Someone To Talk To

When we're in emotional trouble, and our friends and family get to their wits' end with trying to help us, they're likely to say, "Do you think maybe you should, um, well, you know, talk to someone?"

That's a curious phrase, don't you think? After all, we've been talking to the very folks who say it. And they obviously know that. So why the phrase, "Talk to someone"? The word "talk" must have some special meaning in this phrase.

And it does. Mental health professionals do a special kind of talk.

Freud referred to psychoanalysts as "secular pastoral workers" in his little book, "The Question of Lay Analysis." Jerome Frank, in "Persuasion and Healing," pointed out that every society has designated healers to help with personal distress-shamans or witch doctors, for instance, in early cultures. Mental health professionals play that role for us. Thomas Szasz, in "The Myth of Mental Illness," said that psychiatrists are more like ministers than physicians.

Over the decades, many others have likened mental health care to religious work - sometimes as a compliment, sometimes as an insult.

A few major figures in the history of mental health care have happily laid claim to religious tradition in explaining and justifying their work - Carl Rogers, for instance, who started his graduate school work at Union Theological Seminary. A great many of us, in private conversation, will talk about how we sometimes feel that we fill a "priestly" role.

For the most part, though, mental health care professionals see themselves as doing something completely different than anything religion has ever done. Indeed, it's common (especially among psychiatrists), to claim that religious care was a Bad Thing, and mental health care has brought The Wonders of Science to human problems, banishing religion and its ignorant superstition.

I think we could gain a great deal if we embraced the idea of pastoral care as a way to understand and shape mental health care.

In one sense, this has already started. In the last decade or so, mainstream counselors and psychotherapists have embraced Buddhism as a source of insight and healing. "Mindfulness" has become a watchword in psychotherapy, and "mindfulness" derives directly from Buddhism. Paradoxically, very few Buddhists meditate, but American psychotherapists teach Buddhist meditation, along with many Buddhist religious beliefs, to their patients.

Of course, these therapists do lots of studies to show that such practices are "effective," and that lets them claim that what they are doing is scientifically legitimate.

But that's a bit of flim-flam. No one, so far as I know, studies whether Christian, Jewish, or Islamic prayer would work as well, or teaches patients such practices. Common sense suggests, though, that these other religions would work nicely: billions of religious adherents find them effective, and there's no reason to think that psychotherapy patients wouldn't benefit as much from them as from Buddhism. Claiming special scientific legitimacy for Buddhist practices is a fig leaf.

In my next few blog posts, I'll begin exploring the notion of secular pastoral care. I say "secular" to make two points: I'm going to claim that pastoral care - a special kind of talk that every society needs, which I believe mental health professionals can provide - need not be affiliated with any religious organization, and it need not be seen as mediating any special supernatural or cosmic powers.

Mental health care can lay claim, though, to certain elements of human experience that, I believe, promote meaning, reconciliation, and peace, elements of human experience of which religion has most often been steward. That's what makes therapeutic talk special, or can. But more on that later.

  • Cathy

    I like this and look forward to your following articles. I actually started looking at mental health to understand some stuff. I realized shortly after reading through the forums of people that my sanity was saved by my belief in God - I had peace that the suffering did not. Special talk? I don't know about that - I can "special" talk without training, just from my heart. I think a lot of mental help professionals play games and most of the people seeking therapy have already been playing games or had people playing games with them so, maybe, if something spiritual - all around them, always with them comes into play - it will be real, no games. It is pretty much impossible to find either counselors or even books that approach "moral" behavior and values or the lack of them as playing any part in one's suffering.

  • Mark Dombeck, Ph.D.


    Well chosen topic as usual.

    I want to point out that there is in fact an influence, and perhaps even a strong influence, of some Christian Contemplative concepts on Dialectical Behavioral Therapy or DBT, that highly regarded creation of psychologist Marsha Linehan, originally forumulated as a way of helping people with severe borderline style personality disorders. DBT was one of the very first modern "post-cognitive" therapies to emphasize "acceptance" as an important therapy modality. You don't here as much about "acceptance" as you do about "mindfulness" these days, and that is because, as you've here pointed out, the Buddhist inspired tradition of mindfulness meditation has occupied the limelight in recent years, entering the therapy culture through Jon Kabat-Zinn's work with stress reduction (which was absolutely Buddhist inspired). Before mindfulness was the flavor of the day, Linehan's DBT did acceptance, and that was most certainly based upon a tradition of Christian meditation she was familiar with. I remember something about her saying that she recognized the similarities with the Buddhist elements later on, but was not initially influenced by that tradition.

    In a similar, but more secular vein, Steven Hayes, psychologist at Reno, created Acceptance and Committment Therapy in the 90s based on behavior-analytic principles. Essentially, he understood thoughts as mental behaviors, and became aware that people made their thoughts - which are fundamentally interpretations and not solid or permanent things - into real boundaries that limited their degrees of freedom. ACT was conceived as a preliminary step before more traditional (rationally based) cognitive therapy which utilized a distancing process to encourage people to objectify and become aware of their thoughts as emphemeral things rather than real boundaries. He essentially looked hard at behaviorism and derived from it some of the core teachings that the Buddhists had come up with several thousand years before. that doesn't do his achievement justice though - to think of it like that. The Buddha was "merely" a visionary (and I don't say that with any intent at disrespect), whereas Hayes is a visionary and a successful scientist and so was able to create a bridge that rationally inspired people might cross into the territory previously occupied by the faith-based religious. Over that bridge, and the ones constructed by Linehan and Kabat-Zinn, came our modern "mindfullness" craze.

    I wrote an essay on this topic some years ago which people might find useful to review if they are interested: "Post-Cognitive Psychotherapy".

    Your topic is spot on and I very much look forward to reading what you have to say next, but you're not quite correct in asserting that only the Buddhists have a lock on introducing religous concepts into contemporary American psychotherapy.


  • air max nike

    Thank you very much for this article!
    For a long time I have done exactly what you warn against. This article was a slap in the face - but a needed one.
    That being said, what is the value of an intuitive explanation? Is it to give a lay person an "ah-ha" moment? Is it good to have SOME understanding, even if it is "vague and mush?"