A second model for the spiritual dimension in psychotherapy is a developmental model. God is involved intimately with each developmental stage of growth among all living things. Spiritual presence is a constant in every human process as author and agent of all we may become. In 1936 Richard Cabot and Russell Dicks wrote The Art of Ministering to the Sitf, which was recognized by many as the first book in the modern era of clinical pastoral education. Cabot, of the famous Boston Cabots who “spoke only to God,” was a prominent physician who taught at Harvard Medical School. Adolescence is marked by the onset of formal operations—the capacity for principled thought, for understanding the laws of cause and effect and becoming critical of ourselves and others. A developmental understanding of spiritual presence means everything that happens in the therapeutic relationship is ultimately a spiritual concern.