Suffering, Trauma, and Relational Integration: Re-Envisioning Spiritual Care and Psychoanalysis in a Decolonial Age

Abstract

Spiritual care is summoned by suffering—by ‘wounds’ that are psychological, relational, spiritual, embodied, and political at once. As disciplines continue to be entrenched and siloed amidst the growing sociopolitical tensions and global crises in a decolonial age, what is at stake is the ability to care for each suffering Other in their complexity. This article offers a selective genealogy and relational integration of psychoanalysis and spiritual care (in a decolonial age). Against both clinical reductionisms and theological certainty, we argue for renewed dialogue between psychoanalysis and spiritual care through a relational integration framework, both as an ethical stance and hermeneutic framework. We first trace how pastoral and practical theology have approached each ‘wound’ in spiritual care through clinical pastoral education, psychoanalytic pastoral care, practical–theological hermeneutics, and liberationist, intercultural, postcolonial, and decolonial turns. We then consider how psychoanalysis itself has undergone significant transformations through object relations, relational–intersubjective theories, existential–phenomenological approaches, and feminist, intercultural, liberationist, and decolonial critiques. Finally, we propose embodied, hermeneutical, developmental, and intercultural commitments for relational integration, further clarified through spiritual dwelling, seeking, and crucibles of transformation. These commitments orient practitioners toward more accountable forms of interdisciplinary formation, witness, healing, justice, and liberation with the suffering Other.

1. Introduction: Attending to the ‘Wound’ (Of the Suffering Other)?

‘Why did this happen to me?… What is the meaning of this?… If there is goodness in the world… Why? Eli, Eli, lama sabachthani…’ The haunting cries (and fragments of theodicy) echo forth from a void, but not merely in abstraction. They come as particular cries, embodied upon the lips of patients, congregants, students, families, communities, and those entrusted to our care. Spiritual care is beckoned, arguably, from the site of such a wound. These wounds may arrive as grief, loss, depression, existential anxieties, spiritual desolation, racialized injustice, moral injury, family ruptures, ecological dread… and at times, they take traumatic forms. In theological terms, these traumatic experiences bend-and-break theories of divine goodness and reframe personal relationships to doctrine. In psychological terms, they may resist articulation fully… sputtering their utterance in silence, numbness, dissociation, grief/rage, bodily constriction, compulsive repetitions… to be witnessed by an Other. Before spiritual care becomes disciplined and specialized, it is summoned by such suffering. Care is called to attend to each wound of life where one’s frameworks and meanings no longer can hold.

The urgency of this task is sharpened in our present moment. Suffering unfolds amid intersecting conditions of racialized violence, forced migration, war, political polarization, ecological disruption, economic precarity, and the enduring effects of coloniality. Indeed, we are sympathetic with approaches that attend to “suffering” as an origin point for pastoral and practical theologies in spiritual care (Cooper-White 2014; Moltmann 1993; Rambo 2010; Sandage and Manalili 2026). Moltmann’s (1993) powerful claim is that suffering is the starting point of all pastoral and practical theology, born from the “open wound of life in this world” (ibid., p. 49; Cooper-White 2014, p. 23). Cooper-White (2014) follows this claim in placing suffering at the beating heart of pastoral and practical theological concern. Suffering is not merely one topic among many others in theology; we argue that is one of the very conditions that make theologizing necessary. Interpreting such suffering is the site where pastoral and practical theology is summoned toward faithful response. Each wound presses questions upon each person that are psychological, moral, relational, spiritual, and political—all at once: What happened? What has been lost? What kind of pain is this? Where might God (or the sacred, the Divine) be amidst the affliction? What forms of care, justice, lament, forgiveness, healing, or hope are possible here (if any)? Within the wound, the entanglement of these is made apparent:

“As the word patient comes from patiens, or suffering, the very act of empathic witnessing—or recognition—is one that demands patient co-suffering from us… Such practical theology includes not only pastoral care and counseling, but all forms of public theology as advocacy for justice.”

(Cooper-White 2014, p. 30)

Pastoral counseling, practical theology, and spiritual care become intelligible because persons suffer the complexity of these traumatic wounds. Cooper-White’s (2014) practical theological stance as an inductive method begins with the concrete human experience, within the beating heart of human suffering. Practical and pastoral theology, at its best, is not the application of the doctrine to pain (nor is it answering the question of theodicy abstractly), but a constructive and liberative struggle to discern faithful response amidst the wounds of persons and communities.

Yet, suffering also resists our desire to understand it quickly. Rambo’s (2010) work on trauma and spirituality reminds us that wounds do not always move cleanly from death to resurrection, from rupture into repair, from injury to restoration automatically with the passage of time. Trauma might remain in the middle, in the aftermath (awaiting as in Holy Saturday), in the not-yet-healed spaces where life persists, but cannot simply be called whole:

“Trauma is what is not integrated in time; it is the difference between a closed and an open wound. Trauma is an open wound. For those who survive trauma, the experience of trauma can be linked to a death… but the reality is that death has not ended; instead, it persists…”

(Rambo 2010, p. 7)

In short, time itself does not heal. Experiences across time with others give the possibility for care, but time itself does not automatically suture these wounds. Furthermore, Levinas (1988) sharpens this warning further by resisting the temptation to render the suffering of the Other as ‘useful,’ to be made a means to an end. For Levinas, suffering is not first an object to be explained, a moral lesson to be extracted, or a theological problem to be solved. Suffering spills in its excessive nature. It sputters forth into the tidiness of my boundaried ego, uttering from the cries of each poor and oppressed. Unlike other phenomena, suffering becomes ‘unassumable’—a refusal of meaning that unsettles the very frameworks by which humans attempt to master life:

“Suffering is excess, a boundary violation, beyond capacities, outside of mastery… suffering reduces and expands me… Rather than grasping ideas, for Levinas, suffering causes a revulsion in consciousness. Indeed, the lived experiences of suffering flood over the abstractions and reductions of thought, and also is the spilling over of these ideas.”

(Goodman and Manalili 2024, pp. 1–2)

Levinas warns that justifying the Other’s (in particularity and in proximity, our neighbor’s) pain and suffering is ethically perilous. Our task of care, then, is not to rush into theodicy, consolation, or explanation, but to remain near enough to hear the cry of the Other. Those in our care do seek meaning amidst their suffering. Indeed, spiritual care involves tender work of meaning-making, reauthoring, ritual, and hoping together. Yet meaning must not become a premature foreclosure, especially when imposed in response to the caregiver’s own anxiety. These sufferings and traumas are wounds to be attended to, accompanied with, and witnessed—prior to interpretation. In short, the suffering Other asks not first to be explained away, but to be received and attended to.

It is here—in these écarts, gaps, wounds when suffering is first received, exceeding immediate meaning and yet seeking witness—where psychoanalysis and spiritual care can be dialogue partners, once more. Pastoral and practical theologies have traditionally offered ways of interpreting wounds in relation to religion, spirituality, community, lament, justice, hope, liberation, and ‘God’ (Browning 1991; Cooper-White 2014; Doehring 2015; Gerkin 1984; Gutiérrez 1988; Lartey 2003, 2013; Miller-McLemore 2012; Rambo 2010). Psychoanalysis and psychotherapy offer practices to listen and attune to each wound, interlaced beneath and betwixt conscious speech and sedimented lived experiences. They are carried through desire, repression, fantasies, mourning, shame, defense, dissociation, counter/transference, sublimations, and relational orientations (Bion 1962; Bromberg 1998; Freud [1917] 1957, [1914] 1958; Freud and Breuer [1895] 1955; Lacan 1978, [1966] 2006; Mitchell 1988; Orange 2011; Winnicott 1965, 1971). Each person does not only proclaim their suffering in speech… they may repeat it, conceal it, displace it, defend against it, and otherwise enact it in ways that often exceed conscious awareness. Psychoanalytic and psychotherapeutic traditions, at their best, train caregivers to listen not only to what is said, but also to what cannot be said (yet can be expressed, as Lacan would note). The past is not simply behind us (temporally), but within us (embodied)—scores, symptoms, stories kept amidst the sedimentation of our bodies and relationships. The wound bears history yet also has a relational life in the present—towards future possibilities.

These are why renewed (and sustained) dialogue between psychoanalysis and spiritual care matters for us. Indeed, psychoanalytic thought became highly influential within particular twentieth-century movements of pastoral counseling, clinical pastoral education, and psychology of religion. The history, however, is not one of an original harmony that was later lost (as we will discuss later). Spiritual care gradually moved elsewhere, often toward narrative, systemic, intercultural, postcolonial, and liberationist paradigms that seemed more responsive to context, power, community, and justice. On the other side, classical psychoanalysis may appear too individualistic, secularizing, Eurocentric, and inattentive to social suffering. Yet psychoanalysis itself has also changed. Relational, existential, intercultural, feminist, queer, liberationist, and decolonial turns have reconfigured psychoanalytic ethics around trauma, culture, and historical context. And while strong historical currents of ambivalence or resistance to spirituality and religion continue to exist in psychoanalytic contexts, there are a growing number of resources and dialogical spaces exploring ways of bridging these divides. Our proposal begins from this shared transformation: the future of psychoanalysis in spiritual care depends not upon returning to an imagined earlier synthesis—a return to Eden—but upon bringing these traditions into renewed relationship after both have been altered by their encounters with suffering, context, and liberation.

What is at stake is the ability to care for the suffering Other in their complexity rather than reducing their suffering to the certainties or prefigured categories of any single theory—amidst the decolonial age. Our proposal builds upon approaches that hold together the tensions and resources of psychology and spirituality, particularly relational integration (Sandage and Brown 2018) and the relational spirituality model (Sandage et al. 2020). Relational integration offers both an ethical stance and a hermeneutical framework: it asks disciplines to remain differentiated without becoming isolated, and mutually responsive without collapsing one into the other. Elsewhere, we have argued for approaching the “wound” through interdisciplinary lenses while acknowledging the risks of reducing spiritual care to psychotherapy or psychotherapy to spiritual care (Sandage and Manalili 2026). By a “decolonial age,” we do not mean an age after coloniality as if the effects have been wiped clean. Rather, we refer to a historical moment in which caregivers, clinicians, theologians, and scholars are increasingly called to reckon with its ongoing psychic, spiritual, institutional, epistemic, and geopolitical afterlife amidst a pluralistic, multicultural and multireligious age.

The article unfolds in three movements. First, we offer a selective genealogy of spiritual care amidst and after psychoanalysis, tracing how pastoral and practical theology moved through clinical pastoral education [CPE], psychoanalytic influence, practical–theological hermeneutics, systemic approaches, and critical–liberative turns. Second, we turn to psychoanalysis itself, showing how object relations, relational/intersubjective theories, existential–phenomenological approaches, and intercultural and decolonial critiques have expanded psychoanalytic listening beyond the limits of classical models. Third, we propose relational integration as a constructive framework for psychoanalytic spiritual care, organized around embodied, hermeneutical, developmental, and intercultural commitments—with attention to spiritual dwelling, seeking, and crucibles of transformation. Throughout this article, our concern is not disciplinary synthesis for its own sake, but to invite practitioners of these complex disciplines into more faithful forms of witness—ways of attending to the wound of the suffering Other that each of our disciplines can offer, together.

2. Spiritual Care (Amidst and After Psychoanalysis)

If spiritual care begins at the wound, then the history of pastoral and practical theology may be read as a history of changing ways of attending to wounds. Let us be clear: These fields have never been singular or stable, and the distinctions that follow are heuristic rather than rigid or comprehensive. For our purpose, “spiritual care” will be taken widely as the practices of care and accompaniment amidst suffering—offered by clergy, chaplains, pastoral counselors, clinicians, congregations, and communities. As we zoom out, “pastoral theology” typically reflects critically and theologically on these practices of care, often attending to persons, relationships, suffering, healing, and SERT matters disclosed in the care encounter. Finally, “practical theology” could be understood as even broader still: concerning the embodiment of SERT practices of persons, systems, communities, institutions, cultures, and publics. Put into nested relationships with each other: “spiritual care” attends to each wound, “pastoral theology” offers ways to interpret the wound, and “practical theology” situates the wound within the wider practices, histories, and social worlds in which care becomes possible. The fields of pastoral theology and practical theology have largely centered Christian traditions and perspectives; however, we value a much more diverse and pluralistic SERT approach to spiritual care and these related disciplines.

Spiritual care has often functioned as one of the privileged sites through which practical theology discovers its questions. In the classical roots of practical theology, Schleiermacher ([1811] 2011) framed the discipline as the culminating and integrative dimension of theological study. His well-known “tree” metaphor imagined theology as a living whole: philosophical theology as the roots that ground theological reflection, historical theology as the trunk that carries the tradition through time, and “practical theology” as the crown or branches where theology bears fruit in the concrete life and needs of the world (Schleiermacher [1811] 2011; Stevenson-Moessner 2016; Weyel 2024). With the emergence of clinical pastoral education [CPE], Boisen (1936) redirected this practical–theological imagination toward persons in crisis, suffering, and spiritual struggle, toward each ‘living human document.’ Human experience thereby became not merely a pastoral problem to be solved, but a locus from which to interpret and theologize. From the vantage of CPE, each sufferer, patient, or congregant was no longer simply the recipient of already-formed doctrine, but a site where theology itself might be encountered, interpreted, and transformed. In this sense, CPE foreshadowed later liberationist claims that theology must emerge from concrete histories of suffering, struggle, and praxis.

These clinical and experiential turns were also deeply shaped by the psychology and psychoanalysis of their time. In the twentieth century, especially within our North American Protestant contexts, spiritual care and pastoral counseling drew on psychoanalytic approaches. Freud, Rogers, and later developmental and relational psychologies offered pastoral caregivers new languages for anxiety, guilt, grief, desire, dependency, family conflict, religious projection, and personal growth. Figures such as Hiltner (1958), Oates (1951), Gerkin (1984), and others helped mediate psychological insight into spiritual care and the formation of others in the field. One of the first church-based mental health clinics and pastoral psychology networks in the U.S. was formed amidst the crisis of the Great Depression by pastor Norman Vincent Peale and psychoanalyst Smiley Blanton in an effort to bring together the healing dynamics of both religion and psychoanalysis to address suffering. Many other examples could be noted. From these perspectives, psychoanalysis and spiritual care intersected around suffering, sharing a pathos-centered concern: both were drawn toward the suffering human person and the hidden meanings and longings carried within these wounds.

These relational ties and psychoanalytic offerings, however, were not without their limitations. As narrative, hermeneutical, and systematic practical theologians later observed, spiritual care could become overly identified with the individual and intrapsychic. Care could become clinically sensitive but theologically thin, psychologically nuanced yet perhaps ethically underdeveloped. Working within and beyond the Chicago school of practical theology, Don Browning is a prominent figure that helps us name this tension (Browning 1991; Browning and Cooper 2004). Drawing upon Ricoeur’s (1970, 1984) narrative and psychoanalytic hermeneutics, Gadamer’s ([1960] 2004) philosophical hermeneutics, and Habermas’s (1984) critical theory, Browning situated psychological interpretation within a wider practical–theological account of moral meanings, communal practices, and visions of the good. Ricoeur’s reading of Freud is especially important here because it recasts psychoanalysis as a hermeneutical practice rather than merely a secular explanation that reduces religion to pathology. Ricoeur (and thus Browning) allowed psychoanalysis to be understood not merely as a secular reduction in religion, but as a ‘hermeneutics of suspicion’ that could expose idols while opening objects of interpretations (like evil or suffering) toward a ‘surplus of meaning.’ As Ricoeur (1970) writes, “the idols must die—so that symbols may live” (p. 531). For practical theology, this creates a third position between rejecting psychoanalysis as simply antagonistic to religion and accepting psychoanalytic reductions as the final truth about religious life. Suspicion is a necessary moment within a larger movement of interpretation, critique, and possible retrieval. Browning extended this hermeneutical approach by bringing unconscious motivations and hidden conflicts into conversation with ethical norms, social contexts, and theological visions. This pushed practical theology to ask the following questions as we apply care: What visions of the good are operative in our approaches and assumptions? What obligations are implied? What human needs are being named (and neglected)? What social and environmental forces shape the situation? What roles and practices mediate care? Browning’s (1991) work sidesteps a naïve rejection of psychologies of the time and an uncritical acceptance of them. These questions invited spiritual care in turn beyond the private counseling exchange—and toward a more integrative account of persons, communities, practices, moral formation, and social transformation (Browning and Cooper 2004).

Systemic turns further widened spiritual care beyond the individual sufferer by asking how wounds circulate through families, congregations, institutions, cultures, and ecologies. Miller-McLemore’s (2012) pivot from Boisen’s ‘living human document’ to the ‘living human web’ is an important one: the suffering person cannot be interpreted apart from the relations, roles, gendered expectations, racial histories, ecclesial systems, and public worlds from which the suffering erupts. Family systems theories gave pastoral and spiritual care further language for this widening. Friedman’s ([1985] 2011) application of Bowenian systems to churches and synagogues, Steinke’s (2021) account of congregations as anxious/emotional systems, and McGoldrick and Hardy’s (2019) emphasis on race, culture, gender, and spirituality—all point towards these systems expansions. Pastoral theologians Doehring (2015), Ramsay (1998), and Greider (2007) likewise press spiritual care to attend to trauma, moral injury, grief, and responsibility towards relational domains. More recently, practical theologians such as McCarroll (2020) beckon our ‘living human web’ beyond anthropocentric systems—to consider ecological grief, eco-anxiety, and promptings of creational flourishing. In these systems frameworks, the wound is not just personal or private, per se. Each wound reverberates amidst relational fields, anxiety-filled systems, institutional injustices, ecological ruptures, and communal patterns that shape the fabrics of what is imprinted upon each person’s suffering.

Critical–liberative perspectives—intercultural, postcolonial, womanist, feminist, liberationist, Black, Latine, ecological, and decolonial—all intensify the call to ask which wounds have been centered… and which have been spiritually bypassed, ignored, and marginalized. Liberationist practical theology, drawing from Gutiérrez (1988), Freire ([1970] 2000), Turpin (2014), and others, insists that theology does not begin from neutral observations, but from communal ‘wounds’—from the praxis of persons living under conditions of oppression and marginalization. Andrews and Smith (2015) situate Black practical theology within prophetic praxis, traditions, and struggles towards justice, while Sheppard (2016) warns that practical theology can reproduce racial harm when it renders raced bodies invisible, fetishizes Black and Brown suffering, or treats marginalized bodies as objects rather than agentic subjects. Sheppard’s (2016) work is particularly noteworthy for our interdisciplinary interests in this paper as she refashions the psychoanalytic theory of Kohut through the frame of womanist practical theology to develop insights about cultural self-objects in suffering and healing. Latine practical theology likewise refuses homogenizing accounts of ‘context.’ For example, Ospino (2014) foregrounds embodied, public, and culturally specific practices (like the Via Crucis) when contemplating how to better attend to communities. Postcolonial approaches, like Kim-Cragg (2018) and Lartey (2003, 2013), challenge Western ideals and Christian-centrism to better foreground interdependence, hybridity, and diverse ways of healing. Kim-Cragg (2018) calls forth the dangers of individuating personhood as a colonial fantasy for self-sufficiency, while Lartey (2013) pushes for care practices that are community-based, beyond Western, White, Protestant-centric norms. Schipani (2013, 2024, 2026) champions multifaith approaches in spiritual care, emphasizing a sense of transformation, intercultural competency, and faithful practices amid religious and cultural pluralism. Finally, decolonial practical theologies deepened concerns by interrogating the coloniality embedded within power discourse, epistemic domination, and dangers of extracting liberationist language without accountability. Medina et al. (2021) caution practical theologians against collapsing liberation, postcolonial, and decolonial approaches into interchangeable tools, prompting caregivers to be mindful of longstanding intellectual traditions supporting each. Regardless, they note that all can point towards a call for “lived hermeneutics,” intellectual humility, and recognition of poor and marginalized communities as the locus and agents of interpretation.

Perhaps, these systemic and critical–liberative developments offered necessary correctives to Western, individualistic, professionalized, and clinically privatized models of healing. These critical and decolonizing turns mark continued prompting of each “wound” to attend to the depth of listening. They made clear that spiritual caregivers always operate within histories of power and that spiritual care is never neutral. And no single interpretive turn is sufficient. However, in moving increasingly beyond psychoanalysis, spiritual care may actually risk losing a depth of attention to the complexity (and unconscious life) of each unique individual in their relational, developmental, and social contexts. Nuances by narrative, systemic, and critical–liberative models all rightly attend to discourse, power, and historical violence. Yet, this external oppression can manifest internally as psychological repressions, sublimations, and highly personalized relational templates that internalize oppressive forces. Indeed, the false choice is between psychic depth and sociopolitical context. Rather than choosing only one hermeneutic lens over another… each can help give a fuller account of the ‘wound.’ Spiritual care’s future need not abandon psychoanalysis. Spiritual care has become more attentive to the context of each person, but the question remains whether we can recover the depth orientation without sacrificing these liberative aspects. Let us now turn to psychoanalysis itself… with contemporary relational, existential, intercultural, and decolonial developments offering points of access and dialogue.

3. Psychoanalysis and Psychodynamic (R)evolutions

Even with its deep affinity for memory, repetition, and the past, psychoanalysis has not remained static either. Throughout this section, we use “psychoanalysis” when referring to the theoretical and institutional tradition originating with Freud, and “psychodynamic” more broadly when describing the wider family of clinical approaches that has developed from and beyond it. The traditions from which some spiritual caregivers distanced themselves are therefore not identical to those available for renewed dialogue today. Nevertheless, the broader field continues to bear the marks of its classical origins: attention to unconscious life, desire, fantasy, mourning, repetition, defense, and the conflicted relational formation of the self.

Indeed, Freud’s relationship to religion was not simply hostile but deeply “ambivalent” in the psychoanalytic sense: he repeatedly repudiated religion even as he remained intellectually and personally preoccupied with its symbols, rituals, and inheritances. Freud was openly skeptical of religion and frequently interpreted religious beliefs and practices through the registers of wish fulfillment, paternal projection, illusion, guilt, and collective neurosis (Freud [1913] 1955, [1907] 1959, [1927] 1961, [1930] 1961). Yet this hostility did not amount to indifference. Religion remained a lifelong object of fascination and interpretation, bound to Freud’s complex relationship with his Jewish inheritance and his sustained engagement with biblical narrative, ritual, sacrifice, and monotheism (e.g., Freud [1939] 1967). Indeed, Freud’s long friendship with the Swiss pastor and psychoanalyst Pfister opened an early dialogue concerning psychoanalysis, faith, and pastoral care (Freud and Pfister 1963). Psychoanalysis thus danced with (and around) spiritual care, neither harmonious yet also not simply absent. It developed through relationships where practitioners and thinkers criticized, appropriated, and transformed one another’s ideas of caring for others.

One example of a (r)evolution of psychoanalysis beyond Freud is Lacan (1978, [1966] 2006), who draws attention to language, desire, lack, and the complexity of the divided subject—with greater openness to religious symbols as helpful in navigating the void of the unconscious. As Ruti (2012) notes, Lacan’s three registers loosely echo Freud’s structural model (i.e., the Symbolic corresponding to the superego’s pull to the normative social order, the Imaginary relates to the egoic ground to be unique individuals, and the Real intrudes into life through jouissance and bodily unintelligibility of the id/dynamic unconscious). Lacan thus recasts the psychic life as an ongoing negotiation among social law, self-image, and bodily excess, with his later seminars noting the re-creative aspects of languaging oneself. (Ironically for the field of psychoanalysis and spiritual care, Ricoeur and Lacan had a tense and contentious relationship, marked by philosophical disagreements, even amidst related aims of how meaning constructs the person and vice versa). Through post-structural and linguistic turns, Lacan notes the following when thinking of lack, desire, and the symbolic worlds through which persons come to speak and be spoken:

“Desire is a relation of being to lack. This lack is the lack of being properly speaking. It isn’t the lack of this or that, but lack of being whereby the being exists…”

(Lacan [1966] 2006, p. 524)

For Lacan, each subject is not just transparent to oneself… but a complexity of wishes, hopes, and dreams that emerge from ashes and scars of our wounds. Lacan helps us see how subjectivity is constituted through language, lack, and the symbolic worlds we inhabit—including religious symbols that may both mediate and fail before the wound (e.g., Waitz and Tisdale 2022). These psychoanalytic concepts offer a space for suffering, (un)conscious embodiment, and (un)spoken expression—within spiritual care. The sigh of exhaustion, the cry of grief, the tremor of a hand in prayer—speak volumes beyond ordinary speech (Capretto 2015). Wounds speak otherwise: through scores, symptoms, stories, and hopes that exceed what persons can presently imagine or say. Through tangles of lack, symbol, desire, and wounded speech, (Lacanian) psychoanalysis moves past the mere decoding of hidden meanings; it can turn toward the profound question of how we might inhabit inner and outer worlds that offer wider openings to spirituality. As an example of (r)evolutions of psychoanalysis, Lacanian thought offers caregivers a framework for wounds that are articulated through language—but ultimately defy its limits.

So, as we can see, psychoanalysis has undergone profound internal revisions (pun intended). To name a few more: object relations theory, ego psychology, and self psychology shifted attention from drives alone towards formative power of early relationships, internalized others, holding environments, and developmental deficits/virtues. Klein (1975), Winnicott (1965, 1971), Bion (1962), Kohut (1971), and many others deepened accounts of how persons come to inhabit their inner worlds formed through relational experiences. Klein’s (1975) account of internal objects, projections, splitting, and paranoid–schizoid and depressive positions illuminates how ‘wounds’ are not carried as static past—but as operations to be worked through:

“It is an essential part of the interpretive work that it should keep in step with fluctuations between love and hatred, between happiness and satisfaction on the one hand and persecutory anxiety and depression on the other…”

(Klein 1975, p. 128)

They become relational orientations towards worlds organized by fear, longing, aggression, guilt, and reparation. Winnicott’s (1965, 1971) attunement to playing and imaging something beyond, Bion’s (1962) invitations to metabolizing, containing, and dreaming—with each sufferer, Kohut’s (1971) invitations to allow ‘idealizing’ mentors and communities to ground anxieties… all give different ways of attending to care amidst the silences, expressions, and projections.

The relational and intersubjective turns in psychoanalysis reconfigured the focus of dynamics, not only intrapsychically but between each relational dyad. Greenberg and Mitchell (1983) sharply distinguish between drive theories and relational models, and Mitchell (1988) presses this further in constructing a “two-person” relational model of the mind; perhaps, “the human psyche is seen not as a conglomeration of hidden drives, but as an interactional field within which the individual arises and struggles to make contact and to articulate himself” (p. 3). Indeed, other thinkers attempt to give space for the complexity of each person. Benjamin (2004) invites this further into a “thirdness”, beyond “doer” vs. “done-to” dynamics, which therapy can foster a third space of two mutual minds. Bromberg (1998) gives ways to attend to traumatized and dissociating patients, where healing happens by allowing safe relational integration through “standing in the space between realities without losing any of them” (p. 166). Thus, therapists (or any caregivers) do not merely objectively observe transference; we each participate in a (re-)construction of the very relational field. This does not eliminate asymmetry or therapeutic responsibility but does reframe care as an ethically charged encounter. Each therapist’s presence, anxiety, defensiveness, humility, and capacity are all implicated in this field of care.

These developments also transformed psychoanalytic interpretations of religious symbols and experiences therein. For example, Jones (2002) develops a psychoanalytic account of religion’s ambiguous capacity for both terror and transformation. He draws especially upon Winnicott, Loewald, and Bollas while placing them in conversation with William James and Carl Jung. Indeed, Winnicott (1971) reframed Freud’s illusion as an intermediate or transitional field between inner subjectivity and shared external reality:

“I am therefore studying the substance of illusion, that which is allowed to the infant, and which in adult life is inherent in art and religion, and yet becomes the hallmark of madness when an adult puts too powerful a claim on the credulity of others, forcing them to acknowledge a sharing of illusion that is not their own. We can share a respect for illusory experience, and if we wish we may collect together and form a group on the basis of the similarity of our illusory experiences. This is a natural root of grouping among human beings.”

(ibid., p. 82; Winnicott 1971, p. 3)

Jones (2002) extends this account through Bollas’s (1987) concepts of the “unthought known” and the transformational object. Jones continues by noting that the primary caregiver–infant relationship casts a shadow not only upon one’s ‘attachment styles’ and transitional objects but on relational–transformative objects. Thus, religious symbols and shared communal practices offer liminal spaces (Turner 1967) to return not only to the longing for care but to the original moments of creation where the self may be reorganized, enlivened, and re-created. Furthermore, Loewald (1978, 1988) similarly reconceived the dynamic unconscious as more than a reservoir of irrational wishes. Jones notes that religious experiences of unity, timelessness, and symbolic connection allow the dynamic unconscious life to replenish rather than merely disrupt conscious experiences. Indeed, Jones concludes:

“As the analytic focus shifts from instinctual control to the quality of experience, religion has a potentially more positive contribution to make to mental health. For Freud, religion can only serve as an agent of instinctual repression… [However] on the contemporary psychoanalytic scene, such ecstatic, trans-rational experiences and states of consciousness can become marks of wholeness, not signs of psychopathology.”

(ibid., p. 104)

Existential–phenomenological movements emerged from and alongside psychoanalysis, bringing the field into conversation with larger human and SERT questions—and interestingly, several pointing towards thinking ethically. Therapists and thinkers such as Binswanger (1963), May (1950), Laing (1960)—and later Stolorow (2011) and Orange (2009, 2011)—brought psychoanalysis into dialogue with Kierkegaard, Nietzsche, Buber, Sartre, Levinas, Heidegger, and many other existentialists and phenomenologists. Rather than interpreting each wound only as an intrapsychic symptom, developmental deficit, or diagnostic category, these approaches attend to a person’s way of being-in-the-world: finitude, freedom, responsibility, guilt, time, embodiment, relationality, and being-toward-death. (Perhaps, these have some of the most direct ties to spiritual care, because of their closeness and openness to SERT questions). Grief, despair, shame, anxiety, moral injury, dread, and such may disclose existential conditions of human life… rather than pathologies or failure of psychological adjustment. When speaking of the complexity of spiritual distress and mental disorders, Viktor Frankl notes the following:

“The existential vacuum is no neurosis; or, if it is a neurosis at all, it is a sociogenic neurosis, or even an iatrogenic neurosis—that is to say, a neurosis which is caused by the doctor who pretends to cure it. How often does a doctor explain away the patient’s concern about an ultimate meaning of life in the face of death, by conceiving of “ultimate concern” as castration fear?…”

(Frankl 1969, p. 84)

Furthermore, these existential thinkers open up the call of the ethical dimension. Orange (2009, 2011) emphasizes balancing the tradition’s hermeneutics of suspicion—with a ‘hermeneutics of trust’ (echoing Gadamer, Levinas, and others, similar to Ricoeur’s positions). Orange prompts clinicians to engage with these thinking traditions, in order to better meet each ‘suffering stranger’ with room for their existential cries and questions of suffering. Linking Lacanian desire with Levinasian responsibility, Ruti (2012, 2015) argues that longing, wishes, and desires are not simply psychopathologies to be cured. These are intricately bound in each person’s unique subjectivity as ‘inimitable and irreplaceable,’ and should be handled with ethical care. From these existential–phenomenological and ethical threads, persons are not detached minds with symptoms—but embodied, embedded, historical, and relational beings whose ways of being-in-the-world have been shaken and shattered. Within their existential cries, echoes forth the call of ethics (even in the clinical room).

Just as in spiritual care—intercultural, feminist, critical, decolonial, liberationist, and other movements—have challenged psychoanalysis, especially the fantasy of a singular universalizing, context-free psyche. Psychoanalytic concepts are never culturally neutral; they are shaped by the warp and woof of power dynamics of race-ethnicity, sex-gender, social class, migratory patterns, coloniality, religiosity, and other symbols underneath the theories. Cushman’s (1990, 1995) historically situated psychology further cautions that suffering selves are formed within cultural and political worlds, such that existential pain can be misread when treated only as private anguish rather than as a wound shaped by social imaginaries. Psychoanalytic and adjacent critical thinkers such as Butler (1990), Benjamin (2004), Layton (2006, 2020), and Akhtar (2011) have examined how socially located identities and histories participate in the constitution of psychic life, clinical theories, and therapeutic relationships. Indeed, the constructive aspect of identity categories should be attended to: “Gender ought not to be construed as a stable identity or locus of agency from which various acts follow; rather, gender is an identity tenuously constituted in time, instituted in an exterior space through a stylized repetition of acts…” (Butler 1990, p. 140). Expanding out to multicultural perspectives, Comas-Díaz (2012), Tummala-Narra (2016), and many others also argue that culture is not an external variable or extraneous demographics added after analysis; culture organizes psychic experiences, clinical processes, and the meaning of suffering from the beginning. Altman (2022) has probed the unique influences of social class on psychoanalytic practice and ways this intersects with spiritual differences, as well. Numerous psychoanalytic clinical scholars have also voiced ways their own SERT traditions and influences have shaped their psychotherapeutic approaches across a range of clinical contexts and diversity concerns (e.g., see Sandage and Strawn 2022). This reflective transparency regarding self-of-the-practitioner formation—akin to making sense of countertransference and its broader implications—is an area of potential rapprochement between spiritual care and psychoanalysis.

Decolonial and liberationist movements press these critiques even further. Fanon ([1952] 2008) hauntingly reminds us that colonial domination does not remain outside the psyche; it structures embodiment, desire, and shame, even given by the gaze of another that seeps into it. “I came into this world anxious to uncover the meaning of things, my soul desirous to be at the origin of the world, and here I am, an object among other objects… The Other fixes me with his gaze, his gestures, and attitude, the same way you fix a preparation with a dye…” (p. 89). More recently, Gaztambide’s (2019) attention to liberatory movements, Sheehi and Sheehi (2021) cry to attend to those occupied, and Morrill and Comas-Díaz’s (2025) charge towards critical liberation psychotherapy—all challenge psychoanalysis and psychotherapy to confront how clinical practice could reproduce domination. Calling psychoanalysis to bear, Morrill and Comas-Díaz (2025) put it succinctly as they advocate for new models:

“We advocate, therefore, for a continued decolonial paradigm shift that refashions psychotherapy… for recontextualizing and rehumanizing clinical praxes that uplift plurality, and for drawing upon a diverse range of in-session processes to support individual and collective liberation as integrally connected.”

(ibid., p. 586)

Caregivers who listen only to the intrapsychic conflicts (or spiritual registers of the case) may miss how racialization, migration, misogyny, supremacy, or coloniality may be contributing a great deal to the angst of the person. Still, these approaches do not simply reject psychoanalysis. They prompt psychoanalysis (and other caregiving professions in turn) to reflect upon its own emancipatory possibilities, while relinquishing colonial innocence. The call to responsibility and ability to respond is what is at stake for these fields in our decolonial age.

For our purposes, these psychoanalytic and psychodynamic (r)evolutions open a renewed possibility for dialogue with spiritual care. Classical psychoanalysis generated enduring resources for understanding unconscious life, conflict, desire, mourning, and repetition, but often lacked sufficient attention to spiritual meaning, cultural difference, and socially produced suffering. Contemporary relational approaches help spiritual caregivers understand wounds as formed and potentially transformed within fields of recognition, rupture, and repair. Object relational and developmental approaches illuminate how religious symbols, communities, rituals, and caregivers may function as holding, transitional, self-object, or transformational presences—with both healing and destructive possibilities. Existential–phenomenological and ethical approaches attend to finitude, freedom, meaning, and responsibility without reducing them to psychopathology. Intercultural, liberationist, and decolonial approaches resist the privatization of wounds produced through history, culture, and power. Together, these movements suggest that the question is not whether psychoanalysis should return to spiritual care as it once was. Our question is how psychoanalysis and spiritual care might meet again after their respective conversions—with deeper capacities for listening, differentiation, humility, and liberative care. We now turn toward relational integration as one possible framework for this renewed dialogue.

4. Relational Integration of Spiritual Care and Psychoanalysis

To attend more faithfully to each “wound,” we propose renewed interdisciplinary dialogue between psychoanalytic and psychodynamic traditions and spiritual care. We are not suggesting that chaplains, pastoral counselors, or spiritual caregivers become psychoanalysts without appropriate training (although that is welcome if they receive training in both). Nor are we asking psychoanalysts and psychodynamic psychotherapists to become professional theologians (although we see the benefits of clinician self-awareness about our own SERT assumptions and frameworks; Sandage and Strawn 2022). Rather, we invite practitioners in these fields into shared disciplines of listening: to the écarts, gaps, lacunae, and wounds; to what is said and unsaid, remembered and repeated, privately suffered and historically produced. And we believe constructive dialogue and bi-directional sharing and learning across the fields of spiritual care and psychoanalysis can be mutually enriching.

For this task, relational integration offers one constructive framework for holding psychoanalysis and spiritual care in dialogue (Sandage and Brown 2018; Sandage and Manalili 2026). Although other integrative approaches are available, we will focus on the model we utilize. It resists hierarchical approaches in which either psychology or theology serves as the master discipline that explains, judges, or absorbs the other. Instead, we hope to emphasize an egalitarian differentiation-based relationality:

“We take an intentional interdisciplinary approach to psychotherapy as spiritual care informed by the relational integration model of psychology and theology… intrigued by the ways interdisciplinary work always involves relational dynamics, and our preferred relational orientations are egalitarian and differentiation-based…

Egalitarian relationality emphasizes intentions of equal power sharing and bidirectional influence rather than privileging one side… Differentiation-based means we value acknowledging differences (e.g., between psychology and theology as disciplines) while also promoting engagement and mutual interfacing of disciplinary partners.

Since interdisciplinary work involves real people, these relational dynamics are not abstract but are embodied within persons who will experience human SERT-related struggles with power, envy, anxiety, and a variety of other issues that can impede interdisciplinary collaboration.”

(Sandage and Manalili 2026)

A central feature of the model is that interdisciplinarity takes place between persons (e.g., Freud and Pfister 1963), not merely between abstract bodies of knowledge. Practitioners bring their own histories, loyalties, anxieties, desires, wounds, and investments into interdisciplinary encounters. Every clinician carries some implicit psychology of how persons suffer and change, and every spiritual caregiver carries some implicit theology or worldview concerning meaning, morality, transcendence, and the nature of reality. These ‘folk psychologies’ and ‘folk theologies’ shape what caregivers notice, what symbols they interpret (or avoid), and which forms of healing they imagine as possible. Interdisciplinary dialogue therefore activates ordinary relational dynamics of power, envy, idealization, inferiority, defensiveness, and competition. Relational integration asks practitioners to bring these dynamics under reflective and relational scrutiny rather than presuming that interdisciplinary work is neutral or disembodied (Sandage and Brown 2018).

Indeed, our differentiated posture is ethically significant for us. Relational integration is first an ethical stance because it concerns how practitioners receive both the disciplines and the persons entrusted to their care. Egalitarian dialogue between disciplines does not mean pretending that all interpretations are interchangeable or that every care relationship is symmetrical. The point is not merely to respect psychology and theology equally. The deeper ethical priority is to prevent either discipline from colonizing the suffering person through explanations imposed for the caregiver’s reassurance, professional identity, or need for certainty. From a Levinasian ethical perspective, the suffering Other interrupts our interpretive systems—before becoming an object of our analysis and care (Levinas [1961] 1969, 1988, [1974] 1998). “The face of the Other at each moment destroys and overflows the plastic image it leaves me… It is, therefore, to receive from the Other beyond the capacity of the I, which means exactly: to have the idea of infinity.” (Levinas [1961] 1969, pp. 50–51). The surplus of meaning emerges from each wound; our disciplines can allow for more, rather than reducing, of these meanings for each person. Each wound asks to be received before it is interpreted either by spiritual care or psychoanalytic models. Thus, in addition to being an interdisciplinary venture, embedded in the relational integration approach is an ethical posture between disciplines—towards the suffering Other.

Relational integration is also a hermeneutical framework because all practices of care involve interpretation. As noted in the previous sections, psychoanalytic, theological, empirical, narrative, and liberationist perspectives each disclose dimensions of suffering while potentially obscuring others. This relational integration between spiritual care and psychoanalysis might be framed through at least four interrelated commitments as we seek to interpret the suffering Other:

• Embodied: Spiritual care is prompted by attention to ‘wounds’ that are carried in each body: numbness, trembling, rage, dissociation, repetition, and exhaustion. “The search for integration always takes place in embodied form (in bodies), as people seek coherence and integrity among the diverse facets of their lived experience” (Sandage and Brown 2018, p. 95). Amidst the “implacements” (Hall and Thoennes 2006) that contextualize a person’s experience and “sedimentation” (Merleau-Ponty [1945] 2012) of how past actions, experiences, and cultural influences accumulate unconsciously over time… each body keeps stories, scores, and such. Psychoanalysis can help spiritual care attend to (silent) symptoms, enactments, defenses, and bodily repetitions as meaningful expressions of suffering. Spiritual care, in turn, reminds psychoanalysis that embodied suffering may also be languaged through spiritual, ethical, sacramental, and theological registers. The body may speak what the person cannot yet say in (verbal) language. Psychoanalytic traditions can also help us trace the unique influences from personal developmental histories that are transmitted and carried through embodied experiences.
• Hermeneutical: Attending to suffering requires interpretations, but relational integration resists treating any one interpretation as complete. Various psychoanalytic, theological, empirical, narrative, and liberationist accounts should be brought into differentiated dialogue. Indeed, “relational integration is hermeneutical—that it always includes acts of interpretation. Yet this hermeneutical given does not stifle the possibility of gaining knowledge” (Sandage and Brown 2018, p. 128). We prioritize a “hermeneutical realism,” like Gadamer and Ricoeur, who highlight the positive interpretative nature of human beings (yet are open to critiques of Lacan, who note that certain experiences may orbit interpretations around traumas that are unnameable and saturated). This form of “hermeneutical realism” trusts that there is a real world to study from differing vantage points, even if access to it is bounded by our finitude (Sandage and Brown 2018, p. 116). This includes probing the large body of empirical evidence supporting psychoanalytic and psychodynamic approaches to psychotherapy to gain insights into embodied relational processes of healing and growth. For dialogue between psychoanalysis and spiritual care, we invite each discipline to dust off its hermeneutic lenses—to allow not only for the polysemic and “surplus of meaning”, but surplus of the interpretations betwixt interdisciplinary dialogues. This hermeneutical commitment therefore involves both epistemic openness and disciplined judgment. Caregivers must be capable of moving between interpretive frames, recognizing when one framework offers needed depth and when it becomes reductive. They must also consider their own participation in interpretation: their countertransference, theological assumptions, social location, institutional role, and preferred theories of healing.
• Developmental: The developmental angle allows change and growth to be born from experiences (and wounds) across time. “A developmental perspective offers insights into the balance between the finite and infinite for considering formation and development, as well as the importance of attachment for human growth and maturation…” (Sandage and Brown 2018, p. 156). Integration does not imply an uninterrupted, positivist movement toward coherence. Rupture, disintegration, grief, uncertainty, and regression may be part of a person’s developmental process without becoming either romanticized or pathologized. Persons who suffer may need relational scaffolding, compassionate pacing, corrective emotional experiences, and safe-enough spaces where suffering can be bearable and thinkable. Indeed, caregivers also require formation over time. The capacity to remain present to suffering, monitor countertransference, regulate anxiety, tolerate ambiguity, and resist premature repair cannot be acquired through content knowledge alone. These capacities develop through supervision, personal reflection, consultation, relational practice, and experiences of rupture and repair. Psychoanalytic traditions remind spiritual care that development includes implicit, unconscious, and relational processes; spiritual care reminds psychoanalytic traditions that development may also involve SERT formation.
• Intercultural: Wounds are carried in particular bodies, languages, communities, histories, religious traditions, and relations of power. Intercultural relational integration resists universalizing theories of personhood, health, spirituality, or maturity. It asks how culture and social location shape both suffering and the theories used to interpret it. “Intercultural awareness and mature forms of alterity have often been sidelined or ignored in such integrative conversations. And we have suggested that there is solid empirical evidence for taking a more differentiated and intercultural perspective in understanding relational integration and relational spirituality…” (Sandage and Brown 2018, pp. 183–84). Attention to difference and alterity offers a bedrock for justice-oriented approaches in each of our fields. “To explore some similar connections between justice, alterity, and spirituality, Sandage et al. (2008) have described a relational spirituality model drawing on an integration of theology and psychology—and have suggested intercultural competence and social justice commitment are related yet distinct dimensions of mature forms of alterity…” (ibid., p. 180). While understanding and knowledge of different cultures, traditions, or fields are important—justice-oriented virtues and liberative themes have distinctive claims. As we saw in our selective genealogies of both spiritual care and psychoanalysis, these considerations seem to be available within the contemporary milieu of each field as we attend to each unique person’s suffering.

Returning back to the wound of the suffering Other, the relational spirituality model clarifies how these commitments may take shape through spiritual dwelling, seeking, and crucibles (Sandage et al. 2020). Spiritual dwelling refers to the refuge, grounding, belonging, and continuity persons find through beliefs, rituals, sacred places, relationships, and communities. Like a secure base (in attachment theory), dwelling can offer stability amid distress, although it can become rigid, coercive, or spiritually bypassing. Spiritual seeking, by contrast, involves movement toward meaning, wisdom, and transformation when inherited answers become insufficient or suffering unsettles a previously stable spiritual world. Mature relational spirituality therefore involves the capacity to seek while remaining grounded and to dwell without foreclosing transformation.

Suffering often places dwelling and seeking within a crucible. Trauma, loss, injustice, migration, betrayal, or spiritual abuse may rupture the traditions and relationships that once offered security, leaving persons simultaneously longing for refuge and searching for new meaning. Intimacy and alterity may become crucibles of transformation as persons negotiate tensions between closeness and difference, belonging and change, recognition and disruption. (However, transformation is never guaranteed in these crucibles, and suffering should not be justified as developmentally useful). Rather, the crucible names relational conditions in which rupture may be met with differentiation, honesty, and openness for new possibilities to emerge.

This is perhaps the ultimate challenge for the approach we are advocating amidst our decolonial age. Can leaders, scholars, and educators in our universities, our seminaries, our psychoanalytic institutes, our therapist and chaplaincy training programs, and the many other sites of this interdisciplinary discourse find ways to help practitioners cultivate the relational virtues of intellectual and cultural humility, curiosity, and the like? Interdisciplinary formation is itself a crucible. It reveals whether practitioners can remain connected without fusion, hold convictions without domination, and encounter religious or cultural differences without treating it as either a threat or danger. At present, some professional and educational contexts are cultivating these capacities, while many others remain fragmented and siloed. Relational integration offers not a finished curriculum but a developmental orientation toward building more accountable communities of learning and care.

We offer this proposal with sensitivity and caution. The wound needs tender witnesses. To attend to each wound in relational integration is to refuse the fantasy that one discipline can save (or, even in good intentions, accidentally benevolently colonize) the Other. Perhaps, each wound needs many witnesses. Relational integration names one way of gathering those witnesses into difficult, differentiated, and unfinished dialogue.

5. Conclusions: Post-Wounded Decolonial (Psychoanalytic) Spiritual Care?

Post-wounded psychoanalytic spiritual care is not care after wounds have disappeared. No discipline can save or master the wound. The wound exceeds us. It exceeds doctrine, diagnosis, interpretation, technique, and politics—even as it requires the wisdom of each. It cries out from each suffering Other—each body, from memory, from history, from God’s seeming absence, from communities struggling to breathe beneath the weight of violence and abandonment. To attend to such a wound is to enter a holy and dangerous space. Rather than a communicative failure, silence can help give embodied witness and respect for each alterity in each grief process emerging (Boynton and Capretto 2018; Capretto 2015). Indeed, to speak of “post-wounded” care is instead to speak of care after certain certitudes and rigidities in our fields have been challenged—illusions that suffering can be mastered by explanation, that theology can redeem pain quickly, that psychoanalysis can interpret without being implicated, or that spiritual care can attend the soul without attending to the full complexities of bodies, systems, histories, and power.

In agreement with the editors and several colleagues in this volume, we do not imagine any version of ‘psychoanalytic spiritual care’ as a triumphal, masterful model. Rather, our selective genealogies and relational integration proposed here invite a disciplined and relational practice of witness. It listens psychoanalytically for what is hidden, repeated, defended, displaced, and desired. It listens theologically for lament, justice, forgiveness, mystery, hope, and fragile possibilities of grace. It listens liberatively for histories of power that make some wounds more likely, some bodies more vulnerable, and some cries muted in the margins. And it listens relationally, knowing that every act of care takes place between persons—whose bodies, histories, theologies, and unconscious worlds are always, already in the clinical and pastoral room—with the possibility of transformation.

Such care also entails practical obligations and considerations. Practitioners must seek formation (and friendships) beyond the limits of their home disciplines, cultivate consultation and referral relationships, examine the power carried by their interpretations, and participate in communities where their clinical, theological, and cultural assumptions can be challenged. Perhaps, institutions should be open to training spaces that support multifaith dialogue, interdisciplinary case reflection, relational supervision, and accountability to the communities whose suffering they seek to address. These forms of intellectual humility and epistemic openness become credible only when it is embodied in practices through which caregivers risk learning, fallibility, and transformation.

In this unfinished work, psychoanalysis and spiritual care may yet meet again—in each of us—not as self-foreclosed echo chambers within their own discourses around suffering, but as dialogue partners in the long labor of witness, repair, and liberation for each suffering Other.