Philosophical Dilemmas in Clinical Psychology My religious orientation is one of my greatest challenges, as a therapist. I consider myself an "objectively moral atheist," which means that I do not believe in the existence of any so-called "supreme being," or "God." I believe that moral behavior can be defined, understood, taught, and practiced utterly without reference to any supreme being. As an objectively moral atheist, my actions are dictated purely by objective concepts such as fairness, equity, equality and by my respect for basic principles of human rights and dignity.

Many of the conflicts and issues in my patients' lives either relate directly to, or require addressing a pervasive sense of inner guilt and shame which originates, to some degree, in their Judeo-Christian religious upbringing. Therefore, I have had to develop a method of addressing these psychological issues in a manner that fulfills my professional and ethical obligations as a therapist, without inspiring unnecessary conflicts with the personal religious beliefs of my patients.

In my professional opinion as a mental health expert, I am inclined to agree with the view expressed by renowned psychologist Nathaniel Branden, who details the prerequisites to the development of healthy self-esteem, outlining the inter- relationships of its components and the overwhelming consequences of its retardation.

According to Branden, instilling a belief in young children during the course of their developing psychological orientation and their initial perception of reality, that events which take place on earth are determined (entirely or in part) by the will of God, undermines their development of self-responsibility, a necessary component of healthy self-esteem.

Similarly, teaching that an omnipotent consciousness is aware of, and more significantly, that it (God) exercises approval and disapproval of every aspect, indeed, of every thought of one's life, plants the seeds of guilt and shame at our psychological core. This is precisely the antithesis of self-acceptance, self-love, and the internal...

In Branden's words, it is absolutely crucial to a healthy psychological orientation that an individual believe that:
I am responsible for my choices and my actions. Not responsible as the recipient of moral blame or guilt, but responsible as the chief causal agent in my life and behavior. Further, self-responsibility means acceptance of my basic aloneness and acceptance of responsibility for the attainment of my own goals." (Branden; p.54)

Part of my practice, dealing with shame-based issues and unwarranted guilt, requires the ability to address some clinical issues directly, but within a framework that is consistent with certain underlying beliefs. For instance, I differentiate certain types of "sin" from others, in order to address behaviors that I believe are harmful to my patients in a clinical sense, without challenging beliefs that are not connected to their clinical symptoms.

Take, for example, a patient who is depressed and guilt ridden because her religious prohibitions against sexual "self abuse" lead her to "resist" her physical urges to masturbate, despite what she describes as "difficulty" doing so. Her history reveals that she periodically engages in casual sexual behavior with virtual strangers when sufficiently intoxicated to suspend her morals. She is deeply depressed and self loathing, because her sexual behavior completely violates her moral beliefs and her religious orientation.

Objectively speaking, masturbation is not normally harmful; in fact, most of my colleagues agree that it plays a perfectly healthy role in normal adult sexuality.

Indiscriminant sexual encounters with virtual strangers while under the influence of alcohol, on the other hand, is (objectively) a…