TREADING ON SACRED GROUND: GUIDANCE FROM A SCHOLAR AND A SAGE.

Tisdale, Theresa Clement

Pargament, Kenneth I. (2007).

Spiritually integrated psychotherapy: Understanding and addressing the sacred. New York, NY: The Guilford Press. Hardcover. 384 pp. $40.00. ISBN 978-1-57230-844-2.

TREADING ON SACRED GROUND: GUIDANCE FROM A SCHOLAR AND A SAGE

Kenneth I. Pargament is Professor of Psychology at Bowling Green State University, where he has been on the faculty since 1979. He has published extensively on the vital role of religion and spirituality in coping with stress and trauma, and has been a leading figure in the effort to bring a balanced view of religion and spirituality to the attention of scientists and professionals.

This book is a standout among the many books and articles that have been written in the last 20 or more years in response to the growing emphasis and interest in spirituality and religion within virtually every health-related discipline. Pargament has been a leader in the field of psychology and religion for over 30 years. His book, The psychology of religion and coping: Theory, research, and practice, broke new ground in the field in the area of understanding how religion and spirituality are a means of coping with stress and trauma. Here, he goes a step further.

In the preface, Pargament relates his intention in writing the book. It represents the fruit of a 10-year focus on "the heart and soul of religion--spirituality--how it develops and evolves over the lifespan, how it operates in everyday life, how it can be a source of solutions to problems, how it can be a problem in and of itself, and how it can be addressed in psychotherapy" (p. x).

Pargament is offering a unified perspective on human behavior that moves from a biopsychosocial model to a biopsyehosociospiritual model of persons. His desire was to provide practitioners with an empirically grounded way to think about spirituality as a foundation for clinical practice. He has done this, and more.

In addition to clinicians, those who teach and train graduate students in psychology will benefit from Pargament's skillful weaving of theory, research, and practice. The book is full of rich clinical vignettes, reviews of research, and anecdotes from his many years of teaching. As APA moves toward defining competency standards for addressing religious and spiritual issues in clinical practice, this book is an exemplary guide. Researchers will also benefit from the wealth of empirical literature Pargament reviews throughout the book and his thoughtful suggestions for future lines of inquiry.

In reading the book it was inspiring to observe and experience how Pargament is able to take what is often an ineffable and evocative topic and present it in an accessible, clear, thoughtful, and humble manner. In addition to being a careful researcher, a skilled clinician, and a patient teacher, Pargament reveals aspects of his own faith journey and in so doing invites the reader to embark on a similar quest to uncover, identify, and articulate what is most sacred for her or himself. In this way, Pargament serves as a type of spiritual director (albeit likely unintended). This I did not expect, but was heartened and enriched by this experience while reading the book. I also used the book as a text in a doctoral course I taught in Summer 2010 entitled "Spiritual Resources in Psychotherapy."

The book is organized into two main sections: Understanding the Sacred and Addressing the Sacred. Understanding the Sacred addresses the foundational question of what is spirituality, which Pargament defines as "a search for the sacred" (p. 12). The sacred includes a sacred core (God, the Divine, and Transcendent reality), but also includes whatever a person may sanctify or imbue with sacred significance, such as marriage. In explicating this foundation, Pargament draws from the literature of a number of religious traditions including Judaism, Islam, Christianity, Hinduism, and Buddhism. This is one of many remarkable features of this book; Pargament is able to draw from a wealth of richness due to his personal willingness to immerse himself in the literature and experience of different religious traditions.

In the remaining chapters of this section, Pargament presents this search for the sacred as a process that involves discovery, conservation, and transformation. These are not one-time events or sequential stages. Once a person discovers the sacred the natural inclination is to want to conserve (to build, to nurture, to guard) what one considers sacred. When adversity or trauma occurs (which is inevitable) conservation as coping occurs. When events or experiences threaten what one holds sacred, how one understands the sacred, and one's capacity to cope through conservation, spiritual struggle occurs which may lead to spiritual disengagement. These struggles and disengagement create opportunities, occasions, and sources of transformation, and in the midst of this transformation discovery occurs yet again. Spirituality for Pargament is not a one act play or a one person show. Spirituality evolves in an open, dynamic, systemic way; I found this a particularly compelling aspect of Pargament's theoretical model (as did my doctoral students). In attending to the spiritual life of a client, the sensitive clinician is encouraged to take particular note of the context, perspective, and language being used when spiritual life and experience are described as these will likely change over time and across situations.

Other chapters further illuminate the model through noting that the trajectory of these movements of discovery, conservation, and transformation may move toward decline in spiritual, psychological, and physical health if experiences are dis-integrated or may move toward growth if a client is able to integrate life experiences in a coherent, meaningful way. Pargament concludes this section with chapters that name and describe what he calls problems of spiritual destinations (small gods, false gods, and sacred clashes) and problems of spiritual pathways (problems of breadth and depth, problems of fir, problems of continuity and change).

With this empirically supported theoretical foundation in place, Pargament moves into the next section, Addressing the Sacred, by introducing his clinical model and then providing chapters on assessment and treatment. "Spiritually integrated psychotherapy," he states "is an approach to treatment that acknowledges and addresses the spirituality of the client, the spirituality of the therapist, and the process of change" (p. 176). Orienting to the spirituality of the client includes realizing that clients do not leave their spirituality at the door, that spiritual problems can be the cause of psychological problems and vice versa, and that spirituality can be a source of solutions and a source of resistance to solutions. These principles hold true for therapists as well, and additionally therapists are cautioned to self-monitor for signs of spiritual intolerance and to develop spiritual literacy, in terms of the change process, this approach affirms: a spiritual dimension of psychotherapy; that the spirituality of both client and therapist may be impacted by treatment, even when the sacred is not an explicit focus of attention; any modality of therapy can be enriched by paying more explicit attention to the spiritual dimension; psychological and spiritual change go hand in hand; and spiritually integrated psychotherapy can provide new perspectives on, and solutions to, psychological problems.

The chapters addressing assessment include initial, implicit, and explicit assessment. Clinical vignettes provide the backdrop for exploring this aspect of the clinical process and also included are sample questions and a chart of promising instruments. Chapters on the process of therapy include: drawing on spiritual strivings, knowledge, and experience; drawing on spiritual practices, relationships, and coping methods; addressing problems of spiritual destinations; and addressing problems of spiritual pathways. This range of titles and the subjects unpacked in these chapters underscores the need for depth, breadth, openness, sensitivity, skill, and self-awareness when attending the spiritual life of clients. Readers will not find merely techniques or interventions in these chapters, they will find wisdom.

Pargament concludes his book by relating an exchange he had 30 years ago at his first presentation to a department of psychology, where he spoke about religion and mental health. The chairman of the department came up to him afterwards and whispered "I am. a Catholic." After a brief comment and pause Pargament asked, "Why are we whispering?" to which the chairman replied that religion was not something talked about "around here" (p. 319). After 30 years of professional and cultural shifts, and the growing theoretical, clinical, and empirical literature on the subject, Pargament underscores that there is no need to whisper any longer.

In this valuable resource intended for practitioners, but equally useful to educators and researchers, Pargament has invited us to consider that spirituality is not just a part of life, it is the heart of life. Fully embracing this reality might revolutionize the way we conduct therapy, the way we teach, and the way we design research. In his manner of presenting this empirically-grounded theory and model for clinical practice, Pargament shows himself to he both a scholar and a sage.

REVIEWERS FOR THIS ISSUE

THERESA C. TISDALE, Ph.D., is a licensed clinical psychologist in California and a Professor of Graduate Psychology at Azusa Pacific University, where she has been on the faculty since 2001. Her academic and clinical specialties are psychodynamic psychotherapy, spiritual formation, and the integration of religion. and spirituality with clinical practice.

Reviewed by THERESA CLEMENT TISDALE, Ph.D.