It is generally accepted that there is a degree of overlap between spiritual direction and psychotherapy, even while directors are strongly admonished in their training to refer directees to psychiatrists or psychologists when warranted.  Western psychotherapies, for the most part, are rooted in secularist presuppositions about how the world works.  They are not necessarily hostile towards religion, but enhancing one's relationship with the Divine is not a key point in the psychotherapeutic agenda.  Early in his career Freud remarked that "...much will be gained if we succeed in transforming your hysterical misery into common unhappiness" (Studies in Hysteria). 

Recently, attention has been given to the therapeutic overtones found in Eastern Orthodox spiritual direction, especially as exemplified in that great compendium of Orthodox teaching, the Philokalia.  Christopher CH Cook's essay "Healing, Psychotherapy, and the Philokalia", excerpted below, may be found in Brock Bingaman and Bradley Nassif, eds, The Philokalia: A Classic Text of Orthodox Spirituality (Oxford 2012), an invaluable guide to the Philokalia and its underlying theological and ascetical foundations. 

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If the Philokalia presents a school of therapy for the soul, designed to bring about its healing, it might well be argued that the Philokalia is a kind of manual for psychotherapy.  However, once the word "psychotherapy" is used, with all its more modern connotations of Freudian and post-Freudian therapies designed to explore the unconscious, and of the cognitive-behavioral therapies based on cognitive and behavioral scientific psychology, we realize at once how the Philokalia is both similar to and radically different from what we now call, in the Western world, psychotherapy.

On the one hand, the Philokalia shares with contemporary psychotherapies a concern with "inwardness" and with self-reflective awareness, a suspicion about the motives that lay behind apparently innocent or well-intentioned actions, and a keen attention to the content and processes of cognition.  Even some of the methods look very similar--especially those that betray a Stoic model of the passions (or in the case of contemporary psychology the emotions) as being fundamentally based upon thoughts (or cognition).  For example, the identification of thoughts/judgements that lead to fear might be a concern of both the cognitive therapist and the disciple of the Philokalia, remembrance of death is also effectively a cognitive strategy for changing patterns of thought, and ascetic discipline might be considered a kind of behavioral therapy orientated toward changing patterns of thought as well as lifestyle.  Even the philokalic injunctions to obedience and submission to an elder or spiritual guide find their parallels in the therapeutic relationship with a therapist, who is seen as having greater wisdom, knowledge, and experience in matters of the inner life. 

On the other hand, contemporary psychotherapies are based on very different theoretical frameworks and aim at very different ends.  While differences in theory might be surprisingly more superficial than they first appear, there are undoubtedly important differences.  The Freudian tripartite model of the psyche as comprising id, ego, and superego, for example, is not so very different from the Platonic model of appetitive, incensive, and rational parts of the soul, a model which influenced both Freud and the authors of the Philokalia.  Or again, both the cognitive therapist and the authors of the Philokalia emphasize the importance of a self-reflective awareness of thought processes which will lead to greater understanding of how to identify aberrant patterns of thought and develop healthy ones.  The scientific rationalism of the cognitive therapist is not necessarily so far removed from the philosophical and contemplative reasoning of the philokalic practitioner when consideration is limited only to matters of cognitive analysis.  But when consideration is broadened to include ultimate concerns, the atheistic assumptions of Freud and the cognitive-behaviorists contrast strongly with the philokalic world of personal spiritual forces which draw the human creature inevitably toward, or away from, a telos which is firmly located in the Divine.  Moreover, the end of human beings in relationship with God involves the authors of the Philokalia in a contemplative "unknowing" which ultimately transcends human rational thought.  this transcendence is completely lacking, at least from Freud and the more scientific cognitive-behavioral schools of therapy, if not from all of the schools of therapy which have emerged since the work of pioneers such as Freud, Skinner, and Ellis.