Encountering the Sacred in Psychotherapy How to Talk with

People about Their Spiritual Lives

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C 2002 The Guilford Press
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All rights reserved

No part of this book may be reproduced, translated, stored in a

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This book is printed on acid-free paper.

Last digit is print number: 9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Griffith, James L., 1950-

Encountering the sacred in psychotherapy: how to talk with people
about their spiritual lives / by James L. Griffith, Melissa Elliott Griffith.
p. cm.
Includes bibliographical references and index.
ISBN 1-57230-701-3 (hardcover)
1. Psychotherapy-Religious aspects. 2. Psychotherapy patients-
Religious life. I. Griffith, Melissa Elliott, 1952- II. Title.

RC455.4.R4 G75 2002

616.89'14-dc2l
2001040474
Of those who have shared their stories with us,

Some live in the perpetual shadow of medical or

psychiatric illness,
Others have survived political torture and exile from
their homelands,
Many people of Kosove, with our colleagues at the
University of Prishtina,
Toil to keep alive the spirit of a people without turning
to hatred.

To these who must live alongside problems that can

be neither solved nor ended,
Whose spirituality has sustained hope, purpose,
and community,
We dedicate this book.
 About the Authors

James L. Griffith, MD, is Professor of Psychiatry and Neurology at The

George Washington University Medical Center, where he directs the
psychiatry residency training program and the consultation-liaison
psychiatry service. Melissa Elliott Griffith, CNS, LMFT, serves on the
psychiatry clinical faculty at The George Washington University Medical
Center and practices psychotherapy in Vienna, Virginia. They are both
affiliated with the Center for Multicultural Human Services in Falls
Church, Virginia. They are also coauthors of The Body Speaks: Thera-
peutic Dialogues for Mind Body Problems (Basic Books, 1994).

vi
 Preface

"Blest be the tie that binds . . ."

The singing of the blessing begins, all the voices of my kin, all who can
come to the Christmas reunion of the descendants of Mose and Minnie
Rivers Elliott. We are crowded together, hands joined in a circle in Aunt
Sue's den in Water Valley, Mississippi. I am not often in this circle now.
Geography and schedules have recently kept me and my family away
more years than not, but being at the gathering in the days of my child-
hood was as constant as Christmas itself. I don't know how old I was
when I noticed my daddy's eyes glistening on the last verse:

"When we asunder part, it gives us inward pain;

But we shall still be joined in heart, And hope to meet again."

At some point, I came to know that all together my family held the
memory of those who had passed on, held them in the circle still, with
longing and with gratitude.
In the moments of fear and despair in my life, this hymn sings to me
and I can know that I am not alone. It is the knowledge that I am not
only connected to the Water Valley circle, but to other circles, broken
and repaired, past and future, seen and unseen, which allows me to be in
vii
viii Preface

a posture of relatedness, arms outstretched, hopeful that circles can be

made and trusted.
Before this writing, I had never put words to what the circle, and
the singing of this blessing, has come to mean to me. I did not realize the
depth and fullness of its significance in my life until now, and because I
have described it to another, it will be even more sustaining and avail-
able to me. This is the gift of telling our spiritual stories. Griff and I
choose to call a story like this a spiritual story because it is one of con-
nection that transcends time and space. It is one that can inspire hope
within me in hard times. When those times come again, and I feel myself
to be unraveling, I may do as I have done before and consult a therapist.
If so, I would like to be able to speak this story, so that it can be woven
in as a strong and shining thread alongside the loose and frayed ones.
When people consult with us as therapists, we want them, too, to be
able to tell spiritual and religious stories that inspire hope and connec-
tion for them, as well as any that bring despair and isolation. We are
each passionately interested in how we can make this possible, how we
as therapists may both encourage and inadvertently thwart the meaning
making of these experiences. With the help of others who have partici-
pated with us in research, therapy, and training, we have been exploring
these interests. We offer in this book our work in progress.
We searched for language that would not make unwanted distinc-
tions, and still we struggle with the words we have chosen. We speak of
opening therapy to sacred conversations when we talk with persons
about their experiences of the spiritual, yet we believe that whenever we
hold with care the trust of those who consult with us, our therapeutic
conversations are sacred encounters. Whenever we listen to or host a
conversation in which people listen to one another with open hearts, the
spiritual is within that connection.
There are myriad ways of expressing spirituality and many tradi-
tions. Our greatest concern about this book is that some of those go un-
mentioned or are discussed only briefly and are rarely illustrated in the
therapy vignettes. Stories of therapies that invoke the Eastern traditions
and spiritualities that are not God-centered are few in this text in com-
parison to the many that include Western traditions, especially those of
Protestant Christianity. Our colleagues who have been our readers have
been concerned for us, that we might be perceived to be too narrow, and
have generously offered to share some of their stories with us to increase
the breadth of this text. We were tempted, but have decided to tell only
 Preface ix

the stories that we have heard in therapy and that we have lived. Surely,
then, we have not addressed many spiritual expressions or dilemmas
that can arise in therapy. Sometimes, acutely aware of our limitations,
we have longed to collaborate in this writing with a group of therapists
that would include, at the least, a Buddhist, a Hindu, a Muslim, and a
Jew. Because it would stray from our purpose, and because we needed to
bring closure to this project, we chose not to do so. To our relief and de-
light, Froma Walsh has recently edited just such a book, Spiritual Re-
sources in Family Therapy (1999), which we recommend as an excellent
complement to this text. Indeed, since this project's inception, much has
been published about psychotherapy and spirituality. Again, in order to
keep focus and to bring closure, we have not attempted to review that
literature here, but this burgeoning body of exciting research and clinical
articles will be even larger by the time this book is published.
We have sought to understand when to open therapy to a dialogue
about spirituality and how to do that in culturally appropriate ways. We
are reminded of a conversation with Charles Waldegrave of the Family
Center in New Zealand, a collaboration of Maori, Pacific Island, and
European workers who have been a fount of spirituality in therapy for
us and so many in North America. We asked Charles, "It's been said that
you honor the Maori spirituality by praying together before a session. Is
it true? Do you pray before all your sessions at the center?"
"Ah, well, life is a prayer, isn't it?" he said. "Sometimes, if it is cul-
turally appropriate, we speak it together, sometimes not."
This is our hope, that we speak about spirituality with those per-
sons for whom it is culturally appropriate and relevant, and do not
speak about it when it is not appropriate or not their desire. Because the
gift people give those listening to their stories is a sacred trust, we must
always try to be attuned to when and how we can most helpfully receive
and respond. This book is the story of the ways we have learned, so far,
to be attuned to these gifts, to be receptive to the varied presentations of
spiritual and religious life, to be discerning of those times when it be-
comes a destructive force, and to be responsive in ways that honor and
strengthen the circles of community, tradition, and faith that sustain and
connect.
 Acknowledgments

The people to whom we are most indebted for the writing of this book,
of course, cannot be named here. They have spoken with us in therapy
sessions, in family meetings, at the hospital bedside, and in research pro-
jects. They have both inspired us with their spiritual stories and in-
formed us about ways to usefully participate with them in story making.
When we sent out the vignettes of this book drawn from our experiences
with these individuals, they responded with edits and permission to pub-
lish. Most of them participated in choosing pseudonyms and disguises to
render their stories true and still protect their privacy, while some
requested that we not alter names or particulars and tell the story just as
it was. Many sent meaningful letters, thoughtful reflections on our time
together, and on developments in their lives since our series of meetings.
Receiving these letters was the best part of writing this book. Though
the format of this book does not allow for their publication, these letters
have improved our rendering of the vignettes and influenced our think-
ing about therapy and about life.
I (Griff) began working in earnest to open my clinical work to the
spiritual lives of my patients in the early 1980s, during my psychiatry
residency at Massachusetts General Hospital (MGH). For generations of
MGH residents, Ned Cassem-Jesuit priest, Harvard professor, and
Chairman of the Massachusetts General Hospital Department of Psychi-
xi
xii Acknowledgments

atry-has modeled a clinical seamlessness that addresses in one move-

ment both symptoms of mental illness and dilemmas of the human spirit.
The discipline and focus that Ned and his faculty colleague, George
Murray, exacted from MGH psychiatry residents led us to suspect that
our clinical training was heavily laced with the rigor of Jesuit training.
Nearly 20 years later I was startled to realize just how much I had ab-
sorbed from Ned when I listened at a national conference to his invited
lecture on spirituality in medical illness. I heard him illustrate in that lec-
ture so many of the kinds of questions I thought I had originated. Under
his supervision and mentorship, I learned even more than I had realized.
A second inspiration in the early 1980s was the "Psychology and
Theology Luncheon Group," a mixed group of psychiatrists, psycholo-
gists, and theologians who met monthly over a long lunch in Cambridge
to discuss an extraordinary range of topics, from religious visions in
temporal lobe epilepsy to the confrontation of evil in a psychotherapy
session. A guiding spirit for this group was Boston psychoanalyst Ana-
Maria Rizzuto, whose seminal work, The Birth of the Living God (Uni-
versity of Chicago PFess, 1979), had given to clinicians the idea of object
relations for understanding the power of a person's felt presence of a
God and its meaning in his or her psychological world. During five years
in Boston, these discussions with John McDargh, Reb McMichael, Da-
vid Bear, Steve Nisenbaum, Bob Weber, and other group members kept
raising practical questions about the beliefs and practices of spirituality
and their meaning for mental illness and mental health.
Our friend Reb McMichael returned to Mississippi and formed
such a group there, inviting us to join in lively conversations with him
and other therapists and clerics, Ruth Black, Ruth Woodliff-Stanley, and
Mark and Lisa McLain among them. One outgrowth of these conversa-
tions was the creation in the 1990s of a research group with psychologist
Jeanetta Rains and psychiatry residents Carol Tingle, Alexis Polles,
Nancy Krejmas, Dinesh Mittal, and Mark McLain that produced a se-
ries of research reports on the significance for clinical work of people's
relationships to a personal God (Griffith et al., 1992, 1995; Polles et al.,
1993; Tingle et al., 1993). Mississippians Priscilla Pearson, Gloria
Howard Martin, and Julie Propst joined our discussions and shared our
excitement about applying narrative ideas to the multiple and contradic-
tory experiences people had of God. We found these notions to closely
fit and to usefully loosen therapy conversations in our culture.
But could these ideas also be useful outside our culture? Griff had
begun to write about this work, and wanted me (Melissa) to join him in
 Acknowledgments xiii

spreading the ideas we were developing, but I was hesitant. Taking these
concepts into the wider world was fraught with difficulties for me. How
could I talk about opening to many different expressions of spirituality
when 95% of my experience, professional and personal, was with
Protestant Christianity? Imposing our culture on others was the last
thing either of us wanted to do. Sallyann Roth came to the rescue and
joined us as a co-presenter the first time we put forth these ideas at a na-
tional meeting. Her presence and stories dispelled any notions of nar-
rowness. Later, Kaethe Weingarten invited me to contribute to an issue
on cultural resistance that she was composing for the Journal of Femi-
nist Family Therapy. She said that what we were doing was "radical" in
the context of secular psychotherapy, and, though I would not have pre-
sumed to call it that, I was heartened that she understood that we
wanted to encourage curiosity and openness toward an aspect of
people's lives that our field had often regarded as boring, irrelevant, and
ignorant. With trembling confidence, I did write and Sallyann penned a
gracious response.
Griff and I then offered a series of workshops. Jill Freedman could
not have known that she finally teased me out of my mire of concerns
with a jovial phone call after one of these workshops. "What is this?"
she said. "It seems like everyone who enters my office is wanting to talk
about God now!" Had it not been for the encouraging acts of these three
women of Jewish lineage, each vastly different from me and from one
another in our expressions of spirituality, all therapists I trusted and ad-
mired, I might never have been able to believe Griff's arguments, that
what we were developing could have wide applicability and that I
should join him in writing this book.
A book as many years in the making as this one has scores of
friends and colleagues to whom we owe gratitude. We have been blessed
with a community of therapists who have a commitment to social justice
and an interest in narrative ideas. Though several of them have experi-
enced the oppressive effects of religion, they nonetheless have created fo-
rums so that we could engage with them and others in understanding
and honoring people's religious and spiritual lives in psychotherapy.
Among these, particularly Sallie Motch, Rachel Dash, Michael Dixon,
Vicki Dickerson, Gene Combs, Glenda Fredman, Susan Shaw, Janet
Adams-Westcott, Bill Madsen, Margarita Tarragona, Jo Ellen Patterson,
Craig Smith, Jerry Gale, Delane Kinney, Ann Madigan, Zoy Kazan,
Peggy Sax, Linda Terry-Guyer, Bill Lax, and Steve Madigan have re-
sponded with interest and honesty to our work. We have been privileged
xiv Acknowledgments

to learn from other narrative teachers, Trevor Hudson, Kiwi Tam-

massee, Charles Waldegrave, Wally McKenzie, and Sue Boardman-
McKissack, who have long honored people's spirituality in therapy.
Some colleagues' influence is so pervasive that it is impossible to ad-
equately cite them. Peggy Penn's graceful and creative therapy and writ-
ing has for many years inspired us to see our own work anew and to
continue to write. We are grateful to Harry Goolishian, Harlene Ander-
son, Tom Andersen, Lynn Hoffman, John Shotter, Karl Tomm, Michael
White, Cheryl White, and David Epston, whose work continues to shape
and challenge ours. Jack Lannamann, Betsy Wood, John Rolland, Froma
Walsh, Frank Fernandez, and Lois Slovik have influenced us both clini-
cally and philosophically.
We have been sustained by Washington colleagues who both be-
friended and believed in us-David and Joann Reiss, Steve and Sybil
Wolin, Jeff Akman, Jane McGoldrick, Eric McCollum, Sandi Stith,
Margie Stohner, Georgeanne Schopp, Ann Womack, and Karen Weihs.
Lynne Gaby and Judy Okawa have extended this work, seeking with us
to understand how spirituality aids the resilience of severely traumatized
refugees.
Friends and family have gathered us up when we could not pull
things together. Our parents, Van and Helen and Lamont and Louise,
taught us not to give up, and our children, Marianna and Van, would
not let us. Janet Cavett, our family theologian, aided us with her biblical
knowledge. Judith Landau informed us with her cultural knowledge.
Carole Samworth, Martha Jurchak, and Jane Bise maternally monitored
our progress. They still asked about the book when we said, "Don't
ask." We are forever grateful to Kaethe Weingarten, who gave her atten-
tion to every paragraph and improved almost every page.
If every person were surrounded by friends like ours and supported
by a professional who gave them the patience, understanding, and en-
couragement that our editor, Kitty Moore, has given to us, we therapists
would have much less work to do. In addition to her considerable edito-
rial skills, Kitty's persistence and forgiveness have made it possible,
when it seemed impossible, for us to complete this project. Near the end,
when our spirits were flagging, Kitty enlisted the aid of Denise Leto,
whose enthusiastic e-mails and exquisitely attentive editing gave us a
second wind and enabled us to stay the course. The entire team at The
Guilford Press has assumed a precise, practical, and hopeful stance to-
ward this project. Their partnering with us has made us better writing
partners to each other.
 Contents

1 New Ways of Hearing Sacred Stories 1

2 Opening the Door 28

3 Metaphor and Spirituality 53

4 Stories of Spiritual Experience 81

5 Conversations between Person and God 103

6 Spiritual and Religious Beliefs 137

7 Rituals, Ceremonies, and Spiritual Practices 164

8 The Community in Spirituality 189

9 When Spirituality Turns Destructive 215

10 Living beyond Medical and Psychiatric Illnesses 258

References 301

Index 313

xv
 Chapter One

New Ways of
Hearing Sacred Stories

In these pages we hope to show ways to open therapy to the spiritual

lives of people who consult us; to listen for and to their experiences; to
learn about their religious beliefs, spiritual practices, and sustaining faith
communities; and to recognize and respond when these powers are used
destructively. We begin with Devi's story because it is about the heart of
this work, which is the practice of wonder. The practice of wonder-
being available to what is not yet known or expected-is a therapeutic
practice for the life of conversations, for the people who consult with us,
and for us.
When Devi first arrived, she had to check to see if her pager was on.
She explained that we might be interrupted because her husband re-
quired that she respond immediately if he called to ask her whereabouts.
Her request was for help in leaving this marriage. While she had not
married for immigration reasons, her pending citizenship would be at
risk if she divorced. Though she was successful in her studies and her
work and fluent in three languages, Devi had come to believe her hus-
band's insults that she was stupid and inept. She said she had lost her ap-
petite for eating, and almost for living. "I feel that I am disappearing,"
she said, and this was reflected in the thinness of her body and the
1
2 ENCOUNTERING THE SACRED IN PSYCHOTHERAPY

vagueness in her eyes. I (Melissa) was the third therapist she had seen.
The couple had attempted marital therapy, and Devi had tried to change
herself in many ways to please her husband, but she could no longer en-
dure his degradation and threats.
Devi and her mother had journeyed from their homeland of India to
the United States to obtain an American education for Devi. She had ex-
celled in school and spoke nearly flawless English. Midway through one
of her sentences she paused, apologizing for a minor linguistic mistake. I
had not noticed. I marveled at her fluency, but I wondered what our con-
versation might be like if she were able to speak about the entrapment in
her marriage in her native tongue. It was then that she told me that her
husband would not permit her to speak in her own language, not even
when talking with her mother on the phone. He considered her to be
culturally and racially inferior and wanted her to disguise as much as
possible of her ethnicity. I offered to search for a therapist who could
communicate with her in Hindi. Devi did not want to see a different
therapist. She didn't mind speaking English in therapy, but she did long
to speak Hindi with her mother on the telephone in her own home.
Two weeks later Devi came to see me again. She still felt trapped.
Although her situation had worsened at home, she was still unable to
leave. She had secured a safe place in case of an emergency, but insisted
that she presently was in no physical danger. The danger, she said, was
that she might give up. She was sustained only by her friends and her
mother. They were worried about her and called daily, begging her to
leave.
I asked that she invite her mother to our next meeting. Her mother,
Ms. Chowdry, arrived dressed in a sari with her head lowered, and, after
a long period of silence, made only one pleading comment in a soft and
deferential tone. I could not understand all of her words, a mixture of
Hindi and English, but I needed no translation for the intense love, help-
lessness, and fear in her voice as she entreated her daughter to leave her
husband, to come home with her that very day. "My mother is saying
that she doesn't want me to become another Nicole Brown Simpson,"
Devi explained. Ms. Chowdry nodded and again addressed her daughter
in Hindi. Devi gently reprimanded, "Speak English." At this moment, I
became acutely aware of Devi's earlier description of her husband re-
quiring that she and her mother converse in English.
"Please," I said, "speak in your own language. You don't need to
translate for me unless you want to. I will ask questions that may be
 New Ways of Hearing Sacred Stories 3

helpful, and the two of you can use them as you wish. I have confidence
that you will find a way to talk with each other about what is most im-
portant, and that your talk will be more comfortable and fruitful if you
talk in your own language."
The conversation seemed to flow well and I became optimistic that
Devi was unified with Ms. Chowdry in the decision to put her safety
first. I was surprised and worried when, near the end of the session, Devi
confessed that she was still confused. She said she would stay in the mar-
riage a bit longer until she achieved more financial and immigration se-
curity. Ms. Chowdry bent down, hiding her face in her hands. I inquired
about her sadness and her worries, expecting her to speak of her sorrow
for her daughter. She spoke plaintively in Hindi and Devi translated:
"My mother says to tell you that she is sad because she is homesick."
"What would she do with such a serious problem if she were at
home?" I asked.
"If she had a serious problem, she would go to the temple," replied
Ms. Chowdry. They conversed a bit more in Hindi. Then Devi turned to
me and said, "My mother says the temple is what she misses most about
home. She went to pray there every day."
I asked Ms. Chowdry to describe the temple and what it was like
to be there. "Peaceful," she answered. I wondered aloud what it
would be like to be in the temple together now: "Would the peaceful-
ness bring answers to Devi?" Ms. Chowdry and Devi became quiet. I
sensed the sacredness of this moment and felt that more questions
would be an intrusion. Then I thought that even my presence might be
an intrusion, much like it might be if I were a guest at their temple,
present when their need was to pray, undistracted by attention to their
guest. I slipped out my office door, telling them I would give them pri-
vacy for a while, and requesting that they open the door when they
had finished talking.
In about 10 minutes, they invited me back. Devi and her mother
seemed peaceful, and her mother no longer looked sad. Devi had re-
solved to leave her husband. We set up our next appointment. Devi
called the next day to let me know that she had left my office with her
mother, never to sleep in her husband's home again. She expressed grati-
tude to me for holding the meeting, for encouraging them to speak in
Hindi, and for leaving the room so that she and her mother could pray.
She identified these acts as different from anything that had happened in
her previous therapies. It was different for me, too, I thought to myself.
4 ENCOUNTERING THE SACRED IN PSYCHOTHERAPY

We chatted a while about our shared admiration for the gentleness and
wisdom of her mother.
Relatively quickly, with the help of Indian and American friends
and immigration lawyers, Devi was able to obtain a divorce. When I last
spoke with her, she was interested in starting a group for immigrant
women trapped in abusive relationships.
Devi had many strengths-intelligence and insight, a good job, a
safe place to go, a concerned, supportive friendship network, and the
love of a wise and persistent mother. Surely all these contributed to the
courageous step she took. However, she was finally able to see clearly
and to act when she and her mother entered the peacefulness offered by
their spirituality.
What did the therapy have to do with the entry into this spiritual-
ity? For us, this is the crucial question. It seemed to "just happen," a mo-
ment of mystery that cannot be fully understood, and certainly could not
have been orchestrated. Nevertheless, we want to understand as much as
possible about it. Devi's reflections after the session may point the way:
"It is good that we spoke in our own language," she said, "and good
that my mother and I could pray."
Urging Ms. Chowdry and Devi to speak in a language unknown to
me was, in that particular instance, prompted by my wishing the therapy
atmosphere to be radically different from the home atmosphere of Devi's
marriage. But that specific act is reflective of the general way we aspire
to work with people's spiritual experiences in therapy. The two of us are
often urging them to speak in languages with which we are unfamiliar.
Stepping out of the room, trusting Devi and her mother to determine
when to invite me back in, illustrates what often seems to be the chore-
ography of our conversations with people about their spiritual experi-
ences.

SPIRITUALITY CHALLENGES THERAPISTS

The two of us can tell many similar stories in which a person in crisis
who is constrained by assumptions, beliefs, and customs seems to have
no options. However, shifting the site of negotiations from the psycho-
logical or physical world into the person's spiritual world opens new
possibilities that we can never fully fathom. Perhaps this is no surprise,
given how widespread is the influence of spirituality in the lives of peo-
 New Ways of Hearing Sacred Stories 5

ple. In 1996 the freethinking quarterly Free Enquiry commissioned its

own poll, doubting prior reports about the pervasiveness of religious be-
liefs in American society (Goldhaber Research Associations, 1996). To
its surprise, almost 90% of those interviewed expressed belief in a per-
sonal God who can answer prayer. Given its bias toward agnosticism,
the Free Enquiry poll appeared to settle definitively any questions as to
the pervasiveness of religious beliefs among Americans. When those who
practice spiritualities that are not God-centered are added to these num-
bers, it seems that some form of spiritual life is important for most of
those who come for psychotherapy.
Nevertheless, the majority of mental health professionals, with the
notable exception of pastoral counselors, have struggled during the past
century to find a proper place for people's spiritual lives. This was
brought home to me (Griff) a couple of years ago by two psychiatry resi-
dents who were waiting for me after our morning hospital rounds on a
surgical floor, hesitant but wanting to discuss the way I had spoken with
a patient awaiting surgery. Puzzled and disturbed, the residents said that
they had never mixed religion and psychotherapy because they had al-
ways thought of the latter as a scientific endeavor. Furthermore, they
wondered, "How can you talk about a relationship with God when
there is just one person there?" An internist had asked us to evaluate his
patient, a man with kidney disease, whom the internist believed to be de-
pressed. During the interview, the patient mentioned that he had been
praying. I asked if he were comfortable speaking with me about it.
Would he tell me what words he had prayed? He did so. How had he
sensed that God had received the prayer? What seemed to be God's re-
sponse? He seemed quite interested in speaking about these things, so I
inquired further. What did God know about his problems that others did
not understand? What did he most hope that God could understand? Af-
ter we left his bedside, I had talked briefly with the medical students and
psychiatry residents about the ongoing conversations that many patients
have with a personal God, and the decisions toward healing or dying
that are often made therein, depending on the turns such hidden conver-
sations take. The two residents felt troubled over how they were to fit
what they had witnessed into the rest of what they were learning about
psychiatry.
The mental health professions generally have held an ambivalent
and distant relationship with spirituality and religion. The reasons for
this are multiple and complex. Like the two residents, some feel that psy-