My teachers or supervisors never mentioned God 50 years ago when I was a resident. Psychoanalytic theory dominated the teaching program; in retrospect, the silence about God, religious beliefs and activities, and spirituality in general almost certainly reflected in part an unspoken allegiance to Freud and his negativity about religion.
Later, in my early years of practice, a few practitioners began to advertise themselves as "Christian psychiatrists" or "Christian psychologists." Some of my colleagues and I thought this was an undesirable dilution of psychotherapeutic principles and, perhaps, even a marketing device.
Over the years much has changed. A strong and productive interface has developed between religion and psychology and psychiatry. There has also been a growing interest in understanding belief systems as providing individuals with the cognitive structures in which personal meaning can be sought. For many, if not most Americans, belief systems are religious in nature. Personal meaning is found in one's relationship with God. Given this fact, psychotherapists need to respect the religious belief systems of their patients—however different from their own—and also seek to understand their adaptive implications.
All of this change over the course of my career was brought to mind by two recent experiences. One involved a psychotherapeutic session with a 60-year-old man I have been seeing for several years. The second experience was my reading of the recently published Baylor Religious Survey.1
The patient, abused as a child, was a successful attorney whose solo practice focused on wills and trusts. He was a quiet, self-effacing man with pervasive self-esteem problems. Neither of his two marriages had survived, and his life had been mostly solitary for the past eight years. His only consistent social interaction involved a Bible study group, the members of which shared his fundamentalist orientation. During the interview, he described his belief that the end-time was rapidly approaching. He recounted the details of that scenario, stopped abruptly, and then said, "You don't believe any of this, do you?"
"Is it important to you that I do?" I responded.
"I know you don't," he said with much finality.
"And how is that for you?" I asked quietly.
"I really wish you believed as I do," he said, "but our work together is very important to me."
"So you value our work but have to struggle with my having a different belief system?"
"Yeah, I wish it was the same," he said sadly.
"I think each of us needs a belief system to search for the meaning in our lives. The key issue for me is respecting each other's beliefs," I responded.
"Sometimes I feel that's a cop-out, a way of trying to explain something away," he said without rancor.
"You may be right," I said. "It feels to me more like we're trying to deal openly with some differences so that they won't impede our work together. But, I'm glad you can tell me it feels sometimes like a cop-out to you."