Family therapy and fundamentalism: One family therapist’s exploration of ethics and collaboration with religious fundamentalist families

Abstract

What are the therapeutic limitations of systemic psychotherapy when working with families who hold religious fundamentalist beliefs? At a time of debate about religious fundamentalism, terrorism and radicalisation, where do family therapists position themselves when confronted by extreme beliefs in the therapy room? Research suggests that the increase in modernity within our society equates not just with an increase in secularisation, but rather an increase in pluralism. Contemporary models of family therapy pay explicit attention to issues of gender, culture, ethnicity, discrimination and societal contexts. The author, therefore, proposes that family therapists need to examine their position regarding religious fundamentalism in relation to the social constructionist relativist continuum and engage with uncomfortable questions about whether they believe that fundamentalism has essentially pathological roots. This article will explore whether the dualist position within some religious movements set against a more secular psychotherapeutic and psychiatric cultural milieu can invite a fundamentalised response from clinicians. The author draws on her own work with families who hold religious fundamentalist beliefs and enquires about ethics, transparency and collaboration within family therapy practice. This article invites complex ongoing challenging questions and debate.

Keywords

Religious fundamentalism ethics critical realism religiosity

‘As a scientist, I am hostile to fundamentalist religion because it teaches us not to change our minds’.

‘The God Delusion’ by Prof. Richard Dawkins (2006)

What are the therapeutic limitations in systemic psychotherapy when working with families who hold religious fundamentalist beliefs? A basic theoretical proposition in systemic psychotherapy is the invitation to see another’s position, to go beyond our own perspective. Bateson (1972), when speaking of ‘the difference that makes the difference’, suggests that our goal in therapy is an informed spontaneity in which both therapist and patient acknowledge and learn something new; how possible, then, is it to work within a context of religious fundamentalism that teaches both the family – and potentially the therapist – to hold their position? Interestingly, Professor Dawkins suggests that fundamentalist religion teaches us to not change our minds. Is there a dichotomising effect that increases the likelihood of the therapist and therapeutic system also becoming fundamentalised towards a secular or scientific perspective?

While there has been a steady stream of papers covering the beliefs of families in therapy (Wieselberg, 1992), explorations about religion, orthodoxy, fundamentalism and gender within the systemic community (e.g. Frosh, 1997; Schnall, 2011), religiosity in training (e.g. Neden et al., 2011), extensive writing on the psychology of religion in the wider psychotherapy community (e.g. Loewenthal, 2007) and psychological explorations of the fundamentalist mind (e.g. Alderdice, 2010; Volkan, 2007), there are still few studies dealing directly with religious issues in the therapy room (Wieselberg, 1992). Little has been written on the impact of this work on the therapist and wider system in these contexts. Indeed, little has been written from a systemic perspective about the need to engage with uncomfortable internal discourses about our philosophical position regarding our own religiosity. Pocock notes that the established ‘both/and’ position in family therapy practice offers a safe container for holding the tension between multiple perspectives, but even this position must have its limits (Pocock, 2015). How do we tend to the therapeutic relationship while managing situations which may come into direct conflict with the notion of neutrality? (Palazzoli, Boscolo, Cecchin, & Prata, 1978). Do we support Lang’s suggestion that at such times ‘a clearly defined posture should be adopted and neutrality should be actively avoided in relation to many aspects of the work’ (Lang, Little, & Cronen, 1990, p. 18)?

When working systemically in these situations, perhaps we find ourselves in what Schön describes as the swampy lowland of practice, ‘where situations are confusing “messes” incapable of technical solution’. Rycroft (2004) suggests that we need to investigate this swampy lowland of practice, perhaps the messy relativism position, and puts forward an argument that ‘goes beyond the model’; ‘seeking an ethical practice based on what our clients tell us is important’ (p. 245).

Some years ago I worked systemically with a family who had previously been Jehovah’s Witnesses and became increasingly curious about the experiences they had in relation to their religious community. My client was a deeply distressed 14-year-old girl who had witnessed domestic violence from her father towards her mother. Her nights were now spent in her mother’s embrace, as her mother begged her not to kill herself. However, this was like no other family I had worked with where domestic violence had been present. There were certain characteristics of this family that seemed to be bound up in their experience of belonging to their community and then expelled from it when the husbands’ violence emerged publicly. When my client and her mother first attended family therapy, their stories had become intertwined, with interpretations and meanings that overwhelmed their life stories (Roberts, 1994). The therapeutic work that took place enabled my client and her mother to respect the integrity of each others’ stories and to see themselves as separate – though connected. The dichotomising forces that had driven the family apart had given way to a relationship situation that allowed separation without destruction. Over the course of therapy, I became interested in how this family operated within their community and what impact issues such as gender, patriarchy and hierarchy had on individuals and the family as a whole. Moreover, what impact did exploring these issues have on the wider therapeutic team and on me as the family therapist?

In the early 1970s, the term ‘fundamentalism’ referred only to those religious groups that also engaged in political or militant behaviour (Crabtree, 2012); however, following the events of 9/11 in New York, the dangers of fundamentalist thinking came into sharp focus. The term ‘fundamentalism’ now touches our lives through the media on a daily basis. We hear extensive discussion about the need to understand the ‘fundamentalist mindset’, and the risk of radicalisation has even extended into our safeguarding protocols (Department of Health, 2011). Debates rage about the language and differentiation of moderate Muslims from violent Islamic jihadists. How and where does this impact in our clinical work? We know that psychiatry’s historical relationship with organised religion has been, at best, an ambivalent one (Pies & Geppert, 2013); where does that leave psychotherapy and the increasing drive for empirical evidence-based practice?

This article will present my struggle to make sense of these ethically sensitive and complex issues. How do I manage this murky process within therapy while holding true to my collaborative and ethical position? How do I manage the wider system’s potentially fundamentalising position when confronted by ‘the other’ and the tendency to revert to fundamentalist thinking ourselves at times of crisis (Larsen, 2007)? When we work with families that hold religious beliefs that represent ‘the other’ to us, and strong constructionism no longer supports practice, do we become ‘covert realists’ as Pocock (2015) suggests? In discussion about symptom functionality, Roffman (2005) urges the family therapy field to ‘stop reactively rejecting the old in favour of the new’ (p. 267). How can we draw on ideas such as functionality and critical realism in the therapy room with these families? Frosh (1997) suggests that we need not be scared about formulating a critique of religious fundamentalism to match the well-recognised critique of patriarchy. This article draws on my own clinical practice with a number of religious fundamentalist families to enrich the discussion.¹ Relevant research, literature and clinical implications will be explored.

Philosophical position

On the fringes of religion

I come to this subject as an investigator of religious fervour, but not without my own bias. When recently asked about my religious and spiritual beliefs by one of my therapy trainees, I stumbled for words – struggling to define my broadly secular humanist, vaguely earth-bound spiritual beliefs. As a White British woman born of South African parentage, with a partly Jewish and partly ‘alternative’ background, I grew up in Brighton in the 1970s. My home at that time became an alternative haven for the liberal avant-garde, the zeitgeist of this time being ‘Thatcherite’ Britain. As I grew up, we had a succession of ‘Sanyasins’ lodging with us for a time, the followers of Bhagwan Shree Rajneesh. He was the controversial spiritual leader from India who, although later surrounded by scandal and accusation, established a philosophical connection between Eastern tradition and the Western growth movement (Guest, 2004). From Judaism to new age enlightenment, my interest in these all-encompassing beliefs was ignited. My childhood was spent on the fringes of religion.

I continue to find myself in an observatory rather than participatory relationship with religious practice. There are clear links between family resilience and religion, with a number of studies suggesting that spiritual beliefs and practices foster strong family functioning (Walsh, 2006). Frosh (1997) suggests that those perceiving religious communities from the ‘outside’ are likely to misconstrue some of the complexities of cultural life – if this is the case and I am required to challenge fundamentalism in therapy, how can I develop and nurture a more subtle understanding of these dynamics as he suggests? Since my first therapeutic work with a Jehovah’s Witness family many years ago, I have worked with various religious families in a Child and Adolescent Mental Health context, wading together in the ‘swampy lowlands of practice’ (Schön, 1983).

What do we mean by religious fundamentalism?

The term ‘religious fundamentalism’ was devised in the 1920s in United States to refer to a Christian extremist conservative movement (Mercer, 2009). The term has now spread across to a number of religions in the past 20 years and commonly applies to a literalist reading of the Bible, usually in one of the Abrahamic Faiths. The believers follow a set of absolute and unchangeable doctrines, frequently rejecting modernity. The individuals and groups who are involved in religious fundamentalism ‘believe they have a special relationship with divine power. Accordingly, they differentiate themselves from “others” in a strict fashion’ (Volkan, 2007, p. 2). The rise of fundamentalism has been linked with an existential crisis of modernity, and while some suggest that fundamentalism and postmodernism share many characteristics (Frosh, 1997), we can also understand them to be very different responses to the challenge that modernity presents. For the fundamentalist, the world is war of good against evil, in which apocalypticism inevitably requires an evil ‘other’. This ‘out-group’ is typically responsible for the suffering the subject is experiencing (Strozier, Terman, Jones, & Boyd, 2010).

The ‘fundamentalist mindset’

Fundamentalism – as identified by some as dualistic thinking, paranoia, rage in a group context and a totalised conversion experience (Strozier et al., 2010) – appears to be a growing movement in all three Abrahamic faiths (Pies & Geppert, 2013). For academics and clinicians alike, it may be helpful to consider the notion that fundamentalism is sharply different from strict orthodoxy (e.g. the Amish) in that the orthodox seek to preserve and the fundamentalists seek to change (Strozier et al., 2010). Mercer (2009) suggests that the fundamentalist is ‘driven by anxiety’, and the structure of the fundamentalist world view and the psychology that underpins it is much the same across all religions (p. 2).

Some suggest that the purpose of fundamentalism is to repair group identity, and it can be understood as a phenomenon of large group psychology (Alderdice, 2010). Many make the connection between fundamentalism and violence; however, the majority of people who hold to fundamentalist beliefs do not support overt violence in the form of terrorism. That is not to say, however, that there is not a degree of evangelical militancy in their attitude (Alderdice, 2010; Frosh, 1997).

Secular fundamentalism

The long-standing debates about the coexistence of religion, science and their diametrically opposed methodologies of enquiry have been explored by scientists and theologians alike. Professor Dawkins (2006), an evolutionary biologist, preeminent critic of creationism and author of The God Delusion, has been heavily criticised in the past for his ‘fundamentalist’ atheist position (Jha, 2012). Atheist fundamentalism, a term used by critics of atheism to make a direct comparison with religious fundamentalists, provokes a debate as to whether the term has any real meaning as atheism does not have a system of beliefs that it is possible to fundamentally subscribe to. What may be recognisable to many is the paradoxical discourse about multiculturalism in which ‘liberal secularists’ grapple with ideas about the right to defend a religious heritage and potentially legitimise intolerant religious opinions in the mistaken belief that they represent an ‘authentic voice’ of another culture (Frosh, 1997).

Critical realism and fundamentalism

And no one has the right to say that no water-babies exist, till they have seen no water-babies existing; which is quite a different thing, mind, from not seeing water-babies; and a thing which nobody ever did, or perhaps will ever do. (The Water-Babies, Charles Kingsley, 1863, pp. 79–80)

Kingsley, when writing the moral fable The Water-Babies as part satire of Darwin’s The Origin of Species and part critique of the views held by many scientists of the day, had no difficulty in reconciling his religious beliefs with science and the theory of evolution (Interesting Literature, 2015). Where does psychotherapy position itself in the debate between science and religion? We know that the more fundamentalist denominations within the major faiths are likely to be uncomfortable with the ‘humanistic’ or more secular values of psychiatry (Pies & Geppert, 2013). These are tensions common to psychiatry and psychotherapy alike.

Family therapy prides itself in an ability to manage the tension between multiple perspectives by taking the ‘both and’ position; however, as Pocock so eloquently notes, this position has its limits (Pocock, 2015). This tension touches upon the challenging dilemma faced by all systemic thinkers; ‘if to be systemic is to speak the language of non-systemic others, how does one remain systemic?’ (Larner, 2008, p. 354). In a similar discussion to that introduced by Donovan (2003) in her case to make a therapeutic reclamation of the idea of truth and reality that is also conceptualised within an ethical framework, and in a counter-argument to the ‘strong social constructionism’ that has influenced family therapy in recent years, Pocock draws on Bhaskar’s critical realism theory and suggests that a ‘moderate constructionism is necessary but not sufficient as a metatheory for systemic psychotherapy practice’ (p. 6). He posits that family therapists in practice swing between constructionism and realism, and therefore, we need a ‘metatheory’ that allows us to properly take account of this. Most significantly, this metatheory – critical realism – may be helpful to clinicians not as a theoretical idea per se, but because it offers a coherent framework from which to practice, enabling more of a ‘philosophy of practice than positivism, constructionism or pragmatism – realism needs to be brought out of the shadows if our practice is to be truly reflexive and accountable’ (Pocock, 2015, p. 15).

The critical realist position, in contrast to that of the ‘covert’ realist (Pocock, 2015), enables not only an exploration of the potential causal power of the fundamentalist position in the creation of the symptoms but also offers an understanding of the possible purpose the fundamentalist views might serve – for example, a fear of modernity. One frequent explanatory critique might reveal the operation of power in maintaining the status quo, legitimising extreme patriarchy and hierarchical authoritarianism, for example. Challenge may be necessary at this point, but perhaps the therapist needs to calculate and assess the ‘minimum sufficient challenge’ to facilitate change (Pocock, personal communication, 20 May, 2015).

The psychology of religion

There is a rumour going round that I have found God. I think this is unlikely because I have enough difficulty finding my keys, and there is empirical evidence that they exist. (The late Terry Pratchett, 2013).

Religion is as old as humankind itself and has served as the motivation behind the heights of altruism and stoicism, as well as a source of imposed cruelty and suffering (Beit-Hallahmi & Argyle, 1997). Religion unifies but also creates terrible conflict. It has been the inspiration for some of the world’s greatest works of art, music and literature, and religious ideas and behaviours have shaped all areas of human culture.

Despite the increase in secularism, we live in a growing multi-cultural and multi-ethnic society. There is extensive literature about the links between religion and mental health (see Alderdice, 2010; Loewenthal, 2007). Loewenthal (2007) explores the religious influences on mental health and questions whether ‘religion encourages perfectionism as a defence against anxiety’ (p. 81), suggesting that there is evidence to demonstrate that many forms of mental disorder will be influenced by the religious–cultural context. Many drug and alcohol recovery programmes such as Alcoholics Anonymous have used religious ideology to provide guidance to recovery, referring to a deity or a power greater than themselves (Freedman, 2014).

Durkheim believed that the ‘origins of religion lay in “collective effervescence,” that is, intense emotional arousal which strengthened social bonds’ (1915, as cited in Beit-Hallahmi & Argyle, 1997, p. 54). Walsh (2006) notes the link between family resilience and religion and also identifies that religious beliefs may become harmful if they are held too rigidly or punitively.

Many fundamentalist religious groups share specific characteristics that are common to cults such as apocalyptic beliefs, charismatic leadership, totalitarianism, alienation from the rest of the community and the use of indoctrination (Harrison, 1990; Hassan, 2000). Questions of free will and coercive persuasion are central in understanding this debate and the term ‘cult’ is an ambiguous and controversial one.

A systemic understanding of the fundamentalist family

Religious fundamentalist families will be governed by a clear set of rules, boundaries and beliefs that influence all aspects of daily life. Can we find any systemic characteristics of a ‘typical’ fundamentalist family? Undoubtedly, it would be wrong to suggest that across a myriad of cultural, racial and socio-political landscapes, religious fundamentalist families are the same; however, for the purposes of this article, I propose that fundamentalist families must share certain core characteristics that are identified below to maintain their epistemological world view.

A structural overview

Often the religious organisation rather than individual members will make the adaptations needed to cope with the cultural challenges faced by modernity. Feedback is employed to correct deviations and reinforce stability and homeostasis (Minuchin, 1974). Critical thinking within the family may be actively discouraged and democratic, fluid and flexible boundaries not only pose a threat to the structure of the family but also increase the risk of family members transgressing and being exposed to ideas and behaviours that may go against theocratic teaching. The family members may need to subscribe to a set of rigid polarised beliefs about the world, and this rigidity creates a recursive feedback loop, whereby the need for clear rigid rules and boundaries becomes reinforced (Dallos & Draper, 2005).

These boundaries protect the families from the outside world and increase the sense of group cohesion. The reinforcement of these rigid boundaries can then be understood as helping to maintain a strong sense of identity for the community and the family. Furthermore, the hostility fundamentalist families frequently face may also serve to reinforce the sense of group cohesion and identity.

Power and gender

Gender politics is one of the characteristic features of fundamentalism (Frosh, 1997). These cultures are preoccupied with their own preservation and reproduction, therefore with the socialisation process and ultimately with fertility. The responsibility for this resides not only in male religious leaders but also in women’s ‘adherence to communal values’ (Frosh, 1997, p. 423). In some patriarchal communities, the assumption of men’s right to dominate can lead to violence being used to ensure compliance, and many families in which there is a history of abuse come from an environment of excessive patriarchal structure (Goldner, Penn, Sheinberg, & Walker, 1990). Additionally, there is evidence to suggest that within authoritarian fundamentalist families, the instance of familial abuse is much higher (Larsen, 2007). These patterns of abuse often embody the cultural expectations of gender roles and identities, which can further help to develop and legitimise patterns of abuse (Goldner, 1991).

Communication and interaction

Systems and individuals must act and communicate from their unique epistemology (Dallos & Draper, 2005). Many fundamentalist groups use evangelising to communicate explicit as well as implicit beliefs to others, and a particular notable feature of this communication is the use of language. Metaphor, analogy and pictorial representations are often part of the religious symbolism which helps to create the impression of authenticity (Holden, 2002).

Interactionally, the spiritual dualism that supports only one version of the ‘truth’ creates a potential double bind for any member wishing to question the beliefs and practices of the organisation (Bateson, 1972; Bateson & Bateson, 1987). This double bind can create high levels of anxiety and ambivalence, particularly during adolescence (Bateson & Bateson, 1987). The psychoanalyst, Fairbairn, once suggested that children would rather be ‘sinners in heaven than saints in hell’. A child would rather make himself or herself wrong to make his or her parents right (Fairbairn, 1943). Although postmodern systemic thinking has rejected the modernist assertions of symptom functionality and replaced them with more tentative descriptions (Roffman, 2005), we can hypothesise that symptomatology could emerge as a failed attempted solution to the double bind experienced by a family member when questioning beliefs within that spiritual dualism. Therapeutic implications for these ideas will be explored later in the article.

Ethical considerations in the context of religious fundamentalism

The ‘other’ simultaneously becomes distinctly symbolic of those characters that a society for whatever reason, finds repulsive or alien. (Cade, 2009, p. 21)

Epistemological world view – the definition of terms and credibility

To enable family therapy to progress requires a willingness and ability to tolerate choice and alternative perspectives. This is an impossibility by definition within a purely fundamentalist family (Frosh, 1997), as the ‘truth’ is already known. On these unusual occasions when therapy is undertaken, it is usually a last resort and then only as a means to ‘lure the errant member back to the truth’ (Frosh, 1997, p. 427). Under these circumstances, the extreme nature of the mental health difficulties is then also likely to be heavily influencing the family’s willingness or ability to participate in therapy – for example, the impact of parental mental health problems within the system. The complex and subtle interplay and maintenance cycle between mental health difficulty and the rigid fundamental beliefs need to be explored. Consideration needs to be given to the therapist and family’s sense of agency, which will be determined in part by the context in which the therapy takes place. It is possible under these circumstances for the therapist to act as an advocate for the family member who wishes to be different, but Frosh suggests that the therapist at this point must recognise that within the therapeutic process, they are involved in an ideological struggle rather than the usual process of therapy. He muses as to whether this constitutes family therapy, but nevertheless suggests that if this work takes place, the therapist must knowingly under-take such a therapeutic task (Frosh, 1997).

A more typical scenario is one in which a family has been confronted by an untenable situation that challenges the fundamentalist epistemology or when the usual interventions from the religious community have had little impact and the family is desperate. In these situations, the therapists must work sensitively as it is likely that through the therapeutic process, possibly painful contradictions in the ‘fundamentalist mindset’ are likely to emerge (Frosh, 1997).

At the start of the therapeutic work, there is an attempt to define and deconstruct the problem. Ideas are explored about whether the problem is considered to be an individual phenomenon or as interpersonal and relational, caused and maintained by ongoing relational processes (Dallos & Steadman, 2009). The possible explanation of the perceived problem will potentially, in turn, impact therapeutic goals and expectations about the course of therapy ahead. The process of developing a shared formulation involves the therapist and family drawing on their own unique history and experience (Dallos & Steadman, 2009).

Therapeutic alliance – bridging religious and psychiatric values

There is extensive writing on the common factors of the therapeutic relationship across modalities (see, for example, Sprenkle & Blow, 2004), the most significant of which, in this instance, could be considered to be the credibility of the therapeutic process for the family. There is a requirement, therefore, that the epistemological view will somehow be bridged by the therapist. If what the therapist is doing does not fit with the family’s expectations, or the therapist cannot ‘sell’ the therapy on the merits of the approach, therapy is less likely to be successful (Sprenkle & Blow, 2004). Families holding these strong religious beliefs may struggle with the (perceived) secular psychotherapy/psychiatric service and fear secularising. The therapist may need to find a way of reframing the fundamentalist teachings of religion in a way that is more compatible with secular psychiatric/psychotherapeutic ethics (Pies & Geppert, 2013). For example, reframing the notion of an imposed rule or boundary as the way in which a family expresses love and care for each other may enable the therapy team and family to pull together a mutually agreed agenda for the work.

Working with the family life cycle

Developmental theorists describe the interplay between two complementary processes of differentiation and integration as the key to understanding family change (Root, Fallon, & Friedrich, 1986). Adolescence is a time that presents an additional challenge to the balance between autonomy (differentiation) and intimacy (integration) and is a common time for the onset of mental health difficulties both in young people and in the family system (Carter & McGoldrick, 1989). It is likely that most psychotherapy work with fundamentalist families within the National Health Service at least will take place at this point in the family life cycle. The fragility of this transitional life stage may also explain why late adolescence and early adulthood are the time associated with most religious conversions (Ward, 2002) and radicalisation. Young adults may struggle with true independence and religious community may act as a replacement family (Sirkin, 1990). Young people may be vulnerable to the experience of ‘love bombing’ whereby the potential convert is offered total acceptance and the promise of friendship in exchange for giving up critical thinking (Sirkin, 1990).

Within these families, there will be explicit expectations to replicate scripts from the family of origin which may be at odds with a culturally determined dominant discourse that young people will grow up to live different lives from those of their parents. Children are often encouraged to be more educated and live more ‘successful’ lives than those of previous generations. A fundamentalist group places value on strong transgenerational replicative scripts. Success is measured not by education or financial security but by religious involvement, activity and conformity. There is, however, little research-based knowledge about how and why parental religious transmission occurs and why it does not, but clearly religious identities develop in ways that are linked to the religious identities of parents (Bengtson, Putney, & Harris, 2013).

Although levels of discipline within fundamentalist families vary, second-generation members are crucial for the survival of the movement, and therefore, a transgression is viewed as potentially catastrophic for the community and the young person. Significantly, therefore, there are likely to be differing views between therapist and family on what ‘being better’ looks like. Promoting autonomy risks a rejection of the religious beliefs and practices.

Perceptions about the family – polarised thinking?

In addition to understanding the family system, as reflexive practitioners, we need to understand where we fit within the therapeutic system. How do our own preconceptions affect our understanding of religious fundamentalist groups? Pfeifer (2006) investigates the perceptions of indoctrination techniques and concludes they are based on negative schematic representations, not objective evaluations. We are all significantly affected by the ‘group label’, and our general knowledge is based primarily on indirect sources.

Research suggests that the majority of the population prefers an orientation to psychotherapy that is sensitive to a spiritual perspective and notes that the potential for greater empathy towards religious clients is highlighted by the surprising levels of ‘unexpressed religiosity that exists among mental health professionals’ (Bergin & Jensen, 1990, p. 6). They describe a blend of humanistic philosophy and spirituality that has not been well articulated and advocate this ‘spiritual humanism’, as they describe it, as a valuable aspect of any therapists’ repertoire.

In my clinical practice, I have found the following questions a helpful way of beginning to bring forth my own prejudices, and they give me an opportunity to take up a position which is most likely to create a therapeutic alliance:

How do the team and I perceive the family?

What prejudices do I and the therapy team have about this religious group?

Do we locate the ‘pathology’ of the family and system within the religious beliefs – or vice versa, and are these religious beliefs given a pathological explanation by the team?

How can we guard against/recognise a likely reversion to fundamentalist thinking at times of crises; if the work becomes too challenging or we feel strained within an under-resourced work context? (Larsen, 2007)

If I, as a more secular therapist, only have contact with families with religious fundamentalist beliefs in the context of a mental health service, how might this influence my thinking?

Might I/we over or misattribute the ‘dysfunction’ to the religion rather than family functioning?

‘How can I/we best take up the position of advocate (Frosh, 1997) for the family or a family member if the system around us over or under attributes the ‘dysfunctional’ behaviours to the religious beliefs?

How do I/we clearly define my ‘domains of action’ – what is my professional responsibility within this agency context? (Lang et al., 1990)

Splitting

A significant issue when working within a context of spiritual dualism is a propensity for splitting – within the individual psyche, the family system and/or across the therapeutic team. Dualistic thinking can cause the family and team to see others in partial terms – ‘as part-objects’ making it harder to imagine the inner world and humanity of others (Strozier et al., 2010). Clinicians may be identified as either good or bad, praise lavished on some and denied in others, a dynamic that has the tendency to be self-perpetuating and can be paralleled by how the family is viewed by the therapy team. Some aspects of the therapy and team may need to be split off completely, especially if the complex contradictions within the fundamentalist narrative have been challenged. Splitting can obviate the need to reconcile the paradox.

Vignette

Luke and his mother, who are members of a religious fundamentalist family, attend family therapy. Fifteen-year-old Luke is severely depressed, self-harming and suicidal. During the course of therapy, Luke’s mother becomes increasingly concerned that our emphasis on promoting what I and the family therapy team considered to be ‘appropriate autonomy’ in relation to his adolescence may result in him rejecting his religious community.

Mother:

‘You are turning him away from “The Truth.” Luke is doing things now that we don’t agree with in our community’.

Therapist (me):

‘I’m sorry if it feels like that to you. I have a different way of looking at it . . . The fact that he is ready to embrace these new aspects of his life [visiting non-religious friends] is testimony to how hard you have all worked at helping him feel better. What do you think?’

Mother:

‘No no. You don’t understand. The community is what’s keeping him safe’.

This was a young man who had been systematically abused by his step father within the religious community. It seemed to me that very little within the community had kept him safe. This conversation was one of many in which I grappled for some sense of shared meaning. The therapy progressed with various twists and turns. The mother in this family maintained that she did not wish to discuss her religious beliefs in therapy – but her son very much did. He wished to talk about his own beliefs, his plans to leave the religious community, his desire to go to university, to have a broad group of friends and his most painful – and at times untenable – wish to please his mother and not be rejected by his family. When I felt we had identified a shared goal, the work would change. I journeyed along with this family as the alliance shifted backwards and forwards; the son’s sense of loyalty to his mother only a mistimed question away. Luke constantly needing to modify and shift his loyalty between the family therapy team and his mother to manage both relationships. We moved backwards and forwards with him. At the end of a year, the therapy ended. This young man’s depression and self-harming had lifted and a stronger sense of self had emerged. In the process however, his mother had stopped attending family therapy. Luke generously apologised for his mother, and explained good humouredly and with great insight:

Luke:

‘Someone had to be blamed for me leaving the community – looks like it was you. You had to take the hit – sorry about that!’

Splitting can obviate the need to reconcile the paradox and Luke and his mother’s relationship had remained intact. While splitting may not have been what we had intended therapeutically, the course of therapy had enabled a sense of ‘re-integration’ for Luke. He was now able to hold and manage these complex multiple positions for himself.

Therapeutic implications

I realised that because I wasn’t in the religious community anymore, I would have to redefine myself. I needed to find out what my values and beliefs were, now that there was no one to think for me . . . (Ex-religious community member, 2006)

Systemic self-awareness and religiosity

As culturally competent clinicians, we need to have an active relationship with our experience of ‘the other’ and our own relational reflexivity (Burnham, 2005). If we consider reflexivity to be a conscious cognitive process whereby both theory and knowledge are applied to make sense of remembered reflective episodes (Dallos & Steadman, 2009), we must theorise on our understanding of our situation in terms of gender, class, ethnicity and religiosity, drawing on the ‘self-narratives’ that represent our own autobiographical accounts of our lives (Dallos & Steadman, 2009). Frosh (1997) urges clinicians not to mistake or ascribe ‘orthodoxy’ with fundamentalism and states that therapist needs to know about the diversity within the religious group more urgently that any religious ‘fact’.

‘Organising the therapeutic tasks’

In the context of significant complexity within a family system, the therapist must organise, prioritise and structure their thinking to address the requirements of the work. What becomes critical in this initial phase is the need for the therapist to hold in mind that either now or at some stage, this outlook was the most important factor in this family’s life (Moyers, 1990). At this point, we are often faced with an ethical dilemma; do we attempt to rebuild the psychological armour of the individual or family or help the cracks to widen, allowing the contradictions to become more obvious (Frosh, 1997)? Do we support the individuating process above family cohesion? Supporting an individual in an exploration of what they might consider to be untenable aspects of their religion could result in a further break-down in family functioning. This is where a double bind can come into play for the therapist and team – and decisions on the direction of the therapeutic work can only be established through clinical judgement and experience. This is also the point at which risk management and safeguarding concerns need to be considered in relation to the fundamentalist beliefs and practices. The challenge of shared decision-making faced by family therapists when working with more than one person becomes highlighted at this point – when a consensus is considered about the treatment goals and priorities (Williams, Patterson, & Edwards, 2014).

We need to attune ourselves to the family’s spiritual requirements and use explicit questions to extrapolate how the family wishes their religious and spiritual beliefs to be held in mind. Organising the therapeutic tasks may include exploration about the role of therapist and team as potential advocate for members of the family. A range of systemic techniques may be useful at this point, in particular the genogram, which can provide a wealth of information about the religious context of the family, in addition to offering a practical way of engaging the whole family in a systemic approach (McGoldrick, Gerson, & Shellenberger, 1999). Completing a cultural genogram for the therapist and team (Hardy & Laszloffy, 1995) may also provide the opportunity to reflect on the similarities and differences of their own religious backgrounds (Estrada & Haney, 1998).

Resilience

Using a family resilience approach provides a compassionate understanding of the challenges faced by families (Walsh, 2006). This approach searches for ‘unrecognised strengths’ in the network of family relationships and enables a process of resilience building that can help families become more resourceful in dealing with problems in the future (Walsh, 2006). These strengths can play a key part in the process of helping families respond to the challenges and crises they may face. Resilience is fostered when families are able to view their crisis situation in context (Walsh, 2006). Helping families to recognise what part their religious beliefs may have impacted the crisis – if possible – will be important.

Stories and metaphor

Understanding the propensity for rigidity for these families can help us to recognise how challenging the prospect of novel and flexible interactional patterns may be. The use of the reflecting team may be one way of inviting the family to consider alternative explanations and stories about their lives (Anderson, 1987), and an exploration of ‘unique outcomes’ offers a richer description of the family’s previously unstoried and more successful ways of managing difficulties (White & Epston, 1990). Metaphor may be more explicitly used and the therapists and family can then engage in a process of uncovering the meaning of the metaphors that arise out of the therapeutic process, for example, noticing when a family uses imagery or metaphor to describe interactions or phenomenon and expanding on this imagery, inviting curiosity and reflection. The use of sculptural metaphor may be valuable, creating discontinuity and interrupting the verbal processes to introduce surprise and novelty (Meyerstein, 1998).

Safety and a secure base

Families attending therapy following the rejection of their religious fundamentalist practice may experience the ‘shattered faith syndrome’ in which faith in a primary source of guidance has collapsed altogether (Moyers, 1990). Ex-believers are described as experiencing an over-whelming sense of loss and isolation which can frequently lead to severe depression (Moyers, 1990). We can understand this phenomenon systemically as the collapse of beliefs that gave meaning to the structure and organisation of people’s lives. The family previously may have held the position of ‘safe certainty’ about the world (Hardham, 2006; Mason, 1993), and without this structure, individuals may be floundering in a world of instability.

We can understand how, particularly in times of stress, conformity can be seen as ‘good’ and unconventional innovation as ‘bad’ (Larsen, 2007). Novelty and creativity can create anxiety and safety only occurs within what is familiar. Moyers (1990) describes former fundamentalists as often having a chronic dissatisfaction with life. They may ‘long for the certainty once known and express despair over their inability to regain a similar degree of security’ (p. 42). This factor may impact the therapy as families look to the therapist for safe certainty and therapists may feel pressured to take on too much responsibility for change (Dallos & Draper, 2005). Religion may be replaced by psychotherapeutic fundamentalism (Larsen, 2007), whereby the therapy provides a rigid framework to adhere to and the therapist venerated in some way. By developing an awareness of this process, we can support families shifting from their original positions of safe certainty within the religious community, towards a new position of safe uncertainty about the world (Mason, 1993).

Collaboration and a shared understanding

How can we do our best to uphold a collaborative stance when working with families whom we struggle to understand? Using a dialogical perspective in which the therapist’s inner conversation is conceptualised as a ‘dialogical self’ may be valuable (Rober, 1999, 2005). The therapist’s inner conversation is described as a dialogue between the position of the ‘experiencing self’ and the position of the ‘professional self’. The dynamic interplay between the inner voices are considered to parallel the therapist’s actions in the outer conversation with the client, finding expression in questions, while at other times suggesting silence, thus remaining unexpressed in the outer dialogue (Rober, Elliott, Buysse, Loots, & De Corte, 2008). By developing an awareness of our inner conversations, we start to elucidate our own thinking. A dialogical perspective and the use of a reflective team may again be invaluable in exploring potential splitting – elucidating the both/and position for both the family and the therapy team (Anderson, 1987).

We may invite ourselves to take different positions within which to ‘experience, reflect and to view the drama’ that goes on within and between our different selves (Neden & Cramer, 2009, p. 9). Larsen (2007) introduces the concept of our ‘inner fundamentalist’ and suggests that we all engage in fundamentalist thinking at some point. He recommends that we ‘keep it brief and proportionate, limiting it to five minutes at a time’ (p. 163). He recommends a number of exercises to keep the mind free from ‘dualistic, obsessive and authoritarian tendencies’ including mindfulness techniques and group discussions (p. 175).

Towards a shared understanding

Noticing difference is innate – we are genetically programmed to look for ‘markers of difference’ in others (Gee, 2009). This fundamental premise reminds us all as clinicians to be alert to our own bias and prejudices. When Bergin and Jensen (1990) describe the ‘religiosity gap’ between the secular profession of psychotherapy and the more religious public, they advocate that therapists use their ‘spiritual humanism’ within their clinical work. Where is the common ground? Aponte (1998) suggests that spirituality gives the ‘ultimate meaning to psychotherapy’. All forms of psychotherapy have to grapple with explicit or implicit assumptions about why we suffer and experience hurt in our relationships, and ultimately what brings healing to our lives (Aponte, 1998).

Conclusion

This article has made a detailed exploration of religious fundamentalism, drawing on clinical ideas and introducing suggestions for best practice. As systemic family therapists, we need to understand that fundamentalism is not a religion but a way of being religious. It is not only an individual or familial psychology; it is also a group ideology (Strozier et al., 2010). We need to respect the family’s existing stories and beliefs, or the family will leave therapy, but Frosh (1997) suggests that ‘the liberal framework is too weak to respond to the dangers of fundamentalism; in therapy, the least we can do is to take a stand when the opportunity offers itself’ (p. 428). He recognises that his call to arms sit uncomfortably with the liberalist framework most family therapists operate from. It is challenging to take a stand in therapy on the superiority of one world view against another but contends that ‘if the existing fundamentalist fabric was sufficient for the family there would be no need for therapy at all’ (p. 428). By clearly defining our ‘domains of action’, we can start to elucidate our ethical and professional responsibilities (Lang et al., 1990).

There is much to be learned in these most difficult situations. Lord suggests that there are no untreatable clients, only inadequate treatment modalities, and reflected that our most difficult client situations challenge us to make ‘better and better mistakes as we strive to facilitate change’ (Lord, 2015, p. 209). I would suggest, however, that while there may be no ‘untreatable clients’, there are situations in which the inevitable deconstruction of the problem lays open unbearable contradictions in the epistemology of the fundamentalist family’s world view – and it is perhaps here that we meet the limitations of therapy. I have argued that we need to reconcile liberal psychotherapist values with a critical realist perspective when working with religious fundamentalism. Pocock reminds us that we need our realist ontology. Without it, little can be said about how the therapist decides which ideas need to be brought into the dialogue in the therapeutic process (Pocock, 2015). We need to use our patience, spiritual humanism and humility as well as the more fashionable ‘curiosity’ when working in these contexts (Frosh, 1997). This article has helped to explicate the therapeutic implications of working with religious fundamentalist families, and from the therapists’ perspective, an exploration of the ‘inner fundamentalist’ can reveal how vital it is to understand this process within ourselves before we start to explore it in others.

Footnotes

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Notes

Author biography

Hannah Sherbersky is a Family Therapist and Academic at the University of Exeter, delivering on a number of programmes; the MSc in Family Therapy, Child and Young Peoples IAPT and the Doctorate in Clinical Psychology. Hannah also works clinically across the region and presents nationally on her work.

References

Alderdice

(2010). On the psychology of religious fundamentalism. In Verhagen

Van Praag

Lopez-Ibor

Cox

Moussaoui

(Eds.), Religion and psychiatry: Beyond boundaries (pp. 305–318). London, England: Wiley-Blackwell.

Anderson

(1987). The reflecting team: Dialog and meta-dialogue in clinical work. Family Process, 26, 415–428.

Aponte

(1998). Love, the spiritual wellspring of forgiveness: An example of spirituality in therapy. Journal of Family Therapy, 20, 37–58.

Bateson

(1972). Steps to an ecology of mind. New York, NY: Dutton.

Bateson

M. C.

(1987). Angels fear: Towards an epistemology of the sacred. New York, NY: Bantam.

Beit-Hallahmi

Argyle

(1997). The psychology of religious behaviour, belief and experience. London, England: Routledge.

Bengtson

Putney

Harris

(2013). Families and faith: How religion is passed down across generations. Oxford: Oxford University Press.

Bergin

A. E.

Jensen

J. P.

(1990). Religiosity of psychotherapists: A national survey. Psychotherapy: Theory, Research, Practice, Training, 27(1), 3–7.

Burnham

(2005). Relational reflexivity: A tool for socially constructing therapeutic relationships. In Flaskas

Mason

Perlesz

(Eds.), The space between: Experience, context, and process in the therapeutic relationships (pp. 1–18). London, England: Karnac.

10.

Cade

(2009). Has there really been any change? A look back in time. Context, Issue 105, 21–24.

11.

Carter

McGoldrick

(1989). The changing family life cycle (3rd ed.). Boston, MA: Allyn & Bacon.

12.

Crabtree

(2012). Human religions info. Retrieved from http://www.humanreligions.info/fundamentalism.html#Intro

13.

Dallos

(2006). Attachment narrative therapy. Maidenhead, UK: Open University Press.

14.

Dallos

Draper

(2005). An introduction to family therapy (2nd ed.). Maidenhead, UK: Open University Press.

15.

Dallos

Steadman

(2009). Flying over the swampy lowlands: Reflective and reflexive practice. In Reflective practice in psychotherapy and counselling. New York, NY: Open University Press. Retrieved from https://www.mheducation.co.uk/openup/chapters/9780335233618.pdf

16.

Dawkins

(2006). The god delusion. London, England: Transworld.

17.

Department of Health. (2011). Building partnerships, staying safe. The health sector contribution to HM Government’s prevent strategy: Guidance for healthcare workers. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215253/dh_131912.pdf

18.

Donovan

(2003). Family therapy beyond postmodernism: Some considerations on the ethical orientation of contemporary practice. Journal of Family Therapy, 25, 285–306.

19.

Estrada

A. U.

Haney

(1998). Genograms in a multicultural perspective. In Nelson

Trepper

(Eds.), 101 more interventions in family therapy (pp. 269–275). London, England: Haworth Press.

20.

Fairbairn

(1943). The repression and return of bad objects (with special reference to the ‘War Neuroses’). In Psychoanalytic studies of the personality (pp. 59–81). London, England: Routledge.

21.

Freedman

(2014, February 21). Alcoholics anonymous, without the religion. The New York Times. Retrieved from http://www.nytimes.com/2014/02/22/us/alcoholics-anonymous-without-the-religion.html?_r=0

22.

Frosh

(1997). Fundamentalism, gender and family therapy. Journal of Family Therapy, 19, 417–430.

23.

Gee

(2009). Start the week. Retrieved from http://www.bbc.co.uk/iplayer/episode/b00kcr2n/Start_the_Week_18_05_2009/

24.

Goldner

(1991). Sex, power and gender: A feminist analysis of the politics of passion. Journal of Feminist Family Therapy, 3, 63–83.

25.

Goldner

Penn

Sheinberg

Walker

(1990). Love and violence: Gender paradoxes in volatile attachments. Family Process, 29, 343–364.

26.

Guest

(2004). My life in orange. London, England: Granta Publications.

27.

Hardham

(2006). Bridges to Safe Uncertainty: An interview with Barry Mason. Australia and New Zealand Journal of Family Therapy, 27, 16–21.

28.

Hardy

Laszloffy

(1995). The cultural genogram: Key to training culturally competent family therapists. Journal of Marital and Family Therapy, 21, 227–237.

29.

Harrison

(1990). Cults – The battle for god. London, England: Christopher Helm.

30.

Hassan

(2000). Releasing the bonds: Empowering people to think for themselves. Danbury, CT: Aitan Publishing.

31.

Holden

(2002). Jehovah’s witnesses: Portrait of a contemporary religious movement. London, England: Routledge.

32.

Interesting Literature. (2015). Things you may not know about the water-babies. Retrieved from http://interestingliterature.com/2013/10/09/things-you-may-not-know-about-the-water-babies/

33.

Jha

(2012) Peter Higgs criticises Richard Dawkins over anti-religious fundamentalism. The Guardian. Retrieved from http://www.theguardian.com/science/2012/dec/26/peter-higgs-richard-dawkins-fundamentalism

34.

Kingsley

(1863). The water-babies. Oxford, UK: Oxford University Press.

35.

Lang

W. P.

Little

Cronen

(1990). The systemic professional: Domains of action and the question of neutrality. Human Systems, 1, 39–55.

36.

Larner

(2008). Exploring Levinas: The ethical self in family therapy. Journal of Family Therapy, 30, 351–336.

37.

Larsen

(2007). The fundamentalist mind: How polarized thinking imperils us all. Wheaton, IL: Quest Books.

38.

Loewenthal

(2007). Religion, culture and mental health. Cambridge, UK: Cambridge University Press.

39.

Lord

(2015). Theoretical frameworks for working with harder to reach families: Lines, curlicues, and spirals: Comment on Donovan and Pocock. Journal of Family Therapy, 37, 184–189.

40.

Mason

(1993). Towards positions of safe uncertainty. Human Systems: The Journal of Systemic Consultation and Management, 4, 189–200.

41.

McGoldrick

Gerson

Shellenberger

(1999). Genograms – Assessment and intervention. New York, NY: W.W. Norton.

42.

Mercer

(2009). Slaves to faith: A therapist looks inside the fundamentalist mind. Westport, CT: Praeger.

43.

Meyerstein

(1998). Sculptural metaphors to create discontinuity and novelty in family therapy. In Nelson

Trepper

(Eds.), 101 more interventions in family therapy (pp. 218–222). London, England: Haworth Press.

44.

Minuchin

(1974). Families and family therapy. London, England: Tavistock Publications.

45.

Moyers

J. C.

(1990). Religious issues in the psychotherapy of former fundamentalists. Psychotherapy, 27, 42–44.

46.

Neden

Cramer

(2009). Conversations about transformation: Exploring the Master’s dissertation as a relational context for re-authoring personal and professional development. Context, 103, 8–11.

47.

Neden

Barber

Bradbury

Cheung

(2011). Bringing forth spirituality dialogues in family therapy education. Journal of Family Therapy, 33, 224–228.

48.

Palazzoli

M. S.

Boscolo

Cecchin

Prata

(1978). Paradox and counterparadox: A new model in the therapy of the family in schizophrenic transaction. New York, NY: Jason Aronson.

49.

Pfeifer

(2006). The psychological framing of cults: Schematic representations and cult evaluations. Journal of Applied Social Psychology, 22, 531–544.

50.

Pies

Geppert

(2013). Ethical issues in the psychiatric treatment of the religious ‘Fundamentalist’ patient. Retrieved from http://www.medscape.com/viewarticle/780839

51.

Pocock

(2015). A philosophy of practice for systemic psychotherapy: The case for critical realism. Journal of Family Therapy, 37, 167–183.

52.

Pratchett

(2013). Retrieved from http://www.goodreads.com/author/quotes/1654.Terry_Pratchett?page=1

53.

Rober

(1999). The therapist’s inner conversation in family therapy practice: Some ideas about the therapist: Therapeutic impasse and the process of reflection. Family Process, 38, 209–226.

54.

Rober

(2005). The therapist’s self in dialogical family therapy: Some ideas about not knowing and the therapist’s inner conversation. Family Process, 44, 477–495.

55.

Rober

Elliott

Buysse

Loots

De Corte

(2008). Positioning in the therapist’s inner conversation: A dialogical model based on a grounded theory analysis of therapist reflections. Journal of Marital and Family Therapy, 34, 406–421. doi:10.1111/j.1752-0606.2008.00080.x

56.

Roberts

(1994). Tales and transformations: Stories in families and family therapy. London, England: W.W. Norton.

57.

Roffman

(2005). Function at the junction: Revisiting the idea of functionality in family therapy. Journal of Marital and Family Therapy, 31, 259–268.

58.

Root

M. P.

Fallon

Friedrich

(Eds.). (1986). Bulimia: A systems approach to treatment. New York, NY: W.W. Norton.

59.

Rycroft

(2004). When theory abandons us: Wading through the ‘swampy lowlands’ of practice. Journal of Family Therapy, 26, 245–259.

60.

Schnall

(2011). Multicultural counseling and the Orthodox Jew. Journal of Counseling & Development, 84, 276–282.

61.

Schön

(1983). The reflective practitioner: How professionals think in action. New York, NY: Basic Books.

62.

Sirkin

(1990). Cult involvement: A systems approach to assessment and treatment. Psychology & Religion, 27, 116–123.

63.

Sprenkle

Blow

(2004). Common factors and our sacred models. Journal of Martial and Family Therapy, 30, 113–129.

64.

Strozier

Terman

Jones

Boyd

(2010). The fundamentalist mindset: Psychological perspectives on religion, violence, and history. Oxford, UK: Oxford University Press.

65.

Volkan

(2007). Religious fundamentalism and violence. Retrieved from http://www.vamikvolkan.com/Religious-Fundamentalism-and-Violence.php

66.

Walsh

(2006). Strengthening family resilience. London, England: Guilford Press.

67.

Ward

(2002). Cults and the family. Australia and New Zealand Journal of Family Therapy, 23, 61–68.

68.

White

Epston

(1990). Narrative means to therapeutic ends. New York, NY: W.W Norton.

69.

Wieselberg

(1992). Family therapy and ultra-orthodox Jewish families: A structural approach. Journal of Family Therapy, 14, 305–329.

70.

Williams

Patterson

Edwards

(2014). Research methods in family therapy. London, England: Guilford Press.