Journal of Religion and Health, Vol. 31, No. 2, Summer 1992
The Role of Faith in the P s y c h o t h e r a p e u t i c Context RONALD E. HOPSON ABSTRACT: The focus of this article is the role of faith in psychotherapy. It is suggested that the psychotherapeutic endeavor may be fruitfully informed by insights from other disciplines. The theologian Paul Tillich's view of faith is discussed as it applies to the psychotherapeutic endeavor. The relation between faith and anxiety is explored in the context of the problem of resistance and change in psychotherapy. The work of theorists from various perspectives (existential, analytic) is discussed in the light of Tillich's view of faith.
Ernest Becker, 1 Marvin Goldfried,2 and Phillip Cushman 3 have called for an understanding of human functioning that integrates findings from various paradigms and disciplines. Becker states " . . . human action defies fragmentat i o n . . , and, unhappily, it is just this fragmentation that we are used to when we parcel out the human phenomenon among various disciplines. TM The discipline of therapeutic psychology is as susceptible to a fragmented view of human phenomena as are the disciplines of medicine, sociology, theology, and others. The purpose of this article is to heed Becker's warning and bring the insights of the theologian Paul Tillich to bear on the issue of psychotherapeutic change. It is suggested herein that the understanding of faith that Tillich explicates is a salient aspect of the healing process in psychotherapy. Homans has delineated various areas of congruence between Freud and Tillich. 5 Ritter has outlined some areas of agreement between Tillich and Rollo May in their understanding of the nature of anxiety2 This article places Tillich's discussion of anxiety in the context of faith and attempts to explicate Tillich's view of faith as it is relevant to the success of the psychotherapeutic enterprise. The writings of various psychotherapy theoreticians will be discussed as they relate to Tillich's view of faith.
Ronald E. Hopson, PhD, is Assistant Professor in the Department of Psychology at the University of Tennessee in Knoxville. 95
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Introduction
The question of the therapeutic aspect of psychotherapy has received extensive attention since the advent of the "talking cure. ''7 Various theoretical schools differ in their view of the fundamental therapeutic agent in psychotherapy. Classic psychoanalysis views the fundamental curative element to be accurate, appropriately timed interpretation of the patient's inappropriate libidinal strivings in the transference relationship. 8 Change is accomplished by working through of the exigencies of the therapeutic relationship (the transference), resolving fixations, and freeing libido to attach t o genital levels of development. Ego psychology suggests that therapeutic remediation is achieved through positive identification with the therapist. This facilitates internalization of the therapist as an auxiliary ego by the patient, thus providing "new" ego capacities for sublimation and appropriate management of libidinal strivings. 9 Object relations theory posits change as a function of the interpersonal relationship between the therapist and the patient. The therapist's empathic responses to the patient's strivings for appropriately gratifying relationships facilitate the integration of previously dissociated aspects of the self, the reestablishment of a secure and appropriate attachment to others, and internalization of the capacity for appropriate self-soothing functions. 1~ Cognitive and behavioral schools of therapy focus upon the mental processes and the environmental concomitants which must be altered for change to occur. H These traditions delineate a technology of healing. Applebaum argues that psychotherapy is a part of a much older tradition of healing for which there are common unifying elements. The particular elements of these theories dictate differing behaviors within the therapy session. Beyond these different behavioral requirements, Applebaum suggests it is also important to attend to " . . . the common factors that transcend designated healing procedures [and create] a particular kind of reality. ''12 Several studies of the psychotherapeutic process have attempted to delineate the common factors that facilitate healing in psychotherapy. Applebaum suggests the factors that make up the healing context include "a primitive level of reality and experience, with heightened suggestibility, more feeling and less cognition, needfulness, and the expectation of external help with that need. ''13 These factors form a "basic, fundamental, primitive" context within which the work of therapy occurs. Frank suggests that a therapeutic context is one that fosters a reduction of the state of demoralization of a patient by the "therapist's ability to win the patient's trust and inspire his hopes, and to enlist his active participation in the therapeutic process. ''14 Rogers suggests that the atmosphere created by the therapist is crucial to the outcome of the therapeutic endeavor. ~5The therapist must communicate three basic characteristics in order to facilitate therapeutic success: 1) empathic understanding of the patient's verbal and nonverbal communications; 2) un-
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conditional positive regard for the patient; and 3) congruence between the therapist's communications and his or her internal experience. Strupp states that "psychotherapy is a series of lessons in basic t r u s t . . . [ a n d ] . . . the major task of the therapist is to bring about an experience of trust, which alone permits him to apply the requisite leverage for therapeutically influencing the patient. TM Willingness to cooperate with the therapeutic endeavor (a solid therapeutic alliance and lessening of the resistance), reliance upon the therapeutic environment to "contain" the vicissitudes of the treatment process, and belief in the efficacy of the therapeutic process have also been suggested as aspects of the therapeutic contextY These factors seem to operate independent of the particular healing technology employed. Kiev concurs, and suggests that faith is an essential underlying aspect of all healing contexts. 18 The understanding of faith as an essential element in the psychotherapeutic context may serve to link psychotherapy to the much broader tradition of healing. This linkage may allow persons from various healing traditions (medical, spiritual, social, and so on) greater possibility for dialogue and understanding.
The meaning of faith Faith is seldom discussed in the psychotherapy literature, and is rarely an explicit aspect of theory in the area of psychotherapy. The author conducted a computer search and found that of the more than 7,700 articles on psychotherapy published in the past six years, only 43 explicitly discuss the role of faith in the psychotherapeutic context. This lack of discussion in the area of psychotherapy and faith may be attributable to the almost exclusive use of the term faith within religious contexts. Using the work of Paul Tillich and others, an understanding of faith will be offered that expands faith beyond the domain of the religious, and allows the concept of faith to be usefully applied within the psychotherapeutic context. The word faith has multiple meanings. Synonyms such as hope and trust have been used to express different aspects of faith. Though faith is usually thought of as a non-rational cognitive function, the dichotomy between faith and reason has recently come under sharp criticism. The term faith is also used in relation to something in which has been invested authority, efficacy, or trust. The term faith is used predominantly in religious settings; therefore, faith is most commonly associated with a notion of divinity. 19 Faith may indeed possess religious connotations. However, this is not the only possible understanding of the term faith. Psychologists, historians, and philosophers have advanced conceptualizations of faith that go beyond cognitive definitions (for example, beliefs, doctrine). William James understood faith as "the sense of life by virtue of which man does not destroy himself, but
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lives on. It is the force by which he lives. ''2~The philosopher Gerhard Ebeling maintains that faith is greater than religious tenets; it is a fundamental category that addresses us "in [our] very being. ''21 The historian of religion Wilfred Cantwell Smith insists that religion and faith are not synonymous: Religion is tradition: " . . . faith is nourished and patterned by the tradition, it is formed and sustained by it, yet faith precedes and transcends the tradition, and in turn sustains it. F a i t h . . . is an essential human q u a l i t y . . , that is constitutive of man as human . . . . ,,22 Psychologists and psychoanalysts have also attempted to conceptualize faith from within their paradigms. James Fowler suggests that faith is "a way of moving into the force field of life. ''23 Michael Eigen uses the term faith as a category of experiencing "which is undertaken with one's whole being, all out, with all one's heart, with all one's soul, and with all one's might. ''u These conceptions of faith extend beyond religious beliefs and attitudes. Faith is understood as a way of being in the world, an orientation toward the world, manifest in feelings, thoughts, and actions. Thus, faith may be negative, constrict and delimit one's life, or faith may be positive and give rise to behaviors and attitudes that result in the expansion of life. Similarly, Paul Tillich develops a dynamic concept of faith as a state of being that extends beyond the realm of traditional religious perspectives. Faith, for Tillich, is a state of being that is revealed through one's attitudes and behaviors. It is Tillich's conceptualization of faith that may offer the most meaningful applications to the psychotherapeutic encounter.
Tillich's concept of faith Tillich's conceptualization of faith must be understood in the context of his dialectic ontology. Life is inherently paradoxical: " . . . the polarity of life and death has always colored the word 'life.'" Intrinsic to the definition of life is the reality of death. This paradox naturally engenders anxiety. Thus, anxiety is a natural aspect of the human experience.25Anxiety is rooted in the reality of death (non-being). Anxiety about death is the prototypical anxiety in which all other forms of anxiety are rooted. Tillich views the fundamental problem of human beings as confrontation with anxiety in its various manifestations. Tillich views traditional theological concepts of God as systematic attempts to manage the natural anxiety of being. This understanding closely parallels the understanding of various psychodynamic theoreticians. Freud, Sullivan, and others understand anxiety to be the primary instigating factor in fixation and defense (Freud), security operations (Sullivan), attempts to re~stablish a sense of self esteem (Sullivan), regression (Kernberg), flawed development (Kohut), and maladaptation (Winnicott and Guntrip). 26
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The natural anxiety of being m a y be adequately addressed only through faith. Faith is a state of being that facilitates action. "Faith is not an act of rational functions, as it is not an act of the unconscious, but it is an act in which both the rational and the nonrational e l e m e n t s . . , are t r a n s c e n d e d . . . [faith] is an act of the total personality. ''27 Faith has both a cognitive component and an affective component. It is both volitional and beyond the purview of the will. Faith is the vehicle through which one believes and acts, and it is also revealed through beliefs and action. "Faith is embedded in the totality of psychological processes." However, it is not derived from these processes. 2s Faith has as its object that which is rendered of ultimate concern, or of first priority (God, money, professional success, and so o n ) - - t h u s the formula "faith in." Those things that are rendered of ultimate concern may be "true ultimacies" or "false ultimacies." False ultimacies are " . . . preliminary, finite realities [which] are elevated to the rank of ultimacy." Tillich labels faith based upon "finite realities" idolatrous faith. "Idolatrous faith is faith, and as such, the centered act of a personality, [however] the centering point is something which is more or less on the periphery; . . . therefore, the act of idolatrous faith leads to a loss of the center and to a disruption of the personality." Tillich understands that which is "truly ultimate" as that which can convey a sense of security, worth, and efficacy that transcends any particulars of existence. True ultimacies ground the individual in a context that maintains the ultimate value of the individual despite "finite realities" which m a y be devaluing and negating. ~9 It should be noted here that Tillich does not view true ultimacies as involving necessarily a concept of God as is taught in various religious traditions. Rather, Tillich points toward Transcendence (God beyond god) which supersedes the "transference god" of traditional theological reflection2 ~ Tillich calls for the destruction of the limited view of God as espoused by traditional theology. Indeed, Tillich has been highly criticized for this view of faith21 Faith that has as its object "true ultimacies" is "absolute faith." Absolute faith embraces the natural anxiety of being in all of its potential manifestations. Paradoxically, faith begins at the point of greatest doubt (despair, the moment of potentially overwhelming anxiety): "There is no faith without an intrinsic 'in spite of and the courageous affirmation of o n e s e l f . . . . The faith which makes the courage of despair possible is the acceptance of the power of being, even in the grip of nonbeing . . . . The act of accepting meaninglessness is in itself a meaningful act." However, faith does not remain in despair. Hope and being are affirmed in the act of embracing despair. Tillich describes this as the courage to be. Absolute faith relates the person to a "ground of being" that provides the vitality required to endure in the face of potentially overwhelming anxiety. "Absolute faith is the state of being grasped by the power of being itself. The courage to be is an expression of faith and what faith means must be understood through the courage to be. Therefbre, it is both the courage of despair and the courage in and above every courage. "32
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This understanding of faith maintains the focus that Miller calls for in the therapeutic context: "Therapists are all too willing to translate the patient's concern about life and his life into concerns about one thing or another along his way." The focus upon concerns about one thing or another may obscure the greater task of reworking one's faith. 33
The relevance of faith to the psychotherapeutic process This view of the nature of faith bears direct relevance to the unique difficulties encountered in the process of psychotherapy. Most views of psychotherapy maintain that anxiety is a necessary component of the process24 The relation between faith and anxiety as set forth by Tillich may be especially relevant to the success of the psychotherapeutic endeavor. The purpose of most voluntary psychotherapeutic endeavors is to seek relief from personal distress. This relief often requires that persons change. However, change is often difficult to embrace: "Psychopathology in its infinite variations reflects our unconscious commitment to stasis . . . and deep loyalty to the familiar. ''3~ The person undergoing psychotherapy must be willing to change. Wheelis, Bugental, and Applebaum point to the importance of the will in bringing about change2 6 Insight must be "linked with action as fueled by the will ''37 in order for life changes to occur. However, some persons fail to make the necessary or desired life changes that are the goal of most psychotherapeutic endeavors2 8 The failure to change despite appropriate psychotherapeutic intervention may be considered a special case of the problem of resistance. 39 Mitchell has suggested that " . . . to tolerate the new sense of aloneness that emerges with giving up the fantasied contact with [significant others] which psychopathology often provides, the analysand must begin to believe that another world is possible. ''4~ Belief that another world is possible involves willingness to face the anxiety that attends entry into "another world." Thus, the problem of resistance to change in psychotherapy may be the nexus within which Tillich's view of faith becomes most relevant. The basic emotional component of the phenomenon of resistance is anxiety. Anxiety signals a threatened loss of some familiar relationship or experience and the onset of new unfamiliar patterns. 41The signal function of anxiety was the central understanding of anxiety advanced by Freud in his early work. 4~ Anxiety functioned to signal the individual that some socially proscribed impulse was striving for expression. Sullivan maintained the anticipatory nature of anxiety. However, he understood the causal nexus of anxiety to be interpersonal rather than instinctual. 43 The individual develops an identity organized around the avoidance of anxiety. Attitudes and behaviors are maintained that minimize the potential for the onset of anxiety. As psychotherapeutic endeavor aims to change attitudes and behaviors, anxiety will be a result of the process.
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Bugental and Bugental extend the concept of resistance to change in psychotherapy. They suggest that resistance is the signal of a threat to something beyond the particulars of the patient's life (for example, losing a relationship, changing jobs). Resistance is a threat to the patient's being and sense of continuity in timeJ 4 This theme is also present in Kohut's understanding of the nature of anxiety. Contemplation of change may result in significant anxiety as the individual is, in effect, contemplating the "death" of a way of being. Excessive anxiety may portend fragmentation and the loss of one's sense of self as the self has been known. 45 To change involves the construction of a "new life" of which the person can have little or no prior knowledge. Therefore, the normal anxiety that attends confrontation of an unknown should be anticipated and respected. Bugental and Bugental maintain that the therapist's stance should be one of alliance with this resistance while continually demonstrating "to the client the professional's genuine conviction that the client can protect what is threatened while yet relinquishing what is threatening or crippling the patient's life. This strong affirmation of the client's potency does much to support readiness to move toward change. ''~ Acknowledging the reality of one's potency in the face of anxiety is the act of courage to which Tillich points in his understanding of faith. Tillich's view of faith is also relevant for psychoanalytic views of therapy. Wilfred Bion also views faith as previously outlined as an explicit element in the psychotherapeutic processY He maintains that therapeutic change is accompanied by intense anxiety. This anxiety threatens to overwhelm the patient. However, despite the potentially overwhelming aspects of this anxiety, the patient is encouraged to experience and speak of it. In the moment of potentially overwhelming anxiety, the capacity to symbolize the experience through words facilitates a sense of separateness and helps maintain one's sense of continuity in time. Expanding upon Bion's view, Eigen states that speaking of that which threatens to overwhelm insures that there remains a element of separateness from catastrophe: " . . . a difference remains between oneself and zero, however minuscule, it is infinite. ''48 The capacity to observe the moment of catastrophe and represent this experience symbolically (through language, for example, "I feel overwhelmed") manifests this element of separateness. This is the moment of faith. This is Tillich's faith as affirmation of being even in the face of potentially overwhelming anxiety (non-being). When all doing is rendered fruitless, one's being is affirmed in its simple existence. Bion suggests that in the psychotherapeutic process the therapist and patient must give attention to aspects of reality that are beyond the grasp of the intellect: "In any object, material or immaterial, resides the unknowable ultimate reality, the thing-in-itself. ''49 Writing specifically in regard to psychoanalytic psychotherapy, Bion suggests that the essential work of the psychoanalytic situation occurs beyond the manifest levels of discourse. The basic
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goal of psychoanalytic therapy is to transform the patient's ultimate psychic reality. This reality m a y be often obscured by the patient's verbalizations and the concrete "facts" of the patient's life. However, the therapist must move beyond these concrete facts and attend to the "ultimate reality" (Bion's "O") as revealed in the session: The 'act of faith' depends on disciplined denial of memory and desire . . . . The more the psycho-analyst occupies himself with memory and desire, the more his facility for harboring them increases and the nearer he comes to undermining his capacity for [faith]... this means that he cannot allow the experience ["O"] to obtrude . . . . Thus an analyst may feel, to take a common example, that his married patient is unmarried; if so, it means that psychoanalyticallyhis patient is unmarried: the emotional reality and the reality based upon the supposition of the marriage contract are discrepant2~ F a i t h is manifest in the analyst's willingness to suspend "memory and desire" in order to insure openness to the "emotional truth" of the therapeutic encounter. F a i t h is manifest in the patient's willingness to face the potentially overwhelming anxiety t h a t attends change. Despite the manifest levels of discourse in the psychoanalytic situation, the work of the process of therapy on the deepest level is a reworking of the method of m a n a g i n g the sense of potentially overwhelming anxiety (Bion: catastrophe). Eigen states: More is involved than the capacity to know [insight]. In psychoanalysis, at the levels at stake, knowledge can be part of the disease. A capacity as deep as or deeper than the sense of catastrophe must be called forth if healing or profound maturation is to occur. Bion's solution is a radical one. He fights fire with fire by moving the grounds of discourse between catastrophe and faith.51 These formulations suggest t h a t the work of psychotherapy involves the capacity to endure the n a t u r a l anxiety t h a t attends change. Tillich's understanding of faith as the capacity to endure the "natural anxiety of being" is directly applicable to this understanding. Resistance to change in psychotherapy is overcome through faith. As the patient embraces the anxiety t h a t attends change, a new more trustworthy ground of being is experienced, thus facilitating change. The creation of a new self out of dissociated, repressed, or denied aspects of the self is made possible by an act of faith. This new creation is embarked upon by an act of the total personality, an act of faith. Resistance to the creation of a new self is seen as fundamentally a crisis of f a i t h - - t h e maintenance of an old life-constricting faith, or the embracing of a new life-expanding faith. Psychotherapeutic "cure" is ontological, not intellectual. Faith is the essential element in this curative process. Eigen states: "One might call the psychoanalytic attitude a scientific use of faith. ''~ That almost forgotten declara-
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tion by the founder of psychoanalysis emerges as crucial: " . . . hope and faith [are] an effective force with which we have to r e c k o n . . , in all our attempts at t r e a t m e n t and cure. "~3
Summary This discussion has brought together insights from the disciplines of theology and psychology to bear on the issue of healing in psychotherapy. It has been suggested that faith, as explicated by Paul Tillich, is a salient aspect of the psychotherapeutic encounter. Tillich has defined faith as an act of the total personality resulting from the nature of one's relationship to that which is of ultimate concern. The nature of one's faith is revealed in the manner in which anxiety is met. Various psychotherapy theorists from differing theoretical orientations concur with this view of the meaning and function of faith and suggest that faith provides the essence of the capacity to move through anxiety to change2 4 Faith affirms anxiety as a fundamental element of our existence; yet it asserts courage as the basis of the will and capacity to change.
References 1. Becker, E., The Birth and Death of Meaning. New York, The Free Press, 1962. 2. Godfried, M., "Toward the Delineation of Therapeutic Change Principles," The Amer. Psychologist, 1980, 35, 11, 991-999; Greenberg, L. S., and Pinsof, W. M., eds., The Psychotherapeutic Process: A Research Handbook. New York, Gilford Press, 1986. 3. Cushman, P., "Why the Self Is Empty: Toward an Historically Situated Psychology," Amer. Psychologist, 1990, 45, 5, 599-611. 4. Becker, op. cit. 5. Homans, P., "Toward a Psychology of Religion by Way of Freud and Tillich." In Homans, P., ed., The Dialogue Between Theology and Psychology. Chicago, University of Chicago Press, 1968. 6. Ritter, H., "Anxiety," J. Religion and Health, 1962, 29, 1. 7. Hobbs, N., "Sources of Gain in Psychotherapy," Amer. Psychologist, 1962, 17, 741-747; Rogers, C., On Becoming a Person. Boston, Houghton Mifflin, 1961; Freud, S., Introductory Lectures on Psychoanalysis. New York, W.W. Norton & Co., 1966; Langs, R., Psychotherapy: A Basic Text. New York~ Jason Aronson, Inc., 1982, Greenberg and Pinsoff, eds., op. cir. 8. Fenichel, O., The Psychoanalytic Theory of Neuroses. New York, W. W. Norton & Co., 1945. 9. Blanck, G., Ego Psychology: Theory and Practice. New York, Columbia University Press, 1974. 10. Bowlby, J., Attachment and Loss. New York, Basic Books Inc, 1980; Winnicott, D.W., Playing and Reality. London, Tavistock Publications, 1971; Guntrip, H., Psychoanalytic Theory, Therapy and the Self. New York, Basic Books Inc., 1973; Kohut, H., How Does Analysis Cure? Chicago, The University of Chicago Press, 1984; Cashdan, S., Object Relation Therapy. New York, W.W. Norton & Co, 1988; Mitchell, S., Relational Concepts in Psychoanalysis: An Integration. Cambridge, Harvard University Press, 1988. 11. Beck, A., Cognitive Therapy and the Emotional Disorders. New York, New American Publishers, 1976; Mahoney, M., Cognition and Behavior Modification. Cambridge, Mass., Ballinger Publishing Co, 1974.
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12. Applebaum, S., "Psychoanalytic Therapy: A Subset of Healing," Psychotherapy, 1988, 25 2, 201-208. 13. Ibid. 14. Frank, J., Persuasion and Healing. Baltimore, The Johns Hopkins University Press, 1973, p. 261. 15. Rogers, C., "The Necessary and Sufficient Conditions of Therapeutic Personality Change," J. Consulting Psychology, 1957 21, 95-103. 16. Strupp, H., "On the Technology of Psychotherapy," Archives of General Psychiatry, 1972, 26, 270-278. 17. Chessick, R., Why Psychotherapists Fail. New York, Science House, 1971; Bion, W., Attention and Interpretation. New York, Basic Books Inc., 1970; Langs, op. cit.; Alexander, L., and Luborsky, L., "The Penn Helping Alliance Scales." In Greenberg and Pinsoff, eds., op. cit. 18. Strupp, op. cit.; Kiev, A., Magic, Faith and Healing. New York, Free Press of Glencoe, 1964. 19. Watts, F., and Williams, M., The Psychology of Religious Knowing. Cambridge, Cambridge University Press, 1988. 20. James. W., The Varieties of Religious Experience. New York, MacMillan Publishing Co., Inc., 1961. 21. Ebeling, G., The Nature of Faith, R. G. Smith, trans. Philadelphia, Fortress Press, 1961. 22. Smith, W., Faith and Belief. Princeton, N.J., Princeton University Press, 1979. 23. Fowler, J., Stages of Faith: The Psychology of Human Development and the Quest for Meaning. San Francisco, Harper & Row, 1981. 24. Eigen, M., "The Area of Faith in Winnicott, Lacan and Bion," International J. Psychoanalysis, 1981, 62, 413-433. 25. Tillich, P., Systematic Theology, Volume III. Chicago, The University of Chicago Press, 1963; The Courage to Be. New Haven, Yale University Press, 1969. 26. Freud, S., The Complete Psychological Works of Sigmund Freud, Vol. 7, Strachey, trans, and ed. London, Hogarth Press. Cited in: Frank, J.; Hoehn-Saric, R.; Imber, S.; Liberman, Bernard L.; and Stone, A., Effective Ingredients of Successful Psychotherapy. New York, Brunner/Mazel Publishers, 1978; Sullivan, H., The Interpersonal Theory of Psychiatry. New York, W.W. Norton & Co., Inc, 1953; Kernberg, O., Borderline Conditions and Pathological Narcissism. New York, Jason Aronson, Ine, 1975; Kohut, op. cit.; Winnicott, D.W., The Maturational Processes and the Facilitating Environment. New York, International University Press, 1965; Guntrip, op. eit. 27. Tillich, op. cit. 28. Ibid. 29. , Dynamics of Faith. New York, Harper & Row Publishers, 1957. 30. Homans, op. cit.; Tillich, Dynamics of Faith, op. cit. 31. Oden, T., Contemporary Theology and Psychotherapy. Philadelphia, The Westminister Press, 1967. 32. Tillich, Dynamics of Faith, op. cit. 33. Miller, M., "Time and the Character Disorder," J. Nervous and Mental Disease, 1964, 138, 6, 535-540; Bugental, J., Psychotherapy and Process: The Fundamentals of an Existential-Humanistic Approach. Reading, Mass., Addison-Wesley, 1978. 34. Greenberg, op. cit. 35. Mitchell, op. cit. 36. Wheelis, A., "Will and Psychoanalysis," J. Amer. Psychoanalytic Association, 1956, 4 285-303. 37. Applebaum, op. cit. 38. Hobbs, op. cit.; Bugental, J., and Bugental, E., "A Fate Worse Than Death: The Fear of Changing," Psychotherapy, 1984, 21,543-49. 39. Brenner, C., "Working Through: 1914-1984," Psychoanalytic Quarterly, 1987, 56, 1. 40. Mitchell, op. cit. 41. Fromm-Reichman, F., Principles of Intensive Psychotherapy. Chicago, The University of Chicago Press, 1950; Fialkow, N., and Muslin, H., "Working Through: A Cornerstone of Psychotherapy," Amer. J. Psychotherapy, 1987, 41, 3. 42. Freud, S., The Problem of Anxiety. New York, W.W. Norton and Co. Inc., 1936. 43. Sullivan, op. cit. 44. Bugental and Bugental, op. cit..
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45. Kohut, op. cit. 46. Bugental and Bugental, op. cit. 47. Bion, op. cir.; Elements of Psychoanalysis. New York, Jason Aronson, 1979; Transformation. New York, Basic Books Inc. Publishers, 1983. 48. Eigen, M., "Toward Bion's Starting Point: Between Catastrophe and Faith," International J. Psychoanalysis, 1985, 66, 321-330. 49. Bion, W., Experiences in Groups. New York, Basic Books Inc, 1961. 5O. Ibid. 51. Eigen, op. cir. 52. Ibid. 53. Freud, The Complete Psychological Works of Sigmund Freud, Vol. 7, op. cit.; Frank, J.; Hoehn-Sarie, R.; Imber, S.; Liberman, B.; Stone, A., Effective Ingredients of Successful Psychotherapy. New York, Brunner/Mazel Publishers, 1978. 54. Winnicott, op. cit.; Eigen, o19. cit., Bion, Transformation, op. cit.; Bugental, op. cit.
The Role of Faith in the P s y c h o t h e r a p e u t i c Context RONALD E. HOPSON ABSTRACT: The focus of this article is the role of faith in psychotherapy. It is suggested that the psychotherapeutic endeavor may be fruitfully informed by insights from other disciplines. The theologian Paul Tillich's view of faith is discussed as it applies to the psychotherapeutic endeavor. The relation between faith and anxiety is explored in the context of the problem of resistance and change in psychotherapy. The work of theorists from various perspectives (existential, analytic) is discussed in the light of Tillich's view of faith.
Ernest Becker, 1 Marvin Goldfried,2 and Phillip Cushman 3 have called for an understanding of human functioning that integrates findings from various paradigms and disciplines. Becker states " . . . human action defies fragmentat i o n . . , and, unhappily, it is just this fragmentation that we are used to when we parcel out the human phenomenon among various disciplines. TM The discipline of therapeutic psychology is as susceptible to a fragmented view of human phenomena as are the disciplines of medicine, sociology, theology, and others. The purpose of this article is to heed Becker's warning and bring the insights of the theologian Paul Tillich to bear on the issue of psychotherapeutic change. It is suggested herein that the understanding of faith that Tillich explicates is a salient aspect of the healing process in psychotherapy. Homans has delineated various areas of congruence between Freud and Tillich. 5 Ritter has outlined some areas of agreement between Tillich and Rollo May in their understanding of the nature of anxiety2 This article places Tillich's discussion of anxiety in the context of faith and attempts to explicate Tillich's view of faith as it is relevant to the success of the psychotherapeutic enterprise. The writings of various psychotherapy theoreticians will be discussed as they relate to Tillich's view of faith.
Ronald E. Hopson, PhD, is Assistant Professor in the Department of Psychology at the University of Tennessee in Knoxville. 95
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Introduction
The question of the therapeutic aspect of psychotherapy has received extensive attention since the advent of the "talking cure. ''7 Various theoretical schools differ in their view of the fundamental therapeutic agent in psychotherapy. Classic psychoanalysis views the fundamental curative element to be accurate, appropriately timed interpretation of the patient's inappropriate libidinal strivings in the transference relationship. 8 Change is accomplished by working through of the exigencies of the therapeutic relationship (the transference), resolving fixations, and freeing libido to attach t o genital levels of development. Ego psychology suggests that therapeutic remediation is achieved through positive identification with the therapist. This facilitates internalization of the therapist as an auxiliary ego by the patient, thus providing "new" ego capacities for sublimation and appropriate management of libidinal strivings. 9 Object relations theory posits change as a function of the interpersonal relationship between the therapist and the patient. The therapist's empathic responses to the patient's strivings for appropriately gratifying relationships facilitate the integration of previously dissociated aspects of the self, the reestablishment of a secure and appropriate attachment to others, and internalization of the capacity for appropriate self-soothing functions. 1~ Cognitive and behavioral schools of therapy focus upon the mental processes and the environmental concomitants which must be altered for change to occur. H These traditions delineate a technology of healing. Applebaum argues that psychotherapy is a part of a much older tradition of healing for which there are common unifying elements. The particular elements of these theories dictate differing behaviors within the therapy session. Beyond these different behavioral requirements, Applebaum suggests it is also important to attend to " . . . the common factors that transcend designated healing procedures [and create] a particular kind of reality. ''12 Several studies of the psychotherapeutic process have attempted to delineate the common factors that facilitate healing in psychotherapy. Applebaum suggests the factors that make up the healing context include "a primitive level of reality and experience, with heightened suggestibility, more feeling and less cognition, needfulness, and the expectation of external help with that need. ''13 These factors form a "basic, fundamental, primitive" context within which the work of therapy occurs. Frank suggests that a therapeutic context is one that fosters a reduction of the state of demoralization of a patient by the "therapist's ability to win the patient's trust and inspire his hopes, and to enlist his active participation in the therapeutic process. ''14 Rogers suggests that the atmosphere created by the therapist is crucial to the outcome of the therapeutic endeavor. ~5The therapist must communicate three basic characteristics in order to facilitate therapeutic success: 1) empathic understanding of the patient's verbal and nonverbal communications; 2) un-
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conditional positive regard for the patient; and 3) congruence between the therapist's communications and his or her internal experience. Strupp states that "psychotherapy is a series of lessons in basic t r u s t . . . [ a n d ] . . . the major task of the therapist is to bring about an experience of trust, which alone permits him to apply the requisite leverage for therapeutically influencing the patient. TM Willingness to cooperate with the therapeutic endeavor (a solid therapeutic alliance and lessening of the resistance), reliance upon the therapeutic environment to "contain" the vicissitudes of the treatment process, and belief in the efficacy of the therapeutic process have also been suggested as aspects of the therapeutic contextY These factors seem to operate independent of the particular healing technology employed. Kiev concurs, and suggests that faith is an essential underlying aspect of all healing contexts. 18 The understanding of faith as an essential element in the psychotherapeutic context may serve to link psychotherapy to the much broader tradition of healing. This linkage may allow persons from various healing traditions (medical, spiritual, social, and so on) greater possibility for dialogue and understanding.
The meaning of faith Faith is seldom discussed in the psychotherapy literature, and is rarely an explicit aspect of theory in the area of psychotherapy. The author conducted a computer search and found that of the more than 7,700 articles on psychotherapy published in the past six years, only 43 explicitly discuss the role of faith in the psychotherapeutic context. This lack of discussion in the area of psychotherapy and faith may be attributable to the almost exclusive use of the term faith within religious contexts. Using the work of Paul Tillich and others, an understanding of faith will be offered that expands faith beyond the domain of the religious, and allows the concept of faith to be usefully applied within the psychotherapeutic context. The word faith has multiple meanings. Synonyms such as hope and trust have been used to express different aspects of faith. Though faith is usually thought of as a non-rational cognitive function, the dichotomy between faith and reason has recently come under sharp criticism. The term faith is also used in relation to something in which has been invested authority, efficacy, or trust. The term faith is used predominantly in religious settings; therefore, faith is most commonly associated with a notion of divinity. 19 Faith may indeed possess religious connotations. However, this is not the only possible understanding of the term faith. Psychologists, historians, and philosophers have advanced conceptualizations of faith that go beyond cognitive definitions (for example, beliefs, doctrine). William James understood faith as "the sense of life by virtue of which man does not destroy himself, but
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lives on. It is the force by which he lives. ''2~The philosopher Gerhard Ebeling maintains that faith is greater than religious tenets; it is a fundamental category that addresses us "in [our] very being. ''21 The historian of religion Wilfred Cantwell Smith insists that religion and faith are not synonymous: Religion is tradition: " . . . faith is nourished and patterned by the tradition, it is formed and sustained by it, yet faith precedes and transcends the tradition, and in turn sustains it. F a i t h . . . is an essential human q u a l i t y . . , that is constitutive of man as human . . . . ,,22 Psychologists and psychoanalysts have also attempted to conceptualize faith from within their paradigms. James Fowler suggests that faith is "a way of moving into the force field of life. ''23 Michael Eigen uses the term faith as a category of experiencing "which is undertaken with one's whole being, all out, with all one's heart, with all one's soul, and with all one's might. ''u These conceptions of faith extend beyond religious beliefs and attitudes. Faith is understood as a way of being in the world, an orientation toward the world, manifest in feelings, thoughts, and actions. Thus, faith may be negative, constrict and delimit one's life, or faith may be positive and give rise to behaviors and attitudes that result in the expansion of life. Similarly, Paul Tillich develops a dynamic concept of faith as a state of being that extends beyond the realm of traditional religious perspectives. Faith, for Tillich, is a state of being that is revealed through one's attitudes and behaviors. It is Tillich's conceptualization of faith that may offer the most meaningful applications to the psychotherapeutic encounter.
Tillich's concept of faith Tillich's conceptualization of faith must be understood in the context of his dialectic ontology. Life is inherently paradoxical: " . . . the polarity of life and death has always colored the word 'life.'" Intrinsic to the definition of life is the reality of death. This paradox naturally engenders anxiety. Thus, anxiety is a natural aspect of the human experience.25Anxiety is rooted in the reality of death (non-being). Anxiety about death is the prototypical anxiety in which all other forms of anxiety are rooted. Tillich views the fundamental problem of human beings as confrontation with anxiety in its various manifestations. Tillich views traditional theological concepts of God as systematic attempts to manage the natural anxiety of being. This understanding closely parallels the understanding of various psychodynamic theoreticians. Freud, Sullivan, and others understand anxiety to be the primary instigating factor in fixation and defense (Freud), security operations (Sullivan), attempts to re~stablish a sense of self esteem (Sullivan), regression (Kernberg), flawed development (Kohut), and maladaptation (Winnicott and Guntrip). 26
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The natural anxiety of being m a y be adequately addressed only through faith. Faith is a state of being that facilitates action. "Faith is not an act of rational functions, as it is not an act of the unconscious, but it is an act in which both the rational and the nonrational e l e m e n t s . . , are t r a n s c e n d e d . . . [faith] is an act of the total personality. ''27 Faith has both a cognitive component and an affective component. It is both volitional and beyond the purview of the will. Faith is the vehicle through which one believes and acts, and it is also revealed through beliefs and action. "Faith is embedded in the totality of psychological processes." However, it is not derived from these processes. 2s Faith has as its object that which is rendered of ultimate concern, or of first priority (God, money, professional success, and so o n ) - - t h u s the formula "faith in." Those things that are rendered of ultimate concern may be "true ultimacies" or "false ultimacies." False ultimacies are " . . . preliminary, finite realities [which] are elevated to the rank of ultimacy." Tillich labels faith based upon "finite realities" idolatrous faith. "Idolatrous faith is faith, and as such, the centered act of a personality, [however] the centering point is something which is more or less on the periphery; . . . therefore, the act of idolatrous faith leads to a loss of the center and to a disruption of the personality." Tillich understands that which is "truly ultimate" as that which can convey a sense of security, worth, and efficacy that transcends any particulars of existence. True ultimacies ground the individual in a context that maintains the ultimate value of the individual despite "finite realities" which m a y be devaluing and negating. ~9 It should be noted here that Tillich does not view true ultimacies as involving necessarily a concept of God as is taught in various religious traditions. Rather, Tillich points toward Transcendence (God beyond god) which supersedes the "transference god" of traditional theological reflection2 ~ Tillich calls for the destruction of the limited view of God as espoused by traditional theology. Indeed, Tillich has been highly criticized for this view of faith21 Faith that has as its object "true ultimacies" is "absolute faith." Absolute faith embraces the natural anxiety of being in all of its potential manifestations. Paradoxically, faith begins at the point of greatest doubt (despair, the moment of potentially overwhelming anxiety): "There is no faith without an intrinsic 'in spite of and the courageous affirmation of o n e s e l f . . . . The faith which makes the courage of despair possible is the acceptance of the power of being, even in the grip of nonbeing . . . . The act of accepting meaninglessness is in itself a meaningful act." However, faith does not remain in despair. Hope and being are affirmed in the act of embracing despair. Tillich describes this as the courage to be. Absolute faith relates the person to a "ground of being" that provides the vitality required to endure in the face of potentially overwhelming anxiety. "Absolute faith is the state of being grasped by the power of being itself. The courage to be is an expression of faith and what faith means must be understood through the courage to be. Therefbre, it is both the courage of despair and the courage in and above every courage. "32
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This understanding of faith maintains the focus that Miller calls for in the therapeutic context: "Therapists are all too willing to translate the patient's concern about life and his life into concerns about one thing or another along his way." The focus upon concerns about one thing or another may obscure the greater task of reworking one's faith. 33
The relevance of faith to the psychotherapeutic process This view of the nature of faith bears direct relevance to the unique difficulties encountered in the process of psychotherapy. Most views of psychotherapy maintain that anxiety is a necessary component of the process24 The relation between faith and anxiety as set forth by Tillich may be especially relevant to the success of the psychotherapeutic endeavor. The purpose of most voluntary psychotherapeutic endeavors is to seek relief from personal distress. This relief often requires that persons change. However, change is often difficult to embrace: "Psychopathology in its infinite variations reflects our unconscious commitment to stasis . . . and deep loyalty to the familiar. ''3~ The person undergoing psychotherapy must be willing to change. Wheelis, Bugental, and Applebaum point to the importance of the will in bringing about change2 6 Insight must be "linked with action as fueled by the will ''37 in order for life changes to occur. However, some persons fail to make the necessary or desired life changes that are the goal of most psychotherapeutic endeavors2 8 The failure to change despite appropriate psychotherapeutic intervention may be considered a special case of the problem of resistance. 39 Mitchell has suggested that " . . . to tolerate the new sense of aloneness that emerges with giving up the fantasied contact with [significant others] which psychopathology often provides, the analysand must begin to believe that another world is possible. ''4~ Belief that another world is possible involves willingness to face the anxiety that attends entry into "another world." Thus, the problem of resistance to change in psychotherapy may be the nexus within which Tillich's view of faith becomes most relevant. The basic emotional component of the phenomenon of resistance is anxiety. Anxiety signals a threatened loss of some familiar relationship or experience and the onset of new unfamiliar patterns. 41The signal function of anxiety was the central understanding of anxiety advanced by Freud in his early work. 4~ Anxiety functioned to signal the individual that some socially proscribed impulse was striving for expression. Sullivan maintained the anticipatory nature of anxiety. However, he understood the causal nexus of anxiety to be interpersonal rather than instinctual. 43 The individual develops an identity organized around the avoidance of anxiety. Attitudes and behaviors are maintained that minimize the potential for the onset of anxiety. As psychotherapeutic endeavor aims to change attitudes and behaviors, anxiety will be a result of the process.
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Bugental and Bugental extend the concept of resistance to change in psychotherapy. They suggest that resistance is the signal of a threat to something beyond the particulars of the patient's life (for example, losing a relationship, changing jobs). Resistance is a threat to the patient's being and sense of continuity in timeJ 4 This theme is also present in Kohut's understanding of the nature of anxiety. Contemplation of change may result in significant anxiety as the individual is, in effect, contemplating the "death" of a way of being. Excessive anxiety may portend fragmentation and the loss of one's sense of self as the self has been known. 45 To change involves the construction of a "new life" of which the person can have little or no prior knowledge. Therefore, the normal anxiety that attends confrontation of an unknown should be anticipated and respected. Bugental and Bugental maintain that the therapist's stance should be one of alliance with this resistance while continually demonstrating "to the client the professional's genuine conviction that the client can protect what is threatened while yet relinquishing what is threatening or crippling the patient's life. This strong affirmation of the client's potency does much to support readiness to move toward change. ''~ Acknowledging the reality of one's potency in the face of anxiety is the act of courage to which Tillich points in his understanding of faith. Tillich's view of faith is also relevant for psychoanalytic views of therapy. Wilfred Bion also views faith as previously outlined as an explicit element in the psychotherapeutic processY He maintains that therapeutic change is accompanied by intense anxiety. This anxiety threatens to overwhelm the patient. However, despite the potentially overwhelming aspects of this anxiety, the patient is encouraged to experience and speak of it. In the moment of potentially overwhelming anxiety, the capacity to symbolize the experience through words facilitates a sense of separateness and helps maintain one's sense of continuity in time. Expanding upon Bion's view, Eigen states that speaking of that which threatens to overwhelm insures that there remains a element of separateness from catastrophe: " . . . a difference remains between oneself and zero, however minuscule, it is infinite. ''48 The capacity to observe the moment of catastrophe and represent this experience symbolically (through language, for example, "I feel overwhelmed") manifests this element of separateness. This is the moment of faith. This is Tillich's faith as affirmation of being even in the face of potentially overwhelming anxiety (non-being). When all doing is rendered fruitless, one's being is affirmed in its simple existence. Bion suggests that in the psychotherapeutic process the therapist and patient must give attention to aspects of reality that are beyond the grasp of the intellect: "In any object, material or immaterial, resides the unknowable ultimate reality, the thing-in-itself. ''49 Writing specifically in regard to psychoanalytic psychotherapy, Bion suggests that the essential work of the psychoanalytic situation occurs beyond the manifest levels of discourse. The basic
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goal of psychoanalytic therapy is to transform the patient's ultimate psychic reality. This reality m a y be often obscured by the patient's verbalizations and the concrete "facts" of the patient's life. However, the therapist must move beyond these concrete facts and attend to the "ultimate reality" (Bion's "O") as revealed in the session: The 'act of faith' depends on disciplined denial of memory and desire . . . . The more the psycho-analyst occupies himself with memory and desire, the more his facility for harboring them increases and the nearer he comes to undermining his capacity for [faith]... this means that he cannot allow the experience ["O"] to obtrude . . . . Thus an analyst may feel, to take a common example, that his married patient is unmarried; if so, it means that psychoanalyticallyhis patient is unmarried: the emotional reality and the reality based upon the supposition of the marriage contract are discrepant2~ F a i t h is manifest in the analyst's willingness to suspend "memory and desire" in order to insure openness to the "emotional truth" of the therapeutic encounter. F a i t h is manifest in the patient's willingness to face the potentially overwhelming anxiety t h a t attends change. Despite the manifest levels of discourse in the psychoanalytic situation, the work of the process of therapy on the deepest level is a reworking of the method of m a n a g i n g the sense of potentially overwhelming anxiety (Bion: catastrophe). Eigen states: More is involved than the capacity to know [insight]. In psychoanalysis, at the levels at stake, knowledge can be part of the disease. A capacity as deep as or deeper than the sense of catastrophe must be called forth if healing or profound maturation is to occur. Bion's solution is a radical one. He fights fire with fire by moving the grounds of discourse between catastrophe and faith.51 These formulations suggest t h a t the work of psychotherapy involves the capacity to endure the n a t u r a l anxiety t h a t attends change. Tillich's understanding of faith as the capacity to endure the "natural anxiety of being" is directly applicable to this understanding. Resistance to change in psychotherapy is overcome through faith. As the patient embraces the anxiety t h a t attends change, a new more trustworthy ground of being is experienced, thus facilitating change. The creation of a new self out of dissociated, repressed, or denied aspects of the self is made possible by an act of faith. This new creation is embarked upon by an act of the total personality, an act of faith. Resistance to the creation of a new self is seen as fundamentally a crisis of f a i t h - - t h e maintenance of an old life-constricting faith, or the embracing of a new life-expanding faith. Psychotherapeutic "cure" is ontological, not intellectual. Faith is the essential element in this curative process. Eigen states: "One might call the psychoanalytic attitude a scientific use of faith. ''~ That almost forgotten declara-
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tion by the founder of psychoanalysis emerges as crucial: " . . . hope and faith [are] an effective force with which we have to r e c k o n . . , in all our attempts at t r e a t m e n t and cure. "~3
Summary This discussion has brought together insights from the disciplines of theology and psychology to bear on the issue of healing in psychotherapy. It has been suggested that faith, as explicated by Paul Tillich, is a salient aspect of the psychotherapeutic encounter. Tillich has defined faith as an act of the total personality resulting from the nature of one's relationship to that which is of ultimate concern. The nature of one's faith is revealed in the manner in which anxiety is met. Various psychotherapy theorists from differing theoretical orientations concur with this view of the meaning and function of faith and suggest that faith provides the essence of the capacity to move through anxiety to change2 4 Faith affirms anxiety as a fundamental element of our existence; yet it asserts courage as the basis of the will and capacity to change.
References 1. Becker, E., The Birth and Death of Meaning. New York, The Free Press, 1962. 2. Godfried, M., "Toward the Delineation of Therapeutic Change Principles," The Amer. Psychologist, 1980, 35, 11, 991-999; Greenberg, L. S., and Pinsof, W. M., eds., The Psychotherapeutic Process: A Research Handbook. New York, Gilford Press, 1986. 3. Cushman, P., "Why the Self Is Empty: Toward an Historically Situated Psychology," Amer. Psychologist, 1990, 45, 5, 599-611. 4. Becker, op. cit. 5. Homans, P., "Toward a Psychology of Religion by Way of Freud and Tillich." In Homans, P., ed., The Dialogue Between Theology and Psychology. Chicago, University of Chicago Press, 1968. 6. Ritter, H., "Anxiety," J. Religion and Health, 1962, 29, 1. 7. Hobbs, N., "Sources of Gain in Psychotherapy," Amer. Psychologist, 1962, 17, 741-747; Rogers, C., On Becoming a Person. Boston, Houghton Mifflin, 1961; Freud, S., Introductory Lectures on Psychoanalysis. New York, W.W. Norton & Co., 1966; Langs, R., Psychotherapy: A Basic Text. New York~ Jason Aronson, Inc., 1982, Greenberg and Pinsoff, eds., op. cir. 8. Fenichel, O., The Psychoanalytic Theory of Neuroses. New York, W. W. Norton & Co., 1945. 9. Blanck, G., Ego Psychology: Theory and Practice. New York, Columbia University Press, 1974. 10. Bowlby, J., Attachment and Loss. New York, Basic Books Inc, 1980; Winnicott, D.W., Playing and Reality. London, Tavistock Publications, 1971; Guntrip, H., Psychoanalytic Theory, Therapy and the Self. New York, Basic Books Inc., 1973; Kohut, H., How Does Analysis Cure? Chicago, The University of Chicago Press, 1984; Cashdan, S., Object Relation Therapy. New York, W.W. Norton & Co, 1988; Mitchell, S., Relational Concepts in Psychoanalysis: An Integration. Cambridge, Harvard University Press, 1988. 11. Beck, A., Cognitive Therapy and the Emotional Disorders. New York, New American Publishers, 1976; Mahoney, M., Cognition and Behavior Modification. Cambridge, Mass., Ballinger Publishing Co, 1974.
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12. Applebaum, S., "Psychoanalytic Therapy: A Subset of Healing," Psychotherapy, 1988, 25 2, 201-208. 13. Ibid. 14. Frank, J., Persuasion and Healing. Baltimore, The Johns Hopkins University Press, 1973, p. 261. 15. Rogers, C., "The Necessary and Sufficient Conditions of Therapeutic Personality Change," J. Consulting Psychology, 1957 21, 95-103. 16. Strupp, H., "On the Technology of Psychotherapy," Archives of General Psychiatry, 1972, 26, 270-278. 17. Chessick, R., Why Psychotherapists Fail. New York, Science House, 1971; Bion, W., Attention and Interpretation. New York, Basic Books Inc., 1970; Langs, op. cit.; Alexander, L., and Luborsky, L., "The Penn Helping Alliance Scales." In Greenberg and Pinsoff, eds., op. cit. 18. Strupp, op. cit.; Kiev, A., Magic, Faith and Healing. New York, Free Press of Glencoe, 1964. 19. Watts, F., and Williams, M., The Psychology of Religious Knowing. Cambridge, Cambridge University Press, 1988. 20. James. W., The Varieties of Religious Experience. New York, MacMillan Publishing Co., Inc., 1961. 21. Ebeling, G., The Nature of Faith, R. G. Smith, trans. Philadelphia, Fortress Press, 1961. 22. Smith, W., Faith and Belief. Princeton, N.J., Princeton University Press, 1979. 23. Fowler, J., Stages of Faith: The Psychology of Human Development and the Quest for Meaning. San Francisco, Harper & Row, 1981. 24. Eigen, M., "The Area of Faith in Winnicott, Lacan and Bion," International J. Psychoanalysis, 1981, 62, 413-433. 25. Tillich, P., Systematic Theology, Volume III. Chicago, The University of Chicago Press, 1963; The Courage to Be. New Haven, Yale University Press, 1969. 26. Freud, S., The Complete Psychological Works of Sigmund Freud, Vol. 7, Strachey, trans, and ed. London, Hogarth Press. Cited in: Frank, J.; Hoehn-Saric, R.; Imber, S.; Liberman, Bernard L.; and Stone, A., Effective Ingredients of Successful Psychotherapy. New York, Brunner/Mazel Publishers, 1978; Sullivan, H., The Interpersonal Theory of Psychiatry. New York, W.W. Norton & Co., Inc, 1953; Kernberg, O., Borderline Conditions and Pathological Narcissism. New York, Jason Aronson, Ine, 1975; Kohut, op. cit.; Winnicott, D.W., The Maturational Processes and the Facilitating Environment. New York, International University Press, 1965; Guntrip, op. eit. 27. Tillich, op. cit. 28. Ibid. 29. , Dynamics of Faith. New York, Harper & Row Publishers, 1957. 30. Homans, op. cit.; Tillich, Dynamics of Faith, op. cit. 31. Oden, T., Contemporary Theology and Psychotherapy. Philadelphia, The Westminister Press, 1967. 32. Tillich, Dynamics of Faith, op. cit. 33. Miller, M., "Time and the Character Disorder," J. Nervous and Mental Disease, 1964, 138, 6, 535-540; Bugental, J., Psychotherapy and Process: The Fundamentals of an Existential-Humanistic Approach. Reading, Mass., Addison-Wesley, 1978. 34. Greenberg, op. cit. 35. Mitchell, op. cit. 36. Wheelis, A., "Will and Psychoanalysis," J. Amer. Psychoanalytic Association, 1956, 4 285-303. 37. Applebaum, op. cit. 38. Hobbs, op. cit.; Bugental, J., and Bugental, E., "A Fate Worse Than Death: The Fear of Changing," Psychotherapy, 1984, 21,543-49. 39. Brenner, C., "Working Through: 1914-1984," Psychoanalytic Quarterly, 1987, 56, 1. 40. Mitchell, op. cit. 41. Fromm-Reichman, F., Principles of Intensive Psychotherapy. Chicago, The University of Chicago Press, 1950; Fialkow, N., and Muslin, H., "Working Through: A Cornerstone of Psychotherapy," Amer. J. Psychotherapy, 1987, 41, 3. 42. Freud, S., The Problem of Anxiety. New York, W.W. Norton and Co. Inc., 1936. 43. Sullivan, op. cit. 44. Bugental and Bugental, op. cit..
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45. Kohut, op. cit. 46. Bugental and Bugental, op. cit. 47. Bion, op. cir.; Elements of Psychoanalysis. New York, Jason Aronson, 1979; Transformation. New York, Basic Books Inc. Publishers, 1983. 48. Eigen, M., "Toward Bion's Starting Point: Between Catastrophe and Faith," International J. Psychoanalysis, 1985, 66, 321-330. 49. Bion, W., Experiences in Groups. New York, Basic Books Inc, 1961. 5O. Ibid. 51. Eigen, op. cir. 52. Ibid. 53. Freud, The Complete Psychological Works of Sigmund Freud, Vol. 7, op. cit.; Frank, J.; Hoehn-Sarie, R.; Imber, S.; Liberman, B.; Stone, A., Effective Ingredients of Successful Psychotherapy. New York, Brunner/Mazel Publishers, 1978. 54. Winnicott, op. cit.; Eigen, o19. cit., Bion, Transformation, op. cit.; Bugental, op. cit.
