Applied Psychology of Religion: A Psychotherapeutic Case

Abstract

The case study of Mr. K is used to illustrate how the God representation in transference and countertransference can be identified and treated. The focus of the paper is on the implications of the representation of God for both the patient and the psychotherapist. It is argued that the ability to manage the dynamics of transference and countertransference is the basis for dealing with religious expressions in a tactful and considerate way. We follow the treatment of Mr. K, someone with a borderline personality organisation with paranoid features, from a psychodynamic frame of reference. Aggressive and religious themes emerged in the treatment. Both the working relationship and the representation of God were characterised by aggressive and desperate control. Once the working relationship had survived the storms of aggression, the patient was able to trust the therapist with his God representation and clarify how the God representation played a role in regulating his aggression. The therapist was able to accept the patient’s distress and to express that he needed support. As therapy progressed, the therapist was able to make it clear to Mr. K that his aggression was necessary to keep him away from the debilitating feeling of total abandonment. The patient began to use the therapist; that is, he began to benefit from what the psychotherapist was offering him.

1. Introduction

This case study presents some excerpts from a regular psychotherapeutic treatment with the use of knowledge from the psychology of religion. The case involves the treatment of Mr. K. The psychotherapeutic approach is based on a psychodynamic framework, addressing aggressive and religious themes in the context of Mr. K’s complex mental health issues. The focus is on managing transference and countertransference in religious issues. The ability to monitor these dynamics forms the foundation for addressing religious expressions tactfully and thoughtfully, as suggested by the WPA position statement on spirituality and religion in psychiatry (Moreira-Almeida et al. 2016). This case study particularly highlights the impact of the God representation of both the patient and the therapist. A crucial moment in this psychotherapy can be described as what some psychoanalysts call an authentic relational moment. This moment will be explored in some depth.

Case studies such as the one presented here are relatively rare. One of the key issues is the fundamental question of how religious variables or issues are judged. Usually, authors are not clear about this. The four positions of Dittes are the classic ones (Dittes 1969): two of them include transcendence, the other two exclude it. The first two differ in how religious variables are unique. The second two differ in the extent to which the religious variables are judged to be purely psychological variables.

There are two interesting examples for comparison: Drozek et al. (2023) presented a detailed case description of a mentalisation-based treatment (MBT) with a narcissistic patient wrestling with religious struggles at a later stage of treatment. Earlier, Lomax et al. (2011) presented an excerpt from a psychodynamic psychotherapy with a patient who described what she intellectually considered a paranormal experience. In her spiritual struggle, she worried that such an experience might be evidence to label her as a strange, weird, and pathological individual. In both cases, the clinicians were shown to be open to their patients’ descriptions of their spiritual struggles and to work with them to construct meanings of these experiences that could promote health, positive coping, and growth. Interestingly enough, in the first example, the therapist (Drozek et al. 2023, p. 349) does say something about his own Christian background and that the patient apparently knew how to figure it out, as well as his scepticism about the religious change in the patient, but this particular aspect is not elaborated further in terms of transference and countertransference. In the second article, the authors explicitly bring material from the history and psychology of religion into their considerations.

Methodological Considerations

Earlier in this journal, Suzanne M. Coyle (2023) published a useful paper on the case study method. We broadly follow her suggestion but use a different interpretation in our case study. Whereas she sought an integrative approach with pastoral theology, we seek to use insights from the psychology of religion to understand and treat the patient in question.

The role that religion, spirituality, and meaning can play in psychotherapy has been extensively reported. McAleavey et al. (2019) included in their updated list of evidence-based principles of change that clients who prefer religious or spiritually oriented and adapted psychotherapy may benefit more from therapy than when their preference is not accommodated (see also Hook et al. 2019; Constantino et al. 2021).

The psychotherapeutic format in this case is individual supportive psychodynamic psychotherapy. The two-person perspective shows that not only is insight important, but also the meaning of what is going on in the therapeutic relationship. This means that transference and countertransference are important aspects for reflection. It is important to realise that transference and countertransference can manifest themselves at different levels. By this, we mean to indicate that transference and countertransference take place not only (1) between client and therapist but also (2) between the (sub)cultures of both of them. There are three aspects to this: the relationship (a) to one’s own subculture and (b) to that of the other, as well as (c) how those subcultures relate to each other. Schreurs (2020) called this meta-transference and meta-countertransference. By this, she meant to draw attention to the role that religious denominations and non-religious collectives can play. There is also (3) the cultural context in which the therapy takes place, such as, in our case, the fact that the client was in treatment at a Protestant–Christian mental health institution.

We want to go a step further by examining the religious themes that emerge in this therapy not only from a psychodynamic perspective but also from the perspective of the psychology of religion. In doing so, it is obvious to connect the therapeutic perspective of the therapeutic relationship with attachment, object representations, and non-corporeal God representations. Attachment and object representations are intricately connected in internal working models (Granqvist 2020). In the wake of Ana-Maria Rizzuto’s (1979) seminal work, a great deal of research has been conducted on the subject of God representations. It is now clear that similar to representations of self-related and interpersonal functioning, representations of God are linked to and develop in the context of relationships with early caregivers and current intimate relationships, including the relationship a person may or may not experience with God. Research is also extended to the field of psychodynamic therapy and personality organisation. Van der Velde et al. (2021) found that three different types of God representations could be distinguished among two diagnostically heterogeneous psychiatric patients and non-patient samples. They also found associations between the psychotic, borderline, and neurotic personality organisations (Kernberg 1984, 2016) and the passive–unemotional, negative–authoritarian, and positive–authoritative God representation types, respectively.

There is another issue we will discuss. Jeremy Holmes, a leading figure in psychodynamic psychiatry, argued that the therapeutic setting can become a sacred place. He means that there is a similarity between regular spiritual practices and the regularity of (secular) psychotherapy. In this sense, psychotherapy can become an entry into the world of spirituality (Holmes 2024, pp. 109–10; see also Yaden and Newberg 2022).

In this sense, we argue for a thick description of the case. A thin description provides minimal information and is often a vignette to illustrate a situation, theoretical construct, or context. As Swinton (2020) explains, this can be accompanied by the thinning out of concepts such as spirituality. In mental health care, we are at risk of such a thin, “all-inclusive” notion of spirituality just to avoid offence. A thick description, following Swinton (2020) and Schreurs (2020), includes the stance of the therapist/author, the overall life atmosphere of the person in therapy, the context of mental health care, and the horizon of (global) meaning and spirituality.

2. Case Study

Mr. K is 32 years old (personal details have been anonymised). He does not know who his father is. His mother had a borderline personality disorder with unstable relationships. Mr. K grew up in an unsafe environment and was sexually abused several times from the age of seven. Despite his above-average intelligence, he never completed education beyond VMBO-Kader (in The Netherlands, a preparatory secondary vocational education). He works as a self-employed IT professional and is a talented guitar builder.

According to the DSM-5, he is classified as having a narcissistic personality disorder. Psychodynamically, he is considered to have a borderline personality organisation with paranoid features.

In the first few months of treatment, I (AH) felt under a lot of pressure from Mr. K. He often expressed a wish to end his life. My attempts to connect with him were thwarted: he felt misunderstood, accused me of interrupting him (“let me finish”), and thought I was only interested in him professionally. His dismissive attitude was hard to bear, and I dreaded his sessions and felt discouraged during our conversations.

One day, he mentioned that he was unsure if he was going to make it through the week, leaving concrete suicide plans vague and being unable to commit to appointments. Unsure of what to do, I considered offering him an extra session. My countertransference fantasy was that I am not like others; I will not let you down at such a critical moment. This fantasy clashed with my belief that the therapeutic relationship should be clear and predictable. Realising that offering an extra session might be a way of masking my anger at Mr. K’s constant rejection, I also feared losing him to suicide. Then, Karl Menninger’s statement came to mind: “When in doubt, be human” (quoted in Gutheil and Gabbard 1998, p. 413).

With this in mind, I eventually offered him an extra session, but I knew I was torn and had not made a free choice. I was tempted to tell myself that I had acted compassionately in order to hide the complexity of my reactions. The treatment was at risk, but at that moment, I did not know what else I could have done.

I decided to seek supervision from a colleague because the treatment was in danger of falling apart. In the supervision, I realised how I had become trapped by what Mr. K had brought up in me. My colleague pointed out that my reactions were rooted in Mr. K’s issues. Having grown up in an environment where abuse and rejection were “normal”, Mr. K had learned that it was dangerous to trust anyone. His mother had broken basic safety rules. I began to understand his behaviour as appropriate for him at that moment; he could not let anyone in. Mr. K identified with the perpetrators, while I identified with the rejected child. His hatred manifested itself in a desire to dominate and subjugate me. This split was to be central to the treatment. It was understandable that my avoidant approach to discussing the hatred would trigger fear in Mr. K (my contribution to the difficult therapeutic relationship), making him extra cautious. My colleague and I understood that too direct a confrontation with his aggression at this point would probably be unbearable for Mr. K. Given his vulnerable sense of self and fragile attachment, it could easily be perceived as judgmental and cause him to withdraw. We also discussed Winnicott’s idea (Winnicott 1985; also, Ulanov 2005) that the patient must be able to destroy the therapist while the therapist must survive these attacks before the patient can benefit from the treatment. I then told Mr. K that his behaviour was making it difficult for me to reach him, and that I felt that he could not do otherwise at the moment. I added that I thought he needed a connection that could withstand the storms he had often experienced in relationships. Mr. K responded positively to this approach.

Aggressive and Religious Topics

In the months that followed, Mr. K brought up the following: He always hated his mother. She did not protect him and had brief relationships with men who always disappeared. She may have played an active role in exposing Mr. K to abusive men. She also withheld information about his father, despite Mr. K’s requests. From the beginning of primary school, Mr. K was violent, resorting to physical fights when obstacles arose. This behaviour continued into adulthood and led to police involvement.

In subsequent sessions, the topic of conversation took a turn. He shared that God meant a lot to him and that he attended an evangelical church. People had let him down, but God would never let him down. “God has told me that, and God keeps His word”, he said. It seemed as if he was talking about another subject, but a careful listener understood that he was beginning to explain how he tried to regulate his aggression.

When I heard this, I was tempted to explore with him the idea that God might also be hiding, but I stopped myself. I realised that this would be a covert form of criticism and a countertransference reaction. Mr. K would have to adjust his concept of God and bring it closer to mine, where experiences of God’s absence play a role. However, I also sensed an implicit expectation from the philosophical perspective of the Christian institution where I worked to challenge these religious cognitions. I refrained from doing so because Mr. K’s statements about God revealed that, at that moment in therapy, God served as a self-object that enabled him to counteract the destruction of his fragile self-image. He could not cope with reflecting on his relationship with God from a distance. I asked Mr. K when he became aware of the existence of God. Mr. K grew up in an environment where faith and church played no role. God’s presence was marginal and usually negative. There was swearing at home, and his mother made fun of churches. He remembers a Sacred Heart Church he passed on his way to school, with the heart of Jesus on the outside. It fascinated him: “Would it burst if you touched it?”. At the age of seven, when the abuse began, he became consciously aware of God. God made him realise that there was a reality other than his neglectful environment. He experienced God as someone who admired him, the only one who saw how special Mr. K was. When he was angry, God gave him the strength to fight and win. At the age of eleven, during a visit to an evangelical church, a verse from Psalm 27: 10 stood out: “For my father and my mother have forsaken, but the Lord will take me” (ESV). Since then, he has attended the church, believing that God will take care of him.

After this part of the treatment, he told one day a story about a neighbour who had placed a washing machine and various building materials in the gallery of his apartment building. Mr. K had to squeeze past with great difficulty. The mess had been there for several weeks and was making him angry. Suddenly, Mr. K mentioned that in his prayer to God, he had presented the idea that his enemies were also God’s enemies. He had read this in the Psalms. He had asked God to punish his neighbour with death. I was silent for a moment. Is it permissible to ask such a thing of God? A protesting voice inside me said, ”That is not how God is”. I was almost angry. My concept of God, which emphasises personal responsibility and the ability to rest in God, was being challenged.

Thinking how to react, I suddenly realised that this was the first time Mr. K had revealed that he was not acting aggressively himself but instead was asking someone else to help him. I pointed this out to Mr. K, and he nodded. This was indeed the case. I suggested that it might be a sign of developing trust to leave revenge to someone else, to God, rather than taking it into one’s own hands. Now Mr. K was silent for a moment, and then he acknowledged my intervention again. We saw it as a step forward in his difficult process of building safe relationships. Of course, I discussed what would happen if God did not answer his prayer. Could Mr. K bear it if God did not grant his request to punish his neighbour?

The intervention about developing trust and the possibility that God might not answer his prayer had given Mr. K pause for thought. In the weeks that followed, he returned to the topic many times. At first, he was angry with me because he felt as if I was undermining his unwavering trust in God. Sometimes he was suspicious. But he also understood what I was saying. He talked about his growing contact with an elder in his church who supported the positive changes he was making and gave him the space to move at his own pace.

The treatment started to make progress.

3. God Representation

In order to understand Mr. K’s case, it is necessary to discuss the concept of the God representation (Rizzuto 1979). A God representation is unique in that God is not physically present, seen, or heard but has a significant psychological influence. This immediately raises the question of how the God figure, as a non-corporeal object, can fulfil this function. Granqvist’s solution is that the God figure shares the normative aspects of primary caregivers as attachment figures: offering proximity, a safe heaven, a secure base, and being stronger and wiser (Granqvist 2020, pp. 13–69). However imaginative this comparison between attachment figures may be, it does not tell us much about how we should then imagine the role of the preverbal communication between mother and child in this issue. The work of Winnicott has significance in this. As Wright (2006) describes, Winnicott managed to change the paradigm: from the breast paradigm (associated with Freudian thinking) to the face paradigm. It is the non-material facial expression that becomes central in the preverbal communication between mother and child and the development of imagination (Winnicott 1985; also, Holmes 2024).

People seek support from God, feel disappointed by Him, submit to Him, turn away from Him, and sometimes return to Him. People experience complex and intense emotions in relation to God. The way people interact with their God is as complex as their relationships with others. The God representation undergoes a lifelong development and evolves at each life stage. Representations of God are influenced by attachment styles (Granqvist 2010). Schaap-Jonker (2018) distinguishes between both affective aspects (emotional and relational experiences of God) and cognitive aspects (beliefs, transferable knowledge about God), both of which can be present both implicitly and explicitly. In Mr. K’s case, the affective aspects of his representation of God dominate.

In Mr. K’s case, a God representation develops in an environment that is openly hostile to God. He encounters references to God in curses at home and in the image of Jesus at the Sacred Heart Church.

During a deep crisis when the abuse begins, Mr. K creates the God he needs. This God supports his need for self-respect, sees in him what others do not, and is a fighter who comes to his aid. This God is not a separate, differentiated entity but an extension of the deeply wounded boy. God, like Mr. K, is a fighter who gives help and strength. This God allows himself to be used, and there is little difference between Mr. K and his God. Mr. K’s God representation is coloured by a need for admiration. In his unsecure and humiliating world, God is the one who never disappoints.

In the first part of the therapy, Mr. K could not use the therapist to work on his hatred. Both the therapeutic relationship and the God representation were characterised by aggressive and desperate control: “I attack the therapist so I don’t get disappointed” and “I keep an eye on God so that he will never abandon me”. When the therapeutic relationship survived the storms of aggression, the patient could confide in the therapist about his God representation. The therapist could clarify how the God representation played a role in regulating his aggression. The therapist was able to acknowledge Mr. K’s despair and express his need for support. Mr. K began to use the therapist and benefited from what the therapist offered, as described by Winnicott (1969). We see what Winnicott began to describe in the later years of his therapeutic life. He noted the patient’s growing trust in the psychoanalytic technique and setting and began to avoid breaking up this natural process by making fewer interpretations (Ferruta 2016).

4. Countertransference in Religious Issues

When, in Mr. K’s case, the topic of conversation took a turn and Mr. K began to talk about God in the course of exploring his aggressive behaviour, the therapist needed to be aware of his countertransference reactions. Almost always, the therapist’s (potentially latent) God representations are triggered. Whether the therapist is an atheist, an agnostic, or a practising believer, a mental image of God is always present. In order to deal professionally with religiously coloured issues, the therapist must be able to recognise his or her own religiously coloured countertransference reactions. A number of countertransference reactions have been identified in Mr. K’s treatment. We would like to explore these in more detail.

1. In response to Mr. K’s statement that God would never let him down, the therapist was tempted to discuss his own idea that God might be a hiding God. This is an expression of the classic notion of countertransference in which the therapist responds to the patient’s transference based on his own unprocessed and unconscious patterns. It is a negative and defensive reaction of the therapist in which his own unconscious idea of God is protected and prevents listening to the unfolding story of the patient.

2. The therapist sensed an implicit expectation from the philosophical perspective of the Christian institution where he worked to discuss religious issues. This is an example of metacountertransference, which we described above (Schreurs 2020). Racker (1953; also, Kerssemakers 1989) used the term “indirect transference” to describe this phenomenon. Racker meant that during treatment, therapists have emotional reactions to individuals indirectly involved in treatment (e.g., “My supervisor will appreciate this intervention” or “I can’t bring this up in my team”). In this way, the beliefs about religion within the therapist’s professional group influence the therapist’s reactions.

Mr. K sought help at a Christian mental health institution. In religiously oriented mental health institutions, the beliefs of the institution and colleagues certainly play a role, often implicitly. This dynamic can be a source of indirect transference. It is part of the quality standard for these institutions to address this indirect transference, for example, in peer supervision groups. In religiously neutral mental health institutions, professionals’ beliefs may remain even more implicit if not addressed (e.g., in peer supervision). This is likely to affect the therapeutic process, potentially causing shame and reluctance to discuss religious matters.

3. The therapeutic intervention after Mr. K talked about his aggressive prayer to God can be described in terms of countertransference. At first, the therapist remained silent, and a kind of classic countertransference emerged: “That’s not how God is”. But listening at another level of what was happening between Mr. K and his therapist, another interpretation came up. The therapist realised that it was the first time Mr. K was not acting aggressively himself but instead was asking someone else to help him. The intervention worked out.

Bion coined the term reverie for this specific kind of countertransference. He describes it as an alpha function of the mother: “Reverie is that state of mind which is open to the reception of any ‘objects’ from the loved object and is therefore capable of reception of the infant’s projective identification whether the infant feels them to be good or bad”. (Bion 1962, p. 37). Although Bion did not develop this somewhat vague concept, it became important for post-Bionians and relational psychoanalysts. Grotstein (2009), for example, distinguishes between countertransference and reverie, “reserving Bion’s term ‘reverie’ for the analyst’s own personal emotional monitoring of his analysand’s emotions and countertransference … as manifestations of the analyst’s own infantile emotions” (pp. 228–29). Reverie is a kind of working-through of the analysand’s blocked emotions by the analyst. Busch (2019) describes the value of the concept of reverie but also sees the one-sidedness of the analyst reacting without self-reflection to all the images and ideas that arise within him. The crucial intervention in Mr. K’s case is an example of both the therapist’s negative countertransference reaction (sterile silence, wish to correct Mr. K) and his reverie (sudden reflection that it was the first time that Mr. K had asked for help), contributing to the development of the therapy.

5. Moments of Wonder

In the nexus between psychodynamic psychotherapy, working alliance, and therapeutically applied psychology of religion, we now turn our attention to the aspect called “special moments”. What is meant by this epithet? What is happening in such moments? Is it possible that these moments can evoke or take on spiritual significance?

The special moment when the therapist intervened after Mr. K reported his prayer asking God to kill his neighbour has been described by psychoanalytic psychotherapists (Békés and Hoffman 2021) as an “authentic relational moment”. According to psychoanalytic psychotherapy, these moments are prepared, although not planned. Although these moments are not common in psychotherapies, they may be far more common than is realised. It is striking that they have been hardly studied.

When working with patients with a low-level borderline personality disorder, the preparation lies in “focusing on the exploration of the patient’s unuttered and unformulated disturbing and traumatic self-experiences through the actualisation of the analyst’s countertransference and subjectivity” (Ginnieri-Coccossis and Vaslamatzis 2014). Often, this inner work of the psychotherapist is accompanied by disturbing thoughts (Gabbard and Ogden 2009), as we saw in the first phase of Mr. K’s therapy.

In this kind of mental activity of the analyst, a transformation takes place in which “the disturbing experiences [transforms] into a mental cradle of understanding and care for the patient” (Ginnieri-Coccossis and Vaslamatzis 2014). This mental cradle, what Bion (1962) would call the dynamic of the container–contained, forms the context of “internal moments of meeting” in which “[t]he patient’s truth can take the path of becoming an eventually elaborated narrative experience co-constructed by the analytic dyad” (Ginnieri-Coccossis and Vaslamatzis 2014).

This preparatory work could lead to an authentic relational moment in which “therapist and patient may feel in sync with each other, sharing personal connection and understanding, connecting as two humans sharing an experience rather than as professional and patient” (Békés and Hoffman 2021).

There are related concepts to describe special moments that can occur in psychotherapy or in helping relationships more broadly. Apart from “authentic relational moments” already mentioned, there is also “moments of meeting” (The Boston Change Process Study Group 2010). Broadly, these concepts refer to the fact that insight alone usually is not enough in psychotherapy. The relational process, and what is experienced in it, also contributes to change in psychotherapy. The two terms mentioned, “moments of meeting” and “authentic relational moments”, refer to moments in therapy that bring about a deepening, particularly in the relational domain. It is about the deepening of connection. Qualities of the therapist such as authenticity, understanding, and sharing experiences contribute significantly to this (Békés and Hoffman 2021, pp. 1053–55). All of this adds a special charge to the interaction, which is why it is also called a “meeting” for both participants.

Lomax et al. (2011) also described a fascinating case where a special moment occurred. They referred it as a sacred moment because of the strong spiritual significance it seemed to have for the client in therapy. In this particular case, it is a paranormal experience that the client brings up, and the therapist responds very sensitively. The fact that it is a case of a paranormal experience should not surprise us, as the paranormal is also one of the accepted concepts of spirituality, as is the case in the Netherlands (Berghuijs et al. 2013).

The literature has previously and subsequently focused on the experience and meaning of such special moments, not only during psychotherapy but also in relation to one’s own well-being, stress, and spiritual concerns (Goldstein 2007; Pargament et al. 2017).

The construct of “sacred moments” can be traced back to a famous work by the psychologist William James (1842–1910), namely his “The Varieties of Religious Experience” from 1902 (James [1902] 2002). James introduced a kind of hierarchy in what he called mystical–spiritual experiences. At the bottom of this mystical ladder is the experience of what he called a “deepened sense” of meaning. Then come dream states, trance, and mystical experiences under the influence of substances. And then come the mystical moments or moods: a sudden awareness of the presence of God, a spirit of peace, or infinity. A moment of wonder is less about the content of the specific experience and more about its meaning in relation to the therapeutic alliance. Both aspects are important. Moreover, it is broadly conceived, not only in a strictly religious or spiritual context but also as meaningful.

Moments of wonder, as we like to call them, refer to brief experiences in therapy that have a spiritual dimension for the client. A profound encounter may have a spiritual dimension. Wonder may be evoked because the moment contains something transcendent, a deep truth, or a transcendence of boundaries such as time and place, often in combination with strong so-called spiritual emotions such as awe, gratitude, humility, reconciliation, joy, and/or peace (Wilt et al. 2019).

It is essential to realise that such moments are not reserved for specially designed occasions in appropriate places. Helping relationships, such as a therapeutic relationship, may well be such occasions where spiritual moments occur. The significance of this can include several aspects. Firstly, the experience can be transformative, providing a new source of support or inspiration. This can lead to a (re)discovered of meaning at a deeper level. These moments therefore contribute not only to deepening the therapeutic relationship but also to the desired and meaningful outcome of therapy and well-being.

There is, of course, secondly, a downside. People can be or become trapped in their religious or spiritual beliefs, whether because of traumatic experiences or because of the community to which they belong. The challenge for (psycho)therapists is to create an atmosphere of calm and safety in a respectful way. Questions that can help include: Why am I reacting to this patient the way I am? Am I reacting to this person or to the group or institution to which this person belongs? Can I refocus on this person? What feelings and possible ambivalence do this person evoke in me? How does this affect my approach to this person (Griffith and Griffith 2002)?

Moments of wonder can be undervalued and overvalued. When undervalued, these moments are trivialised, and a patient may feel unrecognised. There is a good chance that the client will then feel ashamed of what they have experienced. However, overrating or idealising those moments can also be dangerous. Then, special moments become an end in themselves and do not contribute to the treatment goals. Another expression of this idealisation is the belief that a treatment is successful only when such a moment occurs. Most treatments are hard work, and these moments do not happen.

There is some additional empirical evidence on the predictors of such special moments. It stands to reason that clients who consider themselves more religious/spiritual and practice their beliefs (attend gatherings, pray, meditate) are more likely to experience moments of wonder. This is also related to the fact that people with a religious or spiritual background are more likely to perceive everyday aspects of life as extraordinary or to want to express the extraordinary in their way of living and dealing with it. The extraordinary is therefore not necessarily something unique, something that stands completely on its own, separate from the rest of everyday life, but the ordinary that is experienced in a special way because of qualities that, as mentioned above, refer to the divine or transcendent, to truth, and to the transcendence of time and place (Pargament et al. 2017). However, it is also noticeable that such a moment can be preceded by a certain restlessness and tension or spiritual struggle. The special experience that follows seems to be a spiritual resolution of that tension (Pargament et al. 2014).

In the case, there was a moment of wonder after Mr. K was reminded that he had opened himself to God’s help. He was silent for a moment and came back to it later.

6. Conclusions

This case highlights the role of religion in transference and countertransference in psychotherapeutic treatment. The surprising aspect is that the religious aspects may not be obvious because of Mr. K’s history. The God representation in this case seems to have a compensatory function, which may or may not be temporary. The therapist’s ability to manage God representations in transference and countertransference is crucial for the progress of treatment. This skill contributes to the development of a coherent self. It is remarkable how many people can talk about a God they claim not to believe in (Jones 1996). In conclusion, there is always the possibility that religious, spiritual, or existential themes will emerge at some point in therapy. There is also the potential for moments of wonder in therapy, which require the therapist to recognise and ground them in ways that enhance the treatment.