Psychotherapeutic Change and Spiritual Transformation: The Interaction Effect

Abstract

Olav was an extremely difficult, regressed, and religiously preoccupied patient, with a long history of unsuccessful outpatient and inpatient treatment. His case study by Stålsett, Engedal, and Austad (2010) is used here to illustrate the VITA treatment program at the Modum Bad Hospital in Norway. This program uniquely combines contemporary psychoanalytic therapy and a focus on religious and spiritual concerns to produce a remarkably intense 12-week inpatient treatment process. My commentary concentrates on some of the theoretical and practical implications of Olav's case for the psychological study of religion and the clinical treatment of religious patients, and it argues in favor of the VITA approach to dealing with religious and spiritual concerns as opposed to other forms of "religious" or "spiritual" therapy. The case presentation implies that the VITA Program succeeded with Olav where others did not because it explicitly focused on religious and existential issues. I offer some suggestions based on selfpsychology why that might be true but also suggest that other factors were at work as well.Key words: psychotherapy and religion; psychoanalysis; affect-regulation theory; psychology and spirituality _____________________________________________________________________________ I have known two of the authors of the case of Olav-Gry Stålsett and Arne Austad-as friends and colleagues for decades. We have met on both sides of the Atlantic and discussed the development of their "VITA" treatment program as well as participating together in case presentations and theoretical explorations. I have watched the program's evolution from Gry and Arne's early theoretical investigations on the integration of psychodynamic approaches with religious and spiritual concerns, their development of an innovative and specifically relevant clinical outcome methodology, and finally the implementation of the full, broad-based and integrative, inpatient treatment model presented in Olav's case. It is thus personally gratifying to be able to comment on this complex and dramatic case study and to see the remarkable clinical fruits of their work.

Reflections on Olav's Therapy: The Roles of Religious Experience, Self Psychology, and Mentalization

“…Central questions are in what way and by what means we address religious issues within the framework of psychodynamic psychotherapy. Richards (2010) and Jones (2010) comment on these questions from different perspectives. Richards refers to what he calls "spirituallyoriented treatment approaches" in which therapists "incorporate spiritual interventions into their practices" (pp.…”

“…Such collaboration was important in the Olav's case for integrating transformed inner representations of self and God, which also seemed to have opened a new access to healthy spirituality and religious belief in Olav. Jones (2010) states that a self-psychological perspective might suggest an additional reason why the VITA program succeeded where others failed. He states that the treatment program provided an ideal therapeutic matrix with empathic and affirming relational experiences that "the patient can then internalize and use to recreate a more cohesive and efficacious sense of self."…”

“…The commentaries by Richards (2010), Jones (2010), and Malitzky (2010) agree that Olav has truly changed and that it seems more than plausible that treatment is responsible for the changes that have taken place. Thus, the two first questions posed by Elliott seem to be answered positively.…”

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ABSTRACTCommentaries 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.

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The notion of transcendence and psychoanalysis in Karl Stern’s works

“…The present study focuses on this very concept of relation between Freudianism and the issues of transcendence, as it seems to be the most relevant philosophy-related problem in Stern's works. It should be remembered, however, that Stern has not been the only theoretician who studied the dialogue between religion, psychiatry and psychoanalysis; Paul Tillich and others have also been interested in this issue (Hart, 2011;Jones, 2010;Tillich, 1951Tillich, , 1952Tillich, , 1958. Martin Buber, like Stern, believed that transcendence formed the process of dialogue between two subjects (Buber, 1992).…”