In the mid-'90s, Carol Waldenburg felt like her life was out of control.
She was in a relationship she knew wasn't healthy. Her job as a mental health counselor wasn't fulfilling; she wanted to do more for people. And her Methodist faith, she felt, did nothing but condemn her.
As a therapist, she knew psychotherapy could help. But she also knew she wanted to explore her religious beliefs and doubted that would happen with most secular therapists. After all, her own training had taught her to immediately send any client who mentioned God or religion to a priest, minister or rabbi.
So she told her minister what she hoped to find in a therapist.
"I didn't necessarily want Christian counseling,'' Waldenburg says. "But I wanted someone who was going to take my faith and the part it played in my life very seriously and. . . use it as a place of healing.''
As society becomes more spiritually aware--check out Oprah, the bestseller lists, and the topics in women's magazines--therapists and their clients see a clear need for counseling that allows, and even encourages, people on the couch to talk about God.
Waldenburg ended up going to the Samaritan Counseling Center, an interfaith center for psychotherapy with offices throughout South Florida. She found a counselor who helped her explore her spiritual issues and the other areas of her life. "It changed the way I look at faith,'' she says. "I don't accept the blind dogma of the church.''
It even led to a career change: She decided to become a pastoral counselor, a therapist with theological training who incorporates faith into treatment for depression, marital troubles, family conflicts, and other problems.
Today, after three years at Duke University Divinity School, Waldenburg is a therapist at the center that helped her years ago, and loves her job.
"I feel more whole as a person, more at peace with myself and with my relationship with God,'' says Waldenburg, 36.
And she feels much better prepared and more "whole'' as a therapist, too.
"It's more than just diagnosing and treating,'' she says. "It's caring for the soul, too. Even if it's not relevant for my client, which is fine, I'm aware of their intrinsic value as a human being, as my brother or sister in the human race, and of their worth to God.''
In the past five years, more counselors, psychotherapists and social workers have challenged traditional teachings about the place of religion in therapy.
"It's hot,'' says Hugh Leavell, a secular marriage and family therapist. "Isn't spirituality always hot? It's the biggest thing in the world.''
Membership in the New York-based Center for Spirituality and Psychotherapy, for example, still grows weekly almost five years after it opened, director Henry Grayson says. He started the center to offer conferences and support for therapists and referrals for clients.
But for years universities and colleges taught prospective counselors little about religion and spirituality--except to avoid the subject with clients.
"Traditionally the fields of psychology and theology have been at odds with one another,'' Waldenburg says. "They have really met one another with suspicion and competition.''
A big part of the blame goes to the controversial "father of psychoanalysis,'' Dr. Sigmund Freud. The self-described "godless Jew'' - most famous for his belief that sexual impulses explain all neuroses - was intolerant of religion and thought healthy people should "outgrow'' their need for God.
"Freud said (God) was something that neurotic people believed in,'' says Terry Northcut, a licensed clinical social worker and professor of social work at Loyola University in Chicago. His beliefs led the clinical world to ignore God or dismiss spirituality as irrelevant.
Some churches contributed to the divide, telling troubled people to pray more or sin less, instead of acknowledging mental illness as a medical condition.
And the desire of academics to remain professional and scientific stopped universities from exploring religion or spirituality in counseling, Northcut says. They also worried that students might proselytize to clients.
"Those are legitimate concerns,'' Northcut says. "Unfortunately, it meant that the subject kind of got squelched. I found that students would ask me kind of on the sly.''
They wondered how to handle clients with beliefs that were different from their own, and how to handle aging or dying clients who almost always ask about life after death and religious issues.
Those questions--and her own interests as a graduate student in Nashville--led Northcut several years ago to start a class called "The Role of Religion and Spirituality in Psychotherapy'' at Smith College. A year ago, she taught it for the first time at Loyola and it filled up 10 minutes after class registration began.
Each semester she has dozens of new books to consider using, but she still doesn't think more than about six colleges and universities teach similar courses. Based on recent e-mails and calls from fellow professors, though, she thinks that will be changing soon. The Council of Social Work Education, a professional organization, also recently mandated that programs touch on spirituality or religion, although not necessarily with a class devoted entirely to the subject.
"It's indicative of the culture,'' Northcut says. "Clients are wanting to figure out how things fit together.''
They come--like many who seek therapy--facing a conflict and asking questions about the meaning of life, about values, about finding purpose and direction. Sometimes, like Waldenburg, they want religion or spirituality to be part of that discussion. Other times, they don't.
Either way, many therapists, especially pastoral counselors or secular therapists interested in spirituality, will ask about religious beliefs when they first meet with a new client.
Once a therapist knows a client's religious background, he or she can incorporate those views into treatment if the client desires. Waldenburg estimates that about half of her clients want their faith involved in some way in their therapy.
This may involve exploring the client's beliefs - for example, how they were formed, how they affect the person's outlook, whether those beliefs can change, and how a life decision might be viewed within the faith.
A devout Roman Catholic struggling with leaving her abusive husband, for example, might need to explore her church's ban on divorce. A pastoral counselor could help her understand the church's theological position and then decide for herself whether it would be wrong to divorce someone who is beating her.
An Orthodox Jew might turn to a pastoral counselor if a loved one dies and an autopsy--typically banned by the faith--is required.
Some clients don't even realize their faith will come up when they first seek help. They might be struggling with anger over the way they were treated by their mother, or they might be trying to decide whether to leave their spouse for someone else.
"These are all theological questions, from my perspective,'' says Bill Larrison, executive director of the Samaritan Counseling Center.
That's because these are moral conflicts and involve values, which many people developed years before in a Sunday school classroom. Therapy might mean updating those values or exploring their basis.
"I see a deeper dimension when people are coming to me with contemporary, cultural questions,'' Larrison says. "And it's helpful for me to know that's a spiritual question because that might affect the intervention I do. I might ask, 'Have you ever thought about how your faith might fit into that?' ''
The question could expose the core of a problem. It did for a woman who came to Waldenburg with marital troubles. Her husband's father had died and her husband was still grieving. The woman wasn't - because she believed her father-in-law was in heaven.
"It turned out, her husband believes that nothing happens afterward,'' Waldenburg says. "And he was very angry with her for accepting it and moving on while he was still stuck in this quagmire of misery. That was tearing them apart.''
Waldenburg helped the woman understand her husband's grieving process, and how he might take much longer to emerge because of his beliefs.
Clients Pick Degree of Religion
Many therapists try simply to listen as clients challenge a church's teachings or wrestle with their understanding of God's teachings. Others, like Laverna Cullom, a licensed clinical social worker in West Palm Beach, advertise specifically as Christian counselors, although they may treat people of all faiths.
Cullom typically starts by telling a new client her point of view: that the Bible is an excellent instruction manual for life. But she also lets clients lead the way on how much religion they want in their therapy.
"I let them know I'm not a minister. I'm a therapist,'' she says. "I'm here to help you get where you want to go. My belief system is if you use the Bible as your guide, things work out really well.''
Cullom couldn't imagine working any other way. Unlike many, she always planned to use her faith in her work, despite little available training in her graduate program. Professors instead encouraged students not to identify their own faith or beliefs, saying that could scare off potential clients.
"I really couldn't do that and I knew that,'' Cullom says. "It had to be this way right from the beginning. It's a niche, but for me it works.
"When people are hurting in their lives, they're looking for something, and if they can call on their faith to help them, it's a good thing.''