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Publications: Book Reviews
Review of Soul on the Couch: Spirituality, Religion and Morality in Contemporary Psychoanalysis,

Title: Soul on the Couch: Spirituality, Religion and Morality in Contemporary Psychoanalysis,
Author: Spezzano, Charles and Gerald Gargiulo
Publisher: Hillsdale, NJ: Analytic Press, 2003 (Reprint)
Reviewed By: Diane Hahn, Winter 2005, pp. 57-60

My interest in the integration of psychoanalysis and religion began with a divine intervention. While working on my dissertation (which was going to be on anorexia and shame) I received a phone call from an evangelical fundamentalist leader whose main purpose was to convince me to cease my studies. From his perspective, healing and transformative change was answered solely with Biblical principles, thus the study of psychology was unnecessary. I was so shocked by this unsolicited plea that I prayed, mobilized my aggression, and decided to passionately pursue the empirical study of “God as a Mirroring and Idealizing Selfobject Function: It’s Influence on Self Cohesion and Mood” as my dissertation.

Five years later, a client, sincerely perplexed over my pregnant belly, exclaimed, “How can you be my therapist? Does the pastor know you’re pregnant?!” She thought that either something must be wrong with my religion, my priorities, or there was some misunderstanding between her and the pastor who referred her. I could not wholeheartedly embrace a Fundamentalist-Baptist belief system (like hers) and be a pregnant, female, nearly full-time practicing clinical psychologist, too. These roles, morals, ethics, and religious values seemed incompatible. More recently, while attending a seminar at the Tampa Bay Psychoanalytic Society, a guest analyst from a Freudian orientation asked, “How can you practice Freudian psychoanalytic concepts and hold onto ‘Fundamentalist’ doctrine?” Questions like these require an openness toward self-reflection about how we come to terms with our spirituality, religion, and morality and how the birthing and revising of our professional and spiritual selves are subtly, transferentially, or countertransferentially absorbed into the therapeutic relationships with our clients. Such questions, whether silently or boldly expressed, force us to comprehend, defend, and analyze, or at the very least, reflect upon, how our “God representations,” to use Ana-Maria Rizzuto’s (1979) term, spiritual mentors, analyst introjects, supervisory introjects, educational training, and the culture within our analytic institutions mutually and, sometimes reciprocally, influence our work as psychoanalytically informed therapists.

Soul on the Couch: Religion, Spirituality, and Morality in Contemporary Psychoanalysis, reissued by Analytic Press as part of its Relational Perspectives Book Series, invites all of us (including those who reject any God) to embrace this issue. It comprises a collection of nine essays and each contribution is valuable in its own right, as aptly pointed out by Jim Jones in the forward. I found myself recalling some of my most religiously committed clients and imagining how I could expand myself further into their spiritual and inner world. I also reminisced about my own psychoanalytic therapy and found some kindred spirits who so eloquently articulated my own experiences, both as client and as therapist.

The book begins with Gerald J. Gargiulo’s essay on “Inner Mind/Outer Mind and the Quest for the ‘I’.” He points out the differences between the cultural shaping of ourselves as individual, separate, autonomous “I”s versus a more “relational, structurally interdependent, and communal” perspective of “I.” The later is more amenable to alternative views of the unconscious, the mind, and the decoding and demystifying of the metaphors we hear. This, he notes, has significant impact on our psychoanalytic interpretations. He sees “psychoanalysis offering a spirituality that is humanly possible rather than religiously necessary …a liberation that is an ongoing task more than an accomplishment” (p. 8). He supports his position borrowing from Eckhart’s thoughts on internality as externality, and Winnicotian ideas that help redefine our ideas about the “I” as relationally interdependent and culture-bound. Analyst, client, and culture come together to create the “mind” out of which come interpretations. He challenges us to see that “spirituality is not necessarily a searching for a God we cannot know, but can be equally a capacity to find, unobtrusively in the present, whatever is holy in life” (p. 6). A rather broad lens on spirituality prepares the reader for future essays. My favorite quote is his definition of what psychoanalysis entails: Within a framework of interdependence.

“[P]sychoanalysis re-represents a spiritual tradition that has among its operational goals an individual’s capacity for communal civility (i.e., cross-identification rather than schizoid isolation; unencumbered personal presence rather than neurotic repetition; love that sees the other as other, not as a mirror or mother; and finally, work that is done competently but not necessarily self-consciously (p. 7).”

Kevin Fauteau’s essay, “Self-Reparation in Religious Experience and Creativity,” resonated so much with my own personal experiences (and those of my clients) that had I read this years ago I would have had the urge to “purge” his ideas to my analyst. He argues that despite the fact that religious experience is regressive, the dismantling of self and returning to unconscious processes that takes place in religious experience can be as reparative as the regression that takes place in experiences such as creativity and therapy. The “purging of secondary ego functions” can lead to the dismantling of the “false” self, while the return to archaic processes can be the regenerative recovery of the “true self” repressed beneath that false self. Fauteau makes excellent comparisons between the artist and religious experiences in terms of primary and secondary ego functions, regression and incubation, and fluidity of boundaries for inspiration, illumination, and reparation, to name just a few.

Drawing from Christianity, Judaism, and Buddhist religions, he answers questions such as: What makes the artist or religious person comfortable with the unconscious processes with which he now feels united, when previously these unconscious processes were deemed dangerous and hence repressed? He also makes a very strong case for how regressive experiences combined with feeling unconditionally loved (as in infancy) and in communion with God (as in the therapeutic transference) can buffer the inevitable negative transference. This allows for reparation of the underlying conflicts and hidden needs that unconsciously motivate the regression. He further elaborates on how religious maturity, and maturity in therapy, or the artist, necessitates the emergence out of the “unity” and symbiotic bliss. Why some are devoured and flooded as they go into the unconscious process and why others tolerate, transcend, and transform the experience is also elucidated

In Steven H. Knoblauch’s essay, “The Patient Who Was Touched By and Knew Nothing About God,” he presents a woman’s experience of her dying process and her use of selfobject functions and the developmental needs that are served. He draws from many psychoanalytic sources, and defends his position that, “selfobject functions (1) can occur without the use of another person; (2) are, therefore, self-initiated, and (3) are able to be sustained outside of the treatment relationship. This developmentally mature capacity utilizes experience for self-cohesion, self-sustaining… and vitalizing functions” (p. 47). He takes us through her use of deity as facilitating her need for support, her capacity to experience feelings of connection to others in her dying phase, and her use of the continuing presence and protection of God for affect integration and how the responsiveness of the therapist facilitated these selfobject functions. Knoblauch’s case illustrates a more visual and tangible view of the intertwining of spirituality, the intersubjective field, and the transferences that transpire. Not only did Knoblauch help her embrace the dying process with dignity, but with an emotional and spiritual aliveness not earlier available. He proves the point that it is never too late to let others borrow our good oxygen until they have their own use of oxygen to make available healthier selfobject relatedness, until death do us part.

In “Formulation, Psychic Space and Time: New Dimensions in Psychoanalysis and Jewish Spirituality,” Daniel J. Rothenberg utilizes his knowledge of Judaism to demonstrate new “points of contact” between religion and psychoanalysis. By looking at reason, formulation, and language; psychic space; and history, remembrance, and time, through the lenses of Soloveichik (the preeminent rabbinic-philosophical authority of this century) and comparing him in complementary fashion to numerous contemporary psychoanalytic thinkers, he clearly illuminates how spirituality (specifically Judaism) and psychoanalysis may find “linkage” where they once only saw dichotomy. I particularly liked his highlighting how claims of irrationality seem ironic in light of the fact that Jewish thought stresses “knowledge” of G-d and that man cognitively organizes his relationship with the divine. I also appreciated his examination of the function of language in religious texts and the evoking of both primary and secondary process and how he used Loewald’s “reconciliatory” view rather than dichotomizing them. He quotes that language, “... ties human beings and self and the object world, and it binds abstract thought with the bodily concreteness and power of life. In the word primary and secondary processes are reconciled.” (p. 62)

Jeffrey Rubin, in his essay “Psychoanalysis is Self-Centered,” expands our understanding of subjectivity by looking at the adaptive functions of “non-self-centered-subjectivity.” It is “characterized by heightened attentiveness, focus and clarity, attunement to the other as well as the self, non-self-preoccupied exercise of agency, a sense of unity and timelessness, and non-self-annulling immersion in whatever one is doing in the present” (p. 80). He argues that the neglect of non-self-centric subjectivity and of the spirituality for which it may be a part is an impoverished view of the self, leaving a narcissistic view of relationships and an incomplete account of morality. He presents material from a psychoanalytic treatment with a Buddhist meditator in order to show the possibilities and liabilities of psychoanalysis and Buddhism. Psychoanalysis can learn from Buddhism how to be less focused on the needs and wishes of the separate self (a Western value) and more focused on the other as well as the self. Thinking more dialectically and crediting both psychoanalysis and Buddhist viewpoints he likens them to music in which neither instrument dominates but cross-fertilization occurs. For example, psychoanalysis teaches that non-entitlement, self-abasement, and self-sabotage can masquerade as spiritual nonattachment—evading a self. Spiritual traditions can teach, for example, fluidity of boundaries that facilitates free association. He challenges us to stretch ourselves further by exploring what a “contemplative” psychoanalysis of the future could look like.

Joseph Bobrow, in his essay “Coming to Life: The Creative Intercourse of Psychoanalysis and Zen Buddhism,” also elucidates the complementary paths between psychoanalysis and Zen Buddhism practices and the potential for mutually enriching one another. Each discipline encourages expansion, recognizes reverie, encourages letting go and coming forth of our self, values an emptying of self, values truth and recognizes deception, requires an intimate path with a teacher, and acknowledges ambiguities and unknowns as pathways to enrich authenticity. Anxiety and blind spots are included in both; and integration of past and present self experiences are necessary for a more joyful, alive and authentic self. Although he simultaneously traverses the differences too, I was left with the feeling that Zen Buddhism has more in common with psychoanalysis than I had previously appreciated.

Stephen Friedlander, in “The Confluence of Psychoanalysis and Religion,” shares a refreshing personal account of his embracing of Judaism and the Oedipal issues present in his Bar Mitzvah. It was enjoyable to be invited into the inner world of an analyst whose experience of God was as real, mature, resourceful and emotionally rich as his analysis. Having personally received “blessings” of a similar ilk to Friedlander, it was pleasurable to experience communal connections, while reading this book, despite differences in doctrine. He highlights how the use of language beyond the symbolic, and reading the Torah in a personal way such that the relationship and the content of the passage itself actually becomes fleshed out in the reader’s life, produces transformative change. He was unabashedly convincing as he contrasted his psychologically sophisticated use of God with the irrational Freudian idea to dispense of a covenant with G-d.

If the seven previous essays have not convicted you how influential our religious orientation is in our sessions, Randall Sorenson’s empirical contribution just might. In “Transcendence and Intersubjectivity: The Patient’s Experience of the Analyst’s Spirituality,” he leaves no stone unturned. He addresses the philosophical, clinical and pedagogical objections to empirically testing the patients’ experience of the analyst’s spirituality. He aptly defends the linear structural equation modeling for testing narrative truths without bogging down in details, and then supplements his findings with six clinical vignettes that add a personal dimension to the study. He concludes: “For patients who happen to be religious and who are themselves clinicians, the analyst’s personal orientation towards, and analysis of, transcendence not only has a big effect on these patients’ God concepts, but also impacts their subsequent clinical work with all the other religious patients who see these therapists across their professional careers. The scale of influence is multiplicative” (p. 195). I fondly appreciate how Sorenson adds empirical truth to the complex intertwining of transcendent and “holy” encounters on the couch.

In the final essay, “On the Horizon of Authenticity: Toward a Moral Account of Psychoanalytic Therapy,” Joel Greifinger addresses the question: What is the “good life” for the analysand? Do contemporary psychoanalysts have a moral ideal of authenticity, for example, and if so, what is its influence? Despite “neutrality” do psychoanalysts subtly or not so subtly try to convert the analysand to our unspoken ideologies, philosophies, morals, and ethics? A thought-provoking discourse, which includes ideas from social-constructivist psychoanalysis and concerns from hermeneutic and moral philosophy, provides more grist for the mill to reflect upon when we are dialoguing with our patients.

This book is a reflection of the shift in the current Zeitgeist. No one was playing God, and it is no longer taboo for analysts to speak of transcendence and God, both personally and professionally. I was impressed with each contributor’s breadth of religious, moral, and psychoanalytic citations, too numerous to mention in this review. If you are looking for one book that provides a diversity of thoughts on the integration of religion, spirituality, and morality in contemporary psychoanalysis this fits the bill. My one disappointment in reading Soul on the Couch was the lack of representation from neurobiology, spirituality and attachment theory. Given that transference and transcendence experiences require intense attachments which influence regulation of affect and self-integration of self states, then one would think that the wiring would get changed, too. With all the advances in neurobiology it seems fitting to also study attachment theory and spiritual experiences, and their influence (perhaps mutual) on our neurological wiring. Daniel Siegel (1999) discusses the internal neurophysiological processes, our attachments, and how the brain interacts to shape our selves, but he does not include a religious variable. Likewise, Allan Schore (1994) has studied affect regulation, attunement, and its links between neurobiology, subjective experience, and attachment theory. Either I remain ignorant about work that integrates the spiritual attachments in this same manner, or it is still in an embryonic phase. I am not referring to the vast amount of research on health and religion (Koenig, 1998) that has already been established. Rather, I am looking forward to seeing the neurobiological context included as part of the dialogue on integration of psychoanalysis, religion, and spiritual or “holy” attachments, thus unifying soma and psyche.

Hahn, D.C. (1994). God as a mirroring and idealizing selfobject function: It’s Influence on self-cohesion and mood. An empirical study. Unpublished doctoral dissertation. DAI, 55, 07B: 3015, San Diego: California School of Professional Psychology.
Koenig (1998). Handbook of religion and mental health, San Diego: Academic Press.
Rizzuto, A.-M. (1979). The birth of the living God. Chicago: University of Chicago Press.
Schore, A.N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Erlbaum.
Siegel, D.J. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York, Guilford Press.

Diane Hahn is a clinical psychologist in private practice in Tarpon Springs, Florida. She is a member of the Tampa Bay Psychoanalytic Society and a Division 39 member.

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