The dark night (John of the Cross)

1. Introduction

Version followed: John of the Cross (1542–1591), The Dark Night (poem and prose commentary, Books I–II), read in the Institute of Carmelite Studies translation by Kieran Kavanaugh OCD and Otilio Rodriguez OCD (The Collected Works of St. John of the Cross, revised edition, ICS Publications, 1991) and the edition hosted by the Christian Classics Ethereal Library (CCEL); contemporary Catholic teaching from Ronald Rolheiser OMI (Oblate School of Theology, 2018); clinical and cultural-psychiatric work by Glòria Durà-Vilà (UCL), with criteria attributed to Gerald May, Kevin Culligan OCD and Font. [source: ICS Publications; CCEL; Rolheiser 2018; Durà-Vilà thesis]

What it is. The "dark night" is not a technique a person chooses; in the Carmelite tradition it is a passage in the life of prayer that John of the Cross describes and teaches people how to recognise and how to conduct themselves through. The Dark Night is organised as a commentary on his poem: Book I treats the night of sense (beginning with the typical imperfections of beginners: spiritual pride, avarice, "luxury", wrath, gluttony, envy and sloth), the signs that a person is entering it, how such souls should conduct themselves, and its benefits; Book II treats the darker night of the spirit and its afflictions, the "secret" contemplation at work in it, and the ten steps of the ladder of love. CCEL's introduction presents the work as the continuation of The Ascent of Mount Carmel. [source: CCEL table of contents and introduction]

Core idea of change, as the tradition holds it. In John's account, as the tradition reads him, God withdraws the felt consolations of prayer so that the person comes to love God rather than the pleasure of devotion; dryness and darkness purify the person and lead toward contemplation and union with God. Rolheiser reads this as a paschal pattern that runs through love, prayer and service: the honeymoon of first fervour ends, so that the person meets the one behind the experience, passes through dryness, and arrives at a deeper peace. These are theological claims of the tradition, described here, not asserted. [source: Rolheiser 2018; mariedenazareth.com encyclopedia page]

What the psychotherapist does with it. The therapist is not a spiritual director. The therapist's work is (a) to respect the client's own framing of a dark night and integrate it into therapy only where the client wishes; (b) to recognise depression, suicidal risk, psychosis, mania, dissociation, scrupulosity and medical causes when they are present, alone or alongside a dark night; and (c) to collaborate with a qualified spiritual director or priest when the client consents. May and Culligan, as reported, agree that the two states often coexist, and May holds that depression should be identified and treated whether or not a dark night is also present. Pathologising the dark night and missing illness are both errors. [source: Borchard 2016 (Psych Central) summarising May and Culligan; Durà-Vilà thesis]

2. Framework

The tradition's map (as John and his interpreters describe it). [source: CCEL TOC and introduction; Rolheiser 2018]

Beginners' stage (Book I, chs. 1–7): fervour and consolation in prayer, together with "spiritual" versions of the seven capital vices. Goal, as the tradition states it: these are purified by the night that follows.
Night of sense (Book I, chs. 8–14): loss of felt consolation in prayer and in creatures, inability to pray in the old imaginative, discursive way, and a painful concern that one is failing God. John gives signs to tell this apart from sin, lukewarmness and bodily "humours" (melancholy). Goal: a shift from discursive meditation to a quieter, receptive loving attentiveness.
Night of spirit (Book II): a deeper, more painful purification that John describes as dark contemplation experienced as grief and torment, followed by the ladder of love. John does not predict how long either night lasts (per Rolheiser).
Rolheiser's six-stage contemporary reading: pre-conversion; conversion (falling in love); first fervour (honeymoon); waning of fervour; proficiency (choosing the value for its own sake, dryness gradually becoming ease); dark night of the spirit (radical choice to live by faith, desolation with a hidden sense of security, then calm and the return of passion).

The therapist's working framework. No published protocol specifies phases, session counts or formats for clinical work with the dark night; the phases below are [synthesis] built from the sources in this guide. Format: ordinary individual sessions in the therapist's usual frequency; no session count is given by any source.

Engagement and safety. Goal: hear the client's account in their own words, assess suicide risk and safety, and screen for depressive, psychotic, manic and dissociative features and for medical causes. Move on when immediate safety is established and the client has said how they want their faith to figure in therapy.
Discernment with the client (not for them). Goal: map which features fit the tradition's description of a dark night, which fit a depressive or other disorder, and which fit both. Move on when there is a shared working formulation (which may be "both").
Parallel tracks. Goal: a spiritual track (with a spiritual director or priest, if the client wants one) and a clinical track (psychotherapy, plus medical review by the client's doctor where depression or another disorder is suspected) run side by side, with consented communication. Move on when the clinical picture is stable or improving and the client feels accompanied in the spiritual track.
Integration and meaning. Goal: help the client make sense of the period in their own tradition's terms without the therapist adjudicating theology.
Review and closure. Goal: relapse prevention for any depressive disorder, an updated safety plan if one was needed, and a clear plan for ongoing spiritual direction.

Criteria for stepping back to phase 1 at any time: new or intensified suicidal thoughts, self-harm, loss of functioning, psychotic or manic features, or medical red flags. [synthesis]

3. Guiding principles

Attribute, do not adjudicate. Describe the night as John and the Carmelite tradition describe it ("in your tradition this is understood as…"), never confirming or denying divine action. Practical meaning: use the client's language; keep theology out of your interpretations. [source: Rolheiser 2018 for the tradition's account; synthesis for stance]
Both/and before either/or. A dark night and a depression can coexist; May held that depression should be identified and treated regardless. Practical meaning: a spiritual reading never rules out assessment or treatment. [source: Borchard 2016 citing May and Culligan]
Safety outranks every heuristic. Font's view that the dark night does not lead to suicide, and Culligan's observation that thoughts of death in a dark night lack obsession or intent, are descriptive teachings, not safety assessments. Practical meaning: any mention of death, hopelessness or wishing not to wake up gets direct enquiry, every time. [source: Durà-Vilà thesis citing Font; Borchard 2016 citing Culligan; NICE NG225 as summarised by Mughal et al. 2023]
No risk scores, a formulation instead. NICE NG225 advises against using risk tools or low/medium/high stratification to predict suicide or decide care, and recommends a collaborative risk formulation and, where relevant, a safety plan. Practical meaning: ask, understand, plan together; do not reassure on the basis of a checklist. [source: Mughal et al. 2023]
Context matters, and medicalisation is a real risk. Durà-Vilà's Catholic participants treated sadness that "makes sense" in context as normal and valued the dark night for growth; she warns against medicalising normal sadness. Practical meaning: do not diagnose from symptom counts alone; assess meaning, context, functioning and hope. [source: Durà-Vilà thesis]
Client-led integration with consent. Practical meaning: ask whether, and how, the client wants faith in the room; record consent; stop if the client withdraws it. [synthesis]
Role clarity. The therapist is not confessor or spiritual director. Practical meaning: refer spiritual questions (whether this is "really" a dark night in John's sense, how to pray now) to a qualified director or priest; avoid dual roles such as directing a client you also treat. Professional ethics codes govern this (the APA Ethics Code is cited in principle only [synthesis]). Published spiritual and religious competencies for psychologists exist (Vieten et al. 2013) [uncertain: not verified].
Self-disclosure and the therapist's own commitments. Practical meaning: whether you are Catholic, of another faith or none, keep your own views on the night out of the work unless disclosure clearly serves the client; seek consultation if you notice yourself steering. [synthesis]
Humility and collateral information. Barrett advises clinicians to acknowledge gaps in their knowledge of a faith, compare current functioning with baseline, rule out organic causes, and seek several collateral sources (which may include a faith leader), keeping confidentiality. Practical meaning: learn the tradition from the client and, with consent, from their director. [source: Barrett 2020]
Hope as a marker, not a verdict. Durà-Vilà treats preserved hope as the essential difference in Font's account. Practical meaning: assess hope explicitly and repeatedly; loss of hope moves you toward a depressive and risk formulation. [source: Durà-Vilà thesis]
Do not force prayer, and do not prescribe it. John's counsel, per the CCEL introduction, is to let the soul rest in peace and quiet rather than force the old meditation. Practical meaning: the therapist neither assigns spiritual practices nor discourages them; adjustments to prayer are the director's domain. [source: CCEL introduction; synthesis]
No health claims. The dark night is a spiritual category; it is not presented as a treatment for any condition, and depression is not treated by waiting it out. [synthesis]

4. Intervention inventory

Items 4.1–4.3 describe the tradition's own counsel as published, so the therapist can understand and, if the client wishes, reflect it; teaching or applying it belongs to a spiritual director. Items 4.4–4.15 are the therapist's own work. No secular or clinical adaptation of the dark night as such has been published in the sources consulted; for adjacent methods see Domain VII (spiritually integrated psychotherapy; contemplative psychotherapy), Domain II (MBSR, MBCT, MSC, CFT) and Domain IV (trauma-sensitive approaches). [uncertain: no published adaptation found]

4.1 Recognising the night of sense: John's signs (tradition)

Purpose / when: John offers signs to tell the night of sense apart from dryness caused by sin or imperfection, by lukewarmness or frailty, or by bodily "humours" such as melancholy. Use as background when a Catholic client asks whether their dryness "is" the dark night. [source: CCEL introduction]
Steps (the signs, as a Marian encyclopedia summarises them, in paraphrase): (1) no satisfaction either in the things of God or in created things; (2) a painful sense of having turned away from or failed God, which the person mistakes for a fall, i.e. ongoing concern for God rather than indifference; (3) inability to meditate or use the imagination in prayer as before, despite effort. Rolheiser calls the key sign a growing, healthy solicitude for God or the beloved even without feeling, which distinguishes it from the dryness of infidelity or laziness. John also gives related signs for leaving discursive meditation in The Ascent of Mount Carmel [uncertain: not verified]. [source: mariedenazareth.com; Rolheiser 2018]
Example language (illustrative): "In your tradition, John of the Cross describes particular signs of this kind of night. Would it help to look at how your experience compares with what he describes, and also with what we know about depression? Your spiritual director may be the best person to help with the first part."
Watch for: the therapist using John's signs as a diagnostic tool or ruling out depression with them. Sign 1 (no pleasure in anything) overlaps with anhedonia; sign 2 (sense of failing God) can mask excessive guilt; John himself names melancholy as something to distinguish. Working well: the client feels their spiritual frame is respected and is still open to a clinical assessment.

4.2 Conduct in the night: not forcing, loving attentiveness (tradition)

Purpose / when: John's counsel for those in the night of sense is, in the CCEL introduction's words, "allowing the soul to remain in peace and quietness" with a peaceful and loving attentiveness toward God, rather than forcing the old discursive meditation. Use when a client describes anxious striving to recover lost fervour. [source: CCEL introduction]
Steps (public outline): the tradition advises ceasing to strain after the former way of meditating; remaining quietly attentive in prayer without demanding feelings; continuing faithfully. Concrete guidance on how a particular person should pray is given by a spiritual director, not the therapist. [source: CCEL introduction; synthesis]
Example language (illustrative): "It sounds as though you're pushing very hard to feel what you used to feel. You mentioned your tradition counsels something different. Is that something to explore with your director? In here, we can look at what the striving does to you."
Watch for: quietist withdrawal from all activity, or a client using "rest" to describe what is actually psychomotor slowing and loss of energy across life. Working well: less anxious striving in prayer while daily functioning holds.

4.3 Patience, fidelity and not chasing the honeymoon (tradition)

Purpose / when: Rolheiser's counsel: John cannot predict how long the night lasts; the person waits through it; efforts to recapture first fervour (a "second honeymoon") fail; fidelity to commitments is the path. Use when a client asks "how long will this last?" or is tempted to abandon commitments to regain feeling. [source: Rolheiser 2018]
Steps: reflect the tradition's view if the client brings it; support the client in keeping commitments that matter to them; keep clinical monitoring going during the wait. [source: Rolheiser 2018; synthesis]
Example language (illustrative): "Your tradition doesn't put a timetable on this. Alongside that patience, I'd like us to keep an eye on your sleep, mood and safety, because waiting is not meant to mean suffering an illness untreated."
Watch for: waiting used to postpone treatment of depression (Borchard reports religious people forgoing treatment in the belief that their pain purifies them). Working well: patience in prayer combined with active self-care and clinical review. [source: Borchard 2016]

4.4 Spiritual and religious history, and consent to integrate

Purpose / when: first sessions with any client who names a dark night, aridity, "God has gone silent", or loss of faith.
Steps: (1) ask about tradition, practice (prayer, Mass, sacraments, retreats, religious vows), community, and current spiritual direction; (2) ask what the client means by "dark night" and where they learned the term (John's writings, a director, popular usage); (3) ask how they would like their faith to figure in therapy; (4) record consent and its limits; (5) ask about a spiritual director or confessor and whether they want any contact. A cultural formulation interview with a spirituality module (DSM-5-TR Cultural Formulation Interview) may structure this [uncertain: not verified]. [synthesis; Barrett 2020 on humility and learning unfamiliar beliefs]
Example language (illustrative): "You used the phrase 'dark night'. Can you tell me what it means to you, and who helped you name it?" / "Some people want their faith to be central in therapy, some want it kept separate. What would suit you?"
Watch for: the popular, loose use of "dark night of the soul" for any hard time (which may not match John's sense); shame about seeking therapy, since seeking help can feel like spiritual doubt to some believers (Barrett). Working well: the client corrects and teaches you. [source: Barrett 2020]

4.5 Structured differential: dark night, depression, or both

Purpose / when: whenever spiritual dryness comes with low mood, loss of pleasure, guilt or withdrawal.
Steps: assess each dimension below, collaboratively, over more than one session; record features pointing each way; the result may be "both". [source: as tagged per row]
- Scope of loss: dark night = loss of pleasure mainly in spiritual things; depression = loss of energy and pleasure in most activities (Culligan, via Borchard).
- Hope: preserved in the dark night; hopelessness in depression; Font treats this as the essential difference (Durà-Vilà).
- Functioning and relationships: community life, work and social contact usually maintained in the dark night; withdrawal in depression (Font, via Durà-Vilà).
- Humour, effectiveness, compassion: typically preserved in the dark night, impaired in depression; depressed people may be bitter and want immediate relief (May, via Borchard and Durà-Vilà).
- Guilt: healthy guilt that motivates repair vs pathological guilt (Font); dark nights seldom involve morbid guilt, self-loathing or worthlessness (Culligan).
- Body: sleep and appetite change, weight change and physical symptoms are not usual in the dark night (Culligan).
- Wish to recover: a clear wish to recover distinguishes the dark night in Font's account.
- Thoughts of death: may occur in a dark night but without obsession or intent (Culligan); always assess directly (4.6).
- Context: sadness with an understandable context was treated as normal by Durà-Vilà's participants; sadness without apparent cause prompted medical help-seeking.
- Clinician's own response: Culligan reports often feeling depressed after listening to a depressed person but not after hearing about spiritual dryness; treat this as a soft cue only.
- Medical and substance causes: compare with baseline, rule out organic causes and substance use (Barrett).
Example language (illustrative): "Is it mainly prayer that has gone flat, or has the colour drained out of everything, food, friends, work?" / "When you think about the future, is there any hope in it, even a thin thread?" / "Has your sleep or appetite changed?"
Watch for: confirmation bias in either direction; a devout client minimising symptoms to protect a spiritual reading; a non-religious clinician dismissing the spiritual reading. Working well: a shared formulation the client recognises, which names any depressive disorder clearly.

4.6 Suicide-risk enquiry and safety planning

Purpose / when: at intake and whenever hopelessness, wishing to die, thoughts of death, self-harm, or a sharp drop in functioning appear. The spiritual teachings above do not reduce the need for this. Suicidal behaviour was among reported adverse events in the meditation literature (Farias et al. 2020). [source: Farias et al. 2020; Borchard 2016]
Steps: (1) ask directly about thoughts of death, wishing not to wake, suicidal thoughts, intent, plans, past attempts and self-harm; (2) ask about religious beliefs that protect (e.g. moral objection to suicide, hope, community) and those that may raise risk (e.g. belief that God has abandoned them for good, that they are damned, or that suffering must be borne without help); (3) build a risk formulation from circumstances, strengths and needs rather than a low/medium/high score, as NICE NG225 advises; (4) consider a collaborative, accessible, regularly reviewed safety plan (warning signs, coping steps, people and places, professional and crisis contacts, making the environment safer); (5) arrange urgent medical or crisis care where there is intent or imminent risk; (6) with consent, include supportive people, who may include a priest or director. [source: Mughal et al. 2023 summarising NICE NG225; synthesis for faith-specific items]
Example language (illustrative): "Sometimes when people feel God has gone silent, life itself can feel pointless. Have you had thoughts of being dead, or of ending your life?" / "Your faith matters a lot to you. Does it make suicide feel more off-limits, or are there moments it feels less so?"
Watch for: reassurance from the client or a director that "it's only the dark night"; religious shame suppressing disclosure of suicidal thoughts; scrupulous fears of damnation. Working well: the client can talk openly about death wishes, has a plan they helped write, and knows whom to contact.

4.7 Screening for other conditions and contemplative adverse effects

Purpose / when: when a client reports intense experiences in prayer or on retreat, or distress that does not fit a dark night or depression.
Steps: (1) screen for psychotic features (fixed beliefs not shared by the client's own community, hallucinations beyond the tradition's norms, disorganisation), manic features (decreased need for sleep, grandiosity, pressured speech), dissociation, and obsessive scrupulosity; (2) ask about practice intensity (retreats, hours in prayer), sleep and fasting, and route health questions to the client's doctor; (3) take adverse effects seriously: Farias et al.'s 2020 systematic review of 83 studies (6,703 practitioners) found a pooled adverse-event prevalence of 8.3%, most often anxiety, depression and cognitive anomalies, including in people with no prior mental-health history; the Varieties of Contemplative Experience study (Lindahl et al. 2017, PLOS ONE) documented meditation-related challenges in over 100 Western Buddhist practitioners and teachers and later papers addressed differential diagnosis and intervention criteria. These studies are mostly of meditation rather than Christian contemplative prayer, so generalisation is [uncertain]. [source: PubMed abstract of Farias et al. 2020; Cheetah House VCE page; Barrett 2020 for rule-outs]
Example language (illustrative): "Besides the dryness, have there been any experiences in prayer that frightened you, or changes in how real things or you yourself feel?"
Watch for: pathologising experiences normal within the tradition; missing a first psychotic or manic episode. Working well: a clear picture of what is tradition-normal (checked with the client and, with consent, the director) and what needs medical assessment.

4.8 Naming it without pathologising: the DSM category

Purpose / when: when faith-related distress is the focus of clinical attention but no mental disorder is present, or alongside a disorder.
Steps: consider recording Religious or Spiritual Problem (listed in DSM-5 as V62.89 / Z65.8, DSM-5 p. 725); Barrett recommends it to avoid misdiagnosis where faith discord affects presentation without causing a disorder. DSM-5-TR retains the Z65.8 code. Explain the code to the client in plain terms. [source: Barrett 2020]
Example language (illustrative): "In my notes I can record this as a spiritual struggle you are going through, which is not a diagnosis of illness. If we also find signs of depression, I'll tell you and we'll talk about what that means."
Watch for: using the code to avoid diagnosing a depression that is present. Working well: records that are accurate on both counts.

4.9 Concurrent treatment of depression within a spiritual frame

Purpose / when: when a depressive disorder is present, whether or not a dark night is also present. May, as reported, held it is better to identify and treat depression wherever it exists. [source: Borchard 2016]
Steps: (1) share the formulation honestly, including "both" where relevant; (2) offer evidence-based psychotherapy for depression in your usual model, adapted to the client's language and values; (3) recommend medical review by the client's doctor; give no advice on medicines; (4) address beliefs that block help-seeking (e.g. that suffering must be borne alone, or that treatment shows lack of faith) using the client's own tradition, ideally with input from their director or priest; (5) monitor mood, function, hope and risk at each session. [synthesis; Borchard 2016 on forgoing treatment]
Example language (illustrative): "Treating depression doesn't have to mean deciding that nothing spiritual is happening. Many people in your tradition have had both at once. Would you be open to working on the depression while you keep your spiritual life going with your director?"
Watch for: the client experiencing treatment as a betrayal of faith; the therapist implying that recovery will end the dark night or vice versa. Working well: mood and functioning improve while the client's spiritual reading remains theirs.

4.10 Collaboration with a spiritual director, confessor or priest

Purpose / when: when the client already has, or wants, spiritual guidance. Durà-Vilà's participants valued spiritual direction and confession, recommended directors skilled in telling the dark night and depression apart, and criticised both mental-health care and priests' limited training; they proposed a priest with mental-health training or a religious psychiatrist as solutions. [source: Durà-Vilà thesis]
Steps: (1) obtain explicit written consent specifying what may be shared; (2) agree roles: the director accompanies prayer and discernment, the therapist assesses and treats mental-health problems; (3) share safety concerns as consent and law allow; (4) keep confidentiality with the faith community (Barrett); (5) if the client has no director, help them identify how their own Church or community finds one (e.g. via their parish, a Carmelite community or a recognised spiritual-direction programme) without recommending individuals you cannot vouch for. [source: Durà-Vilà thesis; Barrett 2020; synthesis]
Example language (illustrative): "Would it help if I spoke with your director, with your permission, so we aren't pulling you in different directions? You decide what I can share."
Watch for: a director who discourages all medical care, or a therapist who second-guesses spiritual counsel; power imbalances in direction relationships (if the client describes control, exploitation or sexual boundary violations, treat it as a safeguarding and possible abuse matter and follow your reporting duties) [synthesis]. Working well: consistent messages and a client who feels held on both sides.

4.11 Meaning-making and integration

Purpose / when: once safety is stable and the client wishes to make sense of the period.
Steps: (1) invite the client's own narrative of what the night has meant; (2) where they use John's or Rolheiser's frame (purification, waning of fervour, choosing love without feeling), reflect it in their words; (3) explore values the client has kept acting on during dryness; (4) where the client's frame has collapsed (faith crisis, leaving), support that without steering. [source: Rolheiser 2018 for the tradition's frame; synthesis]
Example language (illustrative): "Through all of this you kept turning up for your community. What does that tell you about what matters to you?"
Watch for: therapist imposing a growth narrative on suffering that the client experiences as meaningless; spiritual bypassing of grief, trauma or anger. Working well: the client's account becomes more coherent and less self-condemning.

4.12 Dose-reduction, grounding and trauma-sensitive adaptation

Purpose / when: when intense or prolonged prayer, silent retreat or contemplative practice is followed by destabilisation, flashbacks, panic, dissociation or insomnia.
Steps: (1) ask the client to discuss with their director a temporary reduction in intensity or length of solitary prayer, and a shift to more embodied, communal or liturgical forms if the tradition allows; (2) teach ordinary grounding (orienting to the room, feet on the floor, naming objects, eyes open); (3) prioritise sleep and regular meals; route medical questions to the doctor; (4) offer choice and control at each step for trauma survivors; trauma-sensitive mindfulness (Treleaven 2018) is a published adaptation for meditation [uncertain: not verified]; (5) screen before intensive retreats in clients with trauma, psychosis, bipolar disorder or recent severe depression, and agree a plan for what to do if symptoms emerge. [synthesis; Farias et al. 2020 on adverse events]
Example language (illustrative): "It might be worth asking your director whether a gentler rhythm of prayer would be all right for a while. In here, let's practise a way to come back to the room when things get too much."
Watch for: the client experiencing reduction as spiritual failure; therapist overriding the tradition. Working well: fewer destabilising episodes while the client's practice continues in a form they and their director accept.

4.13 Guilt and scrupulosity

Purpose / when: when the sense of failing God (sign 2 of the night of sense) becomes repetitive doubt, compulsive confession, reassurance-seeking or fear of damnation.
Steps: (1) distinguish healthy guilt that motivates repair from pathological guilt (Font, via Durà-Vilà); (2) screen for obsessive-compulsive features; (3) if scrupulosity is present, offer CBT with exposure and response prevention adapted to the client's faith, ideally agreeing with the client's confessor or priest on what is genuinely required by the tradition (the IOCDF publishes guidance on scrupulosity [uncertain: not verified]); (4) avoid giving moral or theological rulings yourself. [source: Durà-Vilà thesis; synthesis]
Example language (illustrative): "When the worry that you've offended God comes, what do you do to make it go away? And how long does the relief last?"
Watch for: the therapist reassuring about sin (which feeds the compulsion); confusing scrupulosity with the tradition's own call to self-examination. Working well: less time spent on rituals of reassurance, and the client's priest and therapist giving compatible messages.

4.14 Psychoeducation for client and family

Purpose / when: when the client, family or community holds a strong either/or view ("it's spiritual, so no treatment" or "it's just illness").
Steps: explain, in the client's terms, that the tradition itself distinguishes the night from melancholy (CCEL introduction), that spiritual writers and clinicians report the two can coexist (May, Culligan via Borchard), and what signs would call for urgent help. [source: as stated]
Example language (illustrative): "Even John of the Cross took care to tell this kind of dryness apart from melancholy. Paying attention to your mood isn't a lack of faith; it's part of taking you seriously."
Watch for: family or community pressure against care. Working well: supporters know the warning signs and whom to call.

4.15 Monitoring and review

Purpose / when: throughout.
Steps: at each session track mood, hope, functioning, sleep and appetite, thoughts of death and safety-plan use; revisit the differential every few weeks or when anything changes; review the safety plan regularly as NICE NG225 recommends; agree with the client when spiritual direction alone is enough. [source: Mughal et al. 2023; synthesis]
Example language (illustrative): "Let's check in on the same few things each week, sleep, hope, how you're managing, any thoughts of death, so we notice changes early."
Watch for: drift into theological discussion that crowds out monitoring. Working well: early detection of any deterioration.

5. Handling problems

The sources describe the dark night and its differential; they do not address therapy process problems. Guidance below is [synthesis] unless tagged.

"It's the dark night, so I don't need treatment." Do not argue theology. Reflect the tradition's own care to distinguish the night from melancholy (CCEL introduction) and the view of May and Culligan that both can coexist (Borchard 2016). Propose a joint review with the client's director. If risk is present, safety takes priority regardless of framing.
"It's just depression; the spiritual stuff is a symptom." (client or another clinician). Keep the spiritual question open; record Religious or Spiritual Problem alongside any diagnosis where it fits (Barrett 2020); offer the client the chance to seek spiritual direction.
Hidden or minimised suicidal thoughts. Ask again, in specific and non-judgemental terms, including about passive death wishes; explore whether religious shame or fear of being seen as faithless is blocking disclosure; agree a safety plan collaboratively and review it (NICE NG225 via Mughal et al. 2023). Never accept a director's or the client's "only the night" reassurance as a risk assessment.
Escalating risk. Intent, plans, recent self-harm or rapid deterioration: arrange urgent assessment through local crisis or emergency services and the client's doctor, involve supporters with consent, and follow your service's procedures. Do not reduce this to a score (Mughal et al. 2023).
Stuck: months of dryness, no change. Revisit the differential (4.5): increasing loss of hope, functioning or bodily symptoms point toward depression. If the picture still fits the tradition's description and the client is functioning and hopeful, the tradition counsels patience with no set duration (Rolheiser 2018); keep monitoring rather than pushing for change.
Overwhelm during prayer or retreat. Grounding, temporary reduction of intensity agreed with the director, sleep and meals, medical review if psychotic or manic features appear (4.7, 4.12). Adverse events can occur without prior mental-health history (Farias et al. 2020).
Non-adherence to clinical treatment because it feels faithless. Explore the belief, invite the director's view, and look for an approach the client can accept (e.g. psychotherapy first, medical review second). Do not advise on medicines.
Ruptures over faith. If the client feels the therapist doubts or patronises their faith, name and repair it; acknowledge gaps in your knowledge (Barrett 2020). If the client feels the therapist is pushing a religious view, check your own commitments and seek consultation.
Conflict between therapist and director. Hold role clarity, return to the client's stated goals, and with consent talk directly with the director. If the director discourages necessary care while risk is present, prioritise safety and tell the client why.
Misconduct or coercion in a spiritual relationship. Signs such as isolation from others, demands for secrecy, control over money or medical decisions, or sexual contact by a director or priest: name it as a concern, follow safeguarding and reporting duties, and support the client to seek independent help within or outside their Church.
Loss of faith rather than a night. Some clients emerge without belief. Support the transition without steering toward or away from faith; attend to grief, loss of community and possible religious trauma.
Comorbid scrupulosity. Use 4.13; avoid reassurance; coordinate with the confessor.
Physical symptoms attributed to the night. Culligan notes that sleep, appetite and weight changes are not typical of the dark night (via Borchard 2016); refer to the client's doctor to rule out medical causes (Barrett 2020).

Sources

Web sources:

Books and works cited:

John of the Cross. The Dark Night; The Ascent of Mount Carmel. In: Kavanaugh K, Rodriguez O (trans.), The Collected Works of St. John of the Cross, rev. ed. ICS Publications, 1991.
Lindahl J, et al. 2017. The Varieties of Contemplative Experience study paper. PLOS ONE 12(5): e0176239 (as listed by Cheetah House).
May G. The Dark Night of the Soul (as cited by Durà-Vilà and Borchard).
Font J. (as cited by Durà-Vilà).
Culligan K, OCD (writing on the dark night and depression, as cited by Borchard and Rolheiser).
Durà-Vilà G. Sadness, Depression, and the Dark Night of the Soul: Transcending the Medicalisation of Sadness.
American Psychiatric Association. DSM-5 (Religious or Spiritual Problem, V62.89/Z65.8, p. 725, as cited by Barrett 2020).
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