Ciarrocchi, Joseph W., and Wicks, Robert J., Psychotherapy with Priests, Protestant Clergy and Catholic Religious: A Practical Guide. Madison, CT: Psychosocial Press of International Universities Press, Inc., 2000. xvii + 211 pp. $40.00
This volume is aimed at practitioners engaged in psychotherapy with Christian clergy and Catholic religious (i.e., nuns and others who have taken public vows such as poverty, celibacy, and obedience). It is the work of two clinical psychologists, faculty members at Baltimore's Loyola College, where Ciarrocchi directs clinical education in the Graduate Program in Pastoral Counseling and Wicks chairs the overall Graduate Programs. Both, according to the jacket description, have been significantly concerned with "the integration of psychology and religion," and one, not identified, has worked within the professional ministry. Their deep knowledge of, and experience and identification with, the Christian clergy become increasingly evident and seem increasingly essential to their therapeutic approach as one reads their account.
It is no surprise that the authors are sensitive to what they call a "religiosity gap" between many less knowledgeable clinicians and their clergy clients. This gap, if not dealt with, can constitute a significant obstacle to therapy. It may be bridged, they propose, first, by discussing clinically relevant psychological issues in terms of the cultural context of persons engaged in professional ministry. A client's developmentally based intrapsychic conflicts, which can create vulnerability to or complicate emotional distress reflected in professional difficulties, will become apparent and require attention as the contextual issues are dealt with.
Second, assessment, treatment planning and intervention strategies are approached within "a multi-cultural context." The authors feel, for example, that "effective treatment with clergy by either a lay clinician, or a clinician with no professed religious beliefs, is analogous to a white therapist treating a black client" (p. xii). It follows that therapeutic interventions must respect the cultural context of the clergy client and that interventions must not create cultural ruptures "reasonably opposed by the client" (p. xiii). It seems clear from their presentation that the therapist should avoid interpretations or other interventions that confront the religious beliefs that are part of the client's security system. They make it clear, however, that they regard agnostic clinicians as equally helpful as religious counselors even with religiously committed depressed persons. The central prerequisite for the therapist, they state, is only "a sincere desire to help" (p. xii). Although it is likely that members of the ministry or religiously committed persons will seek helpers who share their own commitment, this is an area that deserves more attention in a volume with this focus.
The authors' views are translated into active therapeutic interventions, liberally illustrated with brief vignettes. They advise, reassure, clarify, explain, and even, perhaps, exhort (a matter of definition). Although some psychoanalytic language is used, especially references to transference and the superego, the therapist's stance is not that of the psychoanalyst's neutral, anonymous screen upon which the client projects his or her historically determined fantasies that are only occasionally interpreted. Instead, the therapist is a knowledgeable and active collaborator, who shares vital elements of the client's experience and belief system. His explanation to the minister-client, for example, that some parishioners will develop erotic feelings toward him and that these are part of a positive transference, can refer to personal knowledge of the vicissitudes of minister-parishioner relationships.
He can authentically refer to God, Jesus Christ, or items of scripture, in his interventions. In regard to "burnout" or "compassion fatigue," for example: It is "imperative" to confront the "archaic superego ... along with these clients' extreme fear of rejection of limits under the religious rubric of: "Going the extra mile" ... When someone cannot discriminate between the crosses they are being called by God to carry and those which they inflict upon themselves, the result is burnout and the inability to carry any crosses at all" (p. 9).
Or, in regard to the therapist's perception that a female pastor's vulnerability to stress and her ensuing anxiety came from her "propensity to ignore self-care": the client was asked to read one chapter daily of the Gospel of Mark, paying particular attention to "how often Jesus a) rested or took time off; b) went off to pray; or c) allowed someone else to do something pleasant or caring for him" (p. 70).
Or, in regard to compulsive behavior: "Clients easily get confused as to whether they approach or avoid certain urges. We have simplified this with St. Ignatius' dictum of 'Do the opposite' of the impulse" (p. 109).
The book contains many exercises that the therapist may assign to the client or work through with him. Some are taken from Wicks' earlier edited volume, Handbook of Spirituality for Ministers, Vol. I, published in 1995. An example is "Self-Talk," which presents distressing situations and questions which will help to "correct our thinking so healthy action in difficult stress-related times can become more possible" (p. 19). The situations include feeling lost, overworked, worthless, overwhelmed, and the like. Suggested solutions include both secular moves such as consulting friends and religious ones such as taking time for prayer and noting Jesus' behavior as a model.
Other exercises come from Ciarrocchi's earlier book, The Doubting Disease, also published in 1995. An example is a recording sheet that the client suffering from scrupulosity, i.e., a belief that certain thoughts are dangerous and/or unacceptable, can use with the therapist to develop some brief response strategies.
The book is organized according to the problems which the therapist must address. The first section begins with stress produced by a range of situations and goes on to interpersonal and family issues. Next comes the treatment of anxiety, depression, and guilt in religious professionals. Here "moral guilt" and scrupulosity occupy prominent places. The third section begins with addictive disorders including gambling but devotes major attention to sexual problems and issues surrounding celibacy. A final section deals with boundary maintenance. Although it notes that the usual restrictions on socializing that protect client welfare in general counseling cannot apply directly to ministry, there is a significant discussion on the hazards of intimate erotic involvement with parishioners.
Professional clinicians, especially those trained in psychoanalytic therapy, may have mixed feelings about the approaches advocated in this volume. There seems little doubt that the therapist-authors are powerful paternal figures embodying the mystique and knowledge both of psychology and the church. For many patients, the opportunity for a relationship with such a figure must, itself, be profoundly reassuring. The backgrounds of the authors, themselves, make it possible for them to be uniquely empathic and to arrive at intuitive insights into the needs and preconscious conflicts of their clients. Yet, some may wonder if there are situations in which the minister patient, especially the Catholic priest, might be better served by a therapist who cannot be perceived as representing the church. Is it possible that a therapist who does not embody the imago of the religious organization has more freedom than the one who is an extension of the church and is capable of granting the client more freedom as well? The question also arises as to whether the behavioral formula that guides so many of the described interventions might not have a more lasting effect if it were combined with greater insight.
This volume offers the unchurched clinician an instructive view of the potential hazards of life in the Christian clergy and a window into the world of those whose distress impels them to seek help. It is, simultaneously, an account of the therapeutic approaches of two experienced scholars and clinicians. These contributions are sufficiently valuable. One wonders if it could be fleshed out, made more complete, by adding the psychodynamic dimension to the story, both of the individual clients and the context they inhabit.