For more than two decades, Kenneth Pargament and his colleagues have been elucidating a problematic gap between patients and therapists: Patients generally are more religious than therapists, and patients are more eager than therapists to address religious and spiritual concerns in psychotherapy. Moreover, psychotherapists are generally poorly trained in identifying and helping patients with religious and spiritual concerns. This gap is problematic for two reasons. First, religion and spirituality are potentially a vital resource for mental and physical health. Second, and more clinically concerning, what Pargament identifies as “spiritual struggles” are a significant contributor to mental and physical illness. In this book, Pargament and his colleague, Julie Exline, masterfully synthesize contemporary theory and research related to spiritual struggles, defined as “experiences of tension, conflict, or strain that center on whatever people view as sacred” (p. 6).
The authors’ scope is broad and inclusive: They address diverse religious traditions, persons who are spiritual but not religious, and atheists who are not immune to spiritual struggles. In toto, they are grappling with existential concerns that pertain to us all. They also encompass a wide variety of therapeutic orientations, from psychodynamic to cognitive and behavioral. They give equal weight to theory, research, and clinical practice. They have strong scientific backgrounds, not only capably reviewing the increasingly extensive research literature but also having contributed substantially to it. Crucially, they are scientists unencumbered by scientism—the view that science is the only valid pathway to knowledge and truth. They integrate science with comprehensive understanding of diverse religions, theology, and philosophy (ethics and morality).
Despite its broad scope, the book is easy to follow and assimilate because of its systematic argument and organization. The first half of the book sets the stage by articulating a conceptual understanding of spiritual struggles and their development. The basic framework is simple: Spiritual struggles, which are natural and commonplace, are like a fork in the road, potentially leading to growth or decline, wholeness or brokenness—or some combination of both. But the developmental pathways that determine the trajectories are enormously complex, and the authors bring their knowledge of research and their clinical experience to bear on articulating these complexities. Spiritual struggles can lead to psychopathology or result from psychopathology, commonly intertwined in a vicious circle. The fork in the road is an apt metaphor for psychotherapists’ role: sensitive and competent intervention (including involvement of specialists) can influence the struggling patient’s trajectory for the better. Neglecting to address patients’ religious and spiritual concerns is a major failing of mainstream psychotherapy practice and psychotherapy training.
With the foundation laid by the first half of the book, the second half delineates six (intertwined) domains of spiritual struggles: divine struggles (e.g., anger at God, feeling abandoned by God), struggles of ultimate meaning (e.g., sense of purpose, ultimate values), struggles with doubt (e.g., about beliefs or commitments), moral struggles (e.g., guilt about failing to live up to religious standards), demonic struggles (e.g., feeling influenced or attacked by the devil or evil spirits), and interpersonal struggles (e.g., conflicts with family members or congregations). The authors devote a chapter to each domain of struggles, systematically reviewing theory and research on the variety of struggles and contributors to them and then drawing out the implications for clinical practice.
This is a book for all therapists, in part because all of us will be working with clients who wish to address religious and spiritual concerns, many of whom will be engaged in spiritual struggles—more or less consciously. No less important, all therapists will grapple with broadly existential concerns in their life and their work, whether or not they take the form of religious or spiritual struggles. Many therapists, like their patients, will have grappled with spiritual struggles. One potential benefit of reading this book and taking it to heart: It might stimulate awareness of spiritual struggles and offer knowledge, wisdom, and guidance that will be personally as well as professionally valuable to psychotherapists.
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