This case study describes the treatment of "Olav," a divorced lawyer in his mid-30's, who, at the time of treatment, had been continuously hospitalized in closed, short-term psychiatric wards for more than seven years with severe treatment-resistant depression, transient psychotic episodes, self-destructive behavior, suicide attempts, and Axis II diagnoses of Borderline and Paranoid Personality Disorders, with narcissistic traits. He was about to be admitted to a long-term ward for chronic schizophrenics. A great deal of his psychopathology revolved around his feeling tortured from condemning inner voices of what he called "The Committee," which he believed were the sacred voices of God. Olav's treatment took place in our institution's "VITA" unit, a 12-week, group-based, residential day-treatment program that explicitly concentrates on existential and religious issues, and is based on principles drawn from existential, narrative, object relations, and affect theories. The VITA program includes diary-writing, affect consciousness exploration, individual therapy, and regular group sessions with such activities as mindfulness training; art therapy focusing on drawing or painting internal representations of self, father, mother, and God; reflection on existential issues; "here-and-now-oriented" psychodynamic group therapy; and physical exercise. An assessment battery of standardized, quantitative, clinical questionnaires documents Olav's dramatic improvement over the course of treatment and at one-year follow-up. CASE CONTEXT AND METHODHistorically, religious belief as a part of a patient's mental health treatment has not been given the attention it deserves, and the patient's relationship to God is often a neglected issue in psychotherapy (e.g., Rizzuto, 1979;Shafranske, 1992). Rizzuto's (1979) research 30 years ago demonstrated the psychological significance of the individual's representations of God for psychic health and sickness. Many patients state that religious belief is an important part of their life (Bergin, 1991). Recently a journal, Psychology of Religion and Spirituality, has been established by the American Psychological Association, and other developments in the field have shown a gradually increasing focus on religious issues in psychotherapy (e.g., Rizzuto, 1979;Meissner, 1984;Shafranske, 1992; Sperry & Shafranske, 2005;Silverstein, 2008). Nevertheless, there is a long way to go in learning how to address systematically religious belief and related affects in psychiatric treatment. The present case is intended as a contribution to this ongoing development. A. The Rationale for Selecting This Particular Patient for StudyA patient we will call "Olav" had a severe, long-standing, treatment-resistant depression linked to religious pathology, with psychotic episodes and suicidal behavior. This case was chosen to demonstrate how our institution's "VITA" model (Austad & Folleso, 2003; see below) could impact on severe pathology as well as personality structure, affect organization, and inner r...

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The article analyzes the distinctive character of the Christian spirituality developed within the Norwegian movement Korsvei-bevegelsen, The CrossRoad Movement . I seek to demonstrate how this radically Christian spirituality relates to and interacts with dominant processes in its postmodern social and cultural context. These patterns of interaction develop in a characteristically dialectical way: Established cultural patterns and priorities are both confirmed and critically confronted. Christian practices are embedded in as well as strongly opposed to dominating values and lifestyles. This can be seen in a variety of social and ethical issues and in relation to important existential concerns like autonomy and authority, freedom and commitment.

Commentaries on the case study of Olav (Stålsett, Engedal & Austad, 2010) by Richards (2010), Jones (2010, and Malitzky (2010) identify and discuss a number of key issues associated with the case study, including the study's scientific value, the importance of religious experience in relation to psychopathology and psychotherapy, and the roles of selfpsychology, attachment, and mentalization in the therapy change process. In our response to the commentaries, we address these issues. We conclude that all of the perspectives reviewed help to explain the factors that contributed to Olav's success in our VITA treatment program. This multi-perspectival approach was supported by one of the core principles of VITA: the creation of a "culture of inquiry," which specifically helped Olav to experience and regulate his intense negative affects and to understand and integrate his dialectically opposed visions of God and spirituality from a variety of points of view and within a diversity of therapeutic activities.

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