Which God?

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."

This interchange went on for the remainder of the session. We talked about a number of implications of different belief systems, including feeling connected, managing doubt, and struggling to trust.

Later that day I pondered this session, wondering whether my way of dealing with the differences in our belief systems had been helpful. If memory serves me right, this was one of very few direct explorations of such differences in more than 50 years of practice. I reassured myself that after two years in therapy he had initiated our exploration and that meant that at some level he was trusting enough to take such a step. I also reminded myself that at a purely psychological level I believed his belief system-with its promise of being chosen-and his Bible study group were, for him, important adaptive processes. It also seemed impressive that he could confront my efforts to change the focus (from his theological end-time to my psychological tolerance) as a cop-out. Most of all I hoped that my responses had been sufficiently respectful.

He did not reintroduce the topic during subsequent sessions. There is no obvious evidence of a change in our working alliance, and, at the time of this writing, I continue to be watchful. There are no guidelines, however, about dealing with such complex issues.

It was, therefore, with much interest that I read the Baylor Religious Survey.¹ Based on a nationally representative sample of 1721 persons' responses to a nearly 400-item questionnaire, the survey is said to be the most extensive of its kind ever accomplished.

It is interesting reading for clinicians. I did not, however, hope for answers to my issues of psychotherapeutic process. Rather, I anticipated helpful data about religious belief systems. In this I was not disappointed. The authors chose to factor-analyze the subjects' responses to 29 of the items having to do with the nature of God. They found two distinct factors: God's level of engagement in one's personal life and world affairs and the extent to which God was believed to be critical and punitive. They next divided the respondents into those who were high and low on the engagement factor and those who were high and low on God's criticalness. Next, they constructed four groups: high engagement-high criticalness (authoritarian), high engagement-low criticalness (benevolent), low engagement-high criticalness (critical), and low engagement-low criticalness (distant). Although this approach to managing data is common and well accepted in many of the social sciences, some clinicians believe its major concern is numbers and not people, and as such, tells us little, if anything, about the real lives of real persons. With this caveat in mind, what do these different ways of thinking about God reveal?

The authoritarian concept of God (31%) involves the belief that God is highly involved in both one's personal life and world events. He punishes those who do not follow his mandates. Persons with this orientation believe that the Bible is factual and an infallible guide to life. They are more likely to have less education and income and to be women, blacks, and evangelical Protestants. They are also more likely to believe that premarital sex and abortion are always wrong. As a group they also are more supportive of the present Administration and the war in Iraq.

Those with a benevolent concept of God (23%) also believe that God is very involved in both one's personal life and world affairs, but emphasize His loving nature rather than His punitiveness. They also are less likely to be Biblical literalists. In other ways (demographic, moral premises, and political conservatism) they are much like those with an authoritarian orientation.

The critical orientation (16%) involves believing in a God who is distant and uninvolved in personal affairs or world events but who does punish (in another life) those who have not followed His precepts. Persons with this orientation are less apt to be absolute about moral issues and tend to follow a less conservative political philosophy.

The distant concept of God (24%) involves those who believe God is a force in nature (rather than the "He" often endorsed by the other groups). Persons with this orientation are more likely to be better educated men with higher incomes and more liberal political orientations-much like the 5% of the sample who defined themselves as atheists.

These data, though not surprising, add an empirical foundation to that which many have surmised. The data also help locate my patient among those whose concept of God is authoritarian in believing that He will punish nonbelievers during the end-time. One way of understanding the adaptive significance of my patient's belief system is to put it in the context of his childhood relationship with an abusive father who never expressed acceptance or affection. The patient's belief system involves a dangerous God who does, however, accept and love him. This interpretive stance reflects Rizzuto's writings² about the parental origins of concepts (and internal representations) of God.

All of this underscores the importance for psychotherapists to be attentive to differences in belief systems, to reflect genuine respect for those that differ from their own, and to think through the ways in which belief systems may have adaptive significance.