs to really believe that everyone has a unique spiritual fingerprint. That the way this person in their office relates with the spiritual dimension of their life and connects and comes alive is different from the way any other person who sits in their office does it. Even if the other person and you share a similar spiritual background, you must assume that everyone who sits in your office came from a different spiritual planet, and your work is to get to know who that person from that different planet is.

RJ: I think that’s true. That is a spiritually informed value and practice for the therapist. Although, I do want to be clear. There are many wonderful therapists, many of whom are my friends, who have that same value and who say, “But I’m not spiritual at all. There’s not a spiritual bone in my body.” All this I’m saying to you, it’s just how I see it, and I know that’s not the case for everyone.

RJ: I agree with that, and I’m just wanting to protect the space.

RJ: Yes, to protect every therapist’s right to understand themselves the way they understand themselves. So the therapist who says, “Curiosity and humility, I’m all in. I come from that place, as well. But don’t colonize that and tell me it’s spiritual.” You know, “Don’t plant your flag on my island and tell me that I’m spiritual even though I don’t think I am.” If you don’t want to claim it, I don’t want you to claim it.

RJ: That’s exactly right.

RJ: Let me start with the engagement side. Engagement means listening for it and responding to it. If a client says something explicitly religious, you know, “I’ve been talking with my rabbi about this,” we show some curiosity about what that relationship with the rabbi is like and what the role of that is in their life. We don’t ignore it. Some therapists were trained to slide on past the spiritual comments their clients make, because if they talk about it at all, maybe they’re going to cross a boundary. You’re going to end up imposing, so stay away from it.

I think staying away from this client’s conversation with the rabbi or not showing curiosity about it conveys to them that maybe it’s not all that important. So engaging around spirituality means that there’s a spirit of welcoming and hospitality if they say something explicitly spiritual. But even if they say something implicitly spiritual, like “That song came on the radio and something happened in me. And I can’t even tell you what it was,” and we pass over it or don’t engage with it, we have lost an opportunity. That moment deserves a “Can you tell me anything more about that? Can we talk about that experience a little more?” So that’s engaging around spirituality, explicitly or implicitly.

Imposition has more the feel of, “Let me tell you how I make sense of what you just said.” Or “Let me tell you a very helpful way to make sense of what’s going on in your life.” I think the gross examples of imposition would be a therapist who says, “You should become a Christian or a Buddhist. Or a cat lover.” I think imposition at a subtler level is when our client says something that in some way is spiritually bothersome to us. And maybe we don’t even know we’re doing it. It could happen even at the level of an unconscious countertransference reaction. But we pull away, we ignore, we cast some sort of shade on what they just said. I think that’s also a way of imposing our own spiritual perspective on a client and their life.

RJ: Yes, exactly.

RJ: Feeling judgmental toward a client is an example of spiritual countertransference, and that’s one I’m just a wee bit acquainted with. Say I’m talking with someone who is giving voice to a racist or sexist or heterosexist point of view, I might start feeling bothered or judgmental or annoyed or hostile. I know myself as a therapist, and I know I’m probably not going to reach across the room and try to shake those attitudes out of them. But I still have to deal with some degree of judgment in myself that becomes a barrier to really being present in a helpful, caring, loving way with that client.

RJ: I think what you’re smoking out here is that for me, plain old countertransference is also spiritual countertransference. Every experience I have, I feel it in a spiritual way. So judgment—we don’t have to think of that spiritually. But in the spiritual traditions, the deadliest thing going is self-righteousness.

RJ: Right. And when I negate theirs, I negate my own. When I’m in judgment of you, even if it never leaves my mouth and is just in my own head, I’m also harming myself.

RJ: Yes.

RJ: In the way I come at it and practice it, yes. But I think there are spiritually integrated therapies that tie themselves to the more structured, protocol-based therapy models. There are spiritually integrated CBT protocols.

RJ: Ah, but everything has a spiritual flavor. I haven’t done a whole lot of thinking about the spiritual flavor of the CBT model, but I think it does possess an implicit spirituality and that spiritually can be integrated into it. For instance, a CBT therapist helps a client identify a core belief such as, “I’m stupid. I never get it right.” And the spiritually integrated CBT therapist might say, “Is there anything in your spiritual tradition or any part of your faith that speaks to that?” And then, perhaps the client pulls on a sacred text or some sacred affirmation that really emphasizes the value of this person, like maybe the client’s value in God’s eyes. The therapist then helps the client to integrate that belief or to try to switch beliefs.

But to your point, in the way I see the world and practice therapy, spirituality is implicit in everything. And it’s not just a way of conceptualizing, it’s not just technique. It’s a way of being in the therapeutic space. I think in that sense, it’s very much in the same family as the existential and humanistic therapies.

RJ: Yes, I do think that is true. And so, maybe now is the place to talk about what is spirituality, anyway?

First of all, I’ve never read a definition that I find completely satisfying. And the reason is: when we discuss or try to define spirituality, we’re talking about something whose very nature is mysterious and beyond words. So every definition of spirituality in the spiritually integrated psychotherapy literature includes a word that also requires some additional definition. Maybe the best-known definition of spirituality in the literature is Ken Pargament’s notion that spirituality is a search for the sacred. And that’s a great definition, but here we go: what does sacred mean?

In my book, I say spirituality is all the ways you and God relate with each other. But I spend a whole chapter talking about what I mean by God and how I’m using the word God in a poetic, imagistic way. It’s hard to define spirituality. We know it when we feel it. We know it in a way that’s other than linear and rational and definable. But what I mean by spirituality is: it’s the way we orient ourselves to the mysteries of life.

RJ: Right! And the mysteries of life are these things we’re bumping into all the time. Where did I come from? How did all this get here? What happens after I’m gone? Does anything survive? What really, really matters? What’s worth spending this life on? Do you remember the “Once in a Lifetime” song from The Talking Heads? The line that goes: “How did I get here?” Or Mary Oliver’s poem, “The Summer Day,” where she asks, “Tell me, what is it you plan to do with your one wild and precious life?”

Spirituality is the way we live out answers to those questions, and so we’re doing it all the time. You and I are doing something spiritual right now. We decided that sitting together and having this conversation matters, and it feels to me like we’re bringing ourselves to it with a fair bit of passion.

RJ: And what’s the difference, for you?

RJ: That’s the way I heard it, too. Not many people are sitting around thinking, “What is the meaning of life?” Most people are thinking, “What am I going to have for dinner?” And, “How am I going to get ahead?” “How am I going to get that person over there to pay attention to me over here?” But everyone is asking, “How do I get through this day? And what do I need to do to be happy? And am I OK?” And the way they live out their answers to those questions is connected to whatever they feel in their bones is the reason for living.

RJ: Yes. And let me add on to that wonderful summary you just offered. I would say that the most important question in psychotherapy is this: “What do you want?” We ask it the very first time we sit with a client, and we ask it again and again over the course of therapy, “What do you want?” What do you want to be different?” “What are you hoping for?” Whatever their answers are, embedded in them are some underlying assumptions about what it is that’s worth wanting. What matters enough to want? And a lot of the complexity of our lives is due to wanting things that are at odds with each other. “I want to get ahead at work, and I want a close relationship with my friends and family.” So what do you want more? What do you want most? What do you really, really, really want? These are spiritual questions.

RJ: Yes, if you succeed at work, what will that get you? If you have a good relationship with your spouse, what will that get you? What comes of that? What’s beneath all that? And I think the deeper you drop into that question, the more you land in some set of spiritual assumptions. Unprovable spiritual assumptions, but we organize our lives around them all the same.

RJ: Yes. Spiritually integrated psychotherapy is about following your client as deeply as they want to go.

RJ: Yes, following them, inviting them into as deep a space as they want to go to. But no deeper than they want to go right now. I think another way of imposing a spiritual perspective is trying to drag your client into a deeper part of the swimming pool than they want to be in, or deeper than they know, in their bones, they need to go right now.

RJ: Maybe so. You know, everything we do in therapy is an experiment, and hopefully, we’re paying attention enough to our client to see what happens in this experiment and to adjust. I think people come to therapy because they basically want someone to ask them, “What do you want?,” but also the related question, “What needs to happen?”

So, if your daughter is experiencing death anxiety, a spiritually integrated and implicitly worded spiritually integrated question might be, “What needs to happen?” And that question invites some inwardness and invites your daughter to seek a wisdom from a source that is not maybe part of her everyday, ordinary, or habituated way of handling her death anxiety, and invites a shift in perspective. But anyway, I guess I'm just suggesting that instead of saying, “Go stare at the sun,” the first question could be “What do you think needs to happen?”

RJ: Yeah, absolutely.

RJ: Let me say something that I hope is unnecessary, but I’ll say it anyway. We don’t parse between spiritual health and spiritual illness based on the content of our client’s beliefs. We don’t say someone is spiritually ill because they believe something that we think is wacko or is different from the things that we treasure in our spiritual belief system. You know, in religion, there is such a thing as heresy, but in the world of psychotherapy, we’re not interested in heresy. We’re interested in, how well does this person function in their life? To what extent do they experience psychic suffering and to what degree are they impaired? And I think some of the spiritual measures of psychic suffering or impairment would be things like how much are hatred and resentment a part of this person’s experience? How infected or affected by hatred are they? How much is greed infecting and affecting this person? How much—

RJ: Exactly! How connected or disconnected is this person to feeling that “My life matters for something important?”

RJ: Right. And I think connected to the sense of meaning is a sense of awareness and consciousness. You know, how awake or asleep is this person? And on this point, what we mean by spiritual wellness and psychological wellness are really close to each other: to what extent is this person living their life on automatic pilot, in some habituated, unconsciously driven, stimulus-response sort of way? And to what extent are living with awareness?

RJ: Addiction, yeah.

And the opposite of addiction, maybe, is freedom. To what extent am I free in a given moment? And then, another thing I would put in there would be a sense of agency or power. How paralyzed or futile do I feel in my life? And to what extent do I think the choices I make matter? And can I gather my energy behind a choice and a decision that matters?

Another thing to remember is that all these healthy spiritual capacities are usually inseparable from our attachment experiences. They’re inseparable from experiences we may have had with trauma. They’re inseparable from the historical forces that have shaped the world in which I’m coming to be a person. The spiritual dimension is inseparable from all that.

RJ: Thank you.

RJ: Well, it’s funny, you know. When you read the DSM with a spiritual eye, you start seeing spirituality everywhere. Think about the criteria for depression in the DSM. There’s mention of hope, loss of hope, which is a spiritual word.

RJ: Worthlessness.

RJ: Feelings of guilt. And no longer taking pleasure in things that one used to take pleasure in. The spiritual word for what they’re talking about there is joy.

RJ: That’s right. Another way of talking about that is the phrase “the life force.” That’s how I talk about spirit sometimes with clients who are not explicitly religious. How connected or disconnected are they feeling to the life force?

RJ: I understand why you may edit this out. But I’ll speak into that space, too. And my hesitancy to speak into it may be similar to yours. Or not. But mine is I want to be really careful that I’m not imposing my own worldview onto people who aren’t here to speak for themselves.

But as I try to make sense of that scene at the Capitol, a good bit of what I saw really was spiritual. And at the heart of it was despair. The anger was obvious, the rage. But beneath the rage, I think, there is despair. And there are probably many causes of despair, many of them intensely personal. But there are also social forces, collective forces, that are part of it. One of them, in my mind anyway, is economic, the way wealth is so unequally shared.

RJ: Yes, what are our shared spiritual illnesses? Groups and cultures can be healthy or unhealthy, although that’s too either-or a way of saying. Groups and cultures are a blend of healthy and unhealthy, just like individuals, healthy and unhealthy at the same time. You know, I guarantee you, most anybody in that crowd that day, if you could pick them out and have a conversation with them, you would find multiple spiritual virtues in those people. And, I’ll add, multiple spiritual vices. Violence is an expression of a spiritual vice.

RJ: Anger is one of the seven deadly sins in Christianity. In Buddhism, the three poisons are hatred, greed, and delusion. Violence has roots in all that. But my main point is, I think we’re all a blend. I have spiritual virtues and vices, and in different moments, in different circumstances, and under the influence of a crowd, my virtues and vices get amplified.

You know, another thing that was spiritual about that day, and about politics in general, is the projection of hope onto a savior.

RJ: Right. Yeah, “This is our guy.” “This is the one to deliver us from evil and evildoers.”

RJ: Wow, what a powerful example of drawing upon a spiritual virtue in a very intense moment. Something in her helped her see that man as a story, to see a past in him, to see deeper than the skin, deeper than the shield.

RJ: Deeper than the swastika shield. To see the human being behind that shield. Good on her for being able to do that in the moment. That’s not easy. And you know, she earned it. Because it sounded like she had willingly put herself in an uncomfortable situation that stretched her—the previous internship—and it helped her get to that place, where she could remain in the center of her own being. “No matter who this person is around me, here’s the way I’m going to treat him.” That is a very spiritually grounded response that she was able to make.

RJ: Yes. “Who are you? Tell me who you are. I see the color of your skin, and I have these implicit biases about you. I can’t help it. I grew up in this culture that tells me repeatedly who you are. And I have these implicit associations and prejudices. But within myself, spiritually, can I recognize my tendency to distortion and to prejudice, and somehow look at you and see you for who you really are? And ask you to tell me that—who are you?—ask you to show me that.”

RJ: Yes, I agree.

RJ: It’s a hard thing to sum up in a sentence. But if people read this far into the interview, let’s thank them for that with a single sentence. Spiritually integrated psychotherapy is psychotherapy that makes use of the spiritual dimension of our client’s lives and of our own spiritual capacities and wisdom.

RJ: Yes. There are theistic and nontheistic spiritualities. But all humans try to live—to find some reason for living and to actually do their living—in ways that are informed by assumptions about what’s real, what’s true, and what matters.

RJ: Oh, thank you for saying that, Lawrence. I believe in the book and want people to read it. One of my missions in this life is to help therapists feel more confident that they can do this kind of work, and the book is part of that. It’s a therapist talking to other therapists, in everyday language, and there are lots of transcripts from actual therapy conversations. Plus, it’s low-cost, so I don’t have a problem pushing it.

And if I could, I’d like to plug two other resources for therapists who want to grow their competence in working with spirituality. One is relatively small scale. It’s the CareNet Residency in Psychotherapy and Spirituality. CareNet is a state-wide outpatient counseling network in North Carolina. It’s part of the Wake Forest Baptist Health System. Our Residency is a two-year training program for therapists licensed at the associate level. They come to work at CareNet, and they join these learning cohorts. We have 10-12 residents at a time, five or six in their first year, five or six in their second year. I’ve been directing this program for 13 years now, we’ve had the most amazing people come through the program, and they’re the ones who taught me how to talk about this and teach it.

The other resource is larger in scale. It’s a national-in-reach training program in spiritually integrated psychotherapy offered through ACPE (Association for Clinical Pastoral Education). Historically, ACPE has offered top-notch training for chaplains and others who provide spiritual care, but they’ve recently developed a psychotherapy wing. I’ve been part of helping ACPE develop a 30-hour continuing education curriculum and a certification program. We now have 38 trainers offering this program across the country. So, if people want to do more than read a book, if they want to connect with other therapists who are trying to work more skillfully with spirituality, I’d encourage them to check out the ACPE website.

RJ: Thank you, Larry. This was delightful. Thank you for sharing this platform with me. I hope people will read it and find it useful. And if they do, for me, that’ll be gravy. That’ll be a bonus. This real and rich conversation is already gift aplenty.