Step Two Be Clear About Your Definition of Spirituality and Religion

The therapist must next give considerable thought to his or her understanding of the meanings of spirituality and religion that he or she will use to describe these phenomena to group members. I read widely and choose to define terms for my patients in ways that are inclusive without being imprecise.

Definitions That Meet These Criteria

Spirituality encompasses a search for meaning, for unity, for connectedness, for transcendence, and for the highest of human potential. Religion is a (more or less) organized search for the spiritual associated with a covenant faith community with narratives that enhance the search for the sacred (Emmons, 1999).

In other words, although there is a strong connection between the two phenomena, the understanding of spirituality and the context of it varies from individual to individual and may or may not connote religion per se. Furthermore, it may denote a 'theistic or non-theistic orientation. The group leader's function is neither to prescribe nor proscribe an individual's specific approach. Rather, it is to foster this dimension on the individual's own terms.

Step Three: Be Clear About Your Understanding of the Interrelationship Between the Spiritual and Psychodynamic Dimensions to the Work

Having set the stage for inclusion of the spiritual aspect, the next step is to work with it as it manifests itself in the dynamics and process of the individual and the group. There are various ways to frame this; however, I will place emphasis on one dimension I find particularly relevant to group members. This is the area of self-development, especially what can be called searching for the "true self' (Winnicott, 1960) in psychodynamic terms, or responding to one's "vocation" (Merton, 1965), in more spiritual terms.

The chief complaint of many group members is a lack of self-esteem and a profound sense of shame about themselves. Often, in lieu of a real or "true self," a person develops a "false self' and loses connection with himself or herself in the service of survival and protection of the "true self' (Miller, 1981). For many, this is the great tragedy of their lives underlying the presenting complaints. So, what does this have to do with spirituality?

At the heart of my own approach to life and to therapy is the notion that the individual's fundamental "vocation" or task in life is to become who he or she truly is (Merton, 1965). If there is a place for the word "holy" here, its implication is "wholeness." This is not to imply that there is a preestablished mold into which one must fit. Rather, it is a lifelong process of continual efforts at self-understanding, rooted in mind, heart, and spirit, and decision making that actualizes this understanding by good decisions made in freedom.

Step Four: Make Explicit That You Welcome the Spiritual Dimension into the Group Process

My own practice is to invite this topic during the first two individual meetings I have with a prospective group member; the goals of these meetings are as follows:

• To get to know the person and his/her hopes and goals for the group work in a preliminary way and to determine whether there is a mutually good match for the work

• To prepare the person for entrance through discussion and written materials that inform and educate him or her about the ways to get the most out of group

Up to this point the content of our meetings has been generic and psychodynamic. My first introduction of spiritual-religious content occurs when I point to a four-legged table in my office. I ask people to consider the four legs of the table and think of them as the "Four Legs" on which all our lives are built and on which we will be working in group. I call the legs: love, work, play, and pray.

After giving some elaboration to the first three legs, I turn to the pray leg. My mention of the pray leg is often surprising to people because many people who come to therapy do not expect a therapist to inquire into this area. This area may also be very problematic for many patients who have had bad and even traumatic experiences during their religious upbringing. For these reasons it is essential to define and describe my inclusion of this dimension in a way that is more far reaching than the traditional confines of religion.

I tell the person that "pray" might be taken in a more literal sense by some individuals, making use of specific prayers or prayer forms, within a specific religious or spiritual tradition. However, it might also be taken in a broader sense as (1) a philosophy of life by which one lives; (2) a particular spiritual practice or path within a tradition such as Buddhism; (3) a meditative practice such as mindfulness; or (4) the values or principles by which one lives and orders one's life. My point is that we are all searching for some meaning in our lives and this goes to the heart of what spirituality and religion are all about. This is very close to what Yalom (2005) calls "existential factors" in his list of "group therapeutic factors." It is also reflective of what others call "the psychology of ultimate concern," which involves "an ultimate vision of what people should be striving for in their lives" and the strategies to reach those ends (Emmons, 1999).

Step Five: Address Spiritual Issues in the Group

Now when I lead a group I am very aware that I view the members and the group process with a vision I characterize as psychospiritual. This vision is binocular, engaging a dialectic that oscillates between a spiritual view of the work occurring and a psychodynamic conceptualization of what is happening, each mutually informing and reinforc ing the other. Let us consider one such focus that, in psychodynamic terms, can be self-psychologically conceptualized as the establishment of the true self, and, in spiritual terms, can be considered the work of seeking one's "vocation." Both involve a full and rich integration of all aspects of our humanity, the good, the bad, and the ugly.

Practically, what occurs in group is that an individual begins to open up about his or her self-worth. Gradually, as trust in the group and leader increases, the individual invites us into his or her life at a deeper level, overcoming the initial reluctance to do so. A spiritually informed response is: it is not because we are perfect that we are worthy of love, but because we are human that we are worthy of love.

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