(What) do you believe?: Therapist spiritual/religious/non-religious self-disclosure

Objective: Spiritual/religious/non-religious (S/R/N) identity development is often neglected in psychotherapy training and represents an area where psychotherapists feel they lack competence. Such feelings can become even more pronounced when it comes to S/R/N self-disclosure. This study explores the decisions therapists make regarding self-disclosure, which impacts the psychotherapy process. Method: This grounded theory study explores psychotherapists’ S/R/N self-disclosure based on qualitative interviews with 21 psychotherapists representing varied theoretical orientations and spiritual, religious, atheist, and agnostic backgrounds. Results: Findings reveal that while some self-disclosure happens on an explicit level, more often psychotherapists find implicit ways to share S/R/N aspects of the self for purposes of enhancing the therapeutic alliance and to convey openness. Psychotherapists also attempt to avoid the topic altogether, either to protect the therapeutic relationship or because of unresolved S/R/N identity in the therapist. Conclusions: Developing skills related to S/R/N self-disclosure represents an important aspect of multicultural competence, which can impact clients’ feelings of safety and comfort discussing their own S/R/N identity. This capacity is strongly influenced by the therapist’s self-awareness regarding S/R/N identity. Suggestions for engaging S/R/N identity and disclosure in supervisory experiences and academic preparation are discussed.     

Clients' Perceptions of Marriage and Family Therapists Addressing the Religious and Spiritual Aspects of Clients' Lives

Abstract

As marriage and family therapists are emphasizing the actual contexts of clients' lives, religion and spirituality are being addressed as important aspects of culture. This pilot study investigated whether clients felt their therapist adequately addressed the religious and spiritual aspects of their lives according to their desires for such. Thirty-eight clients who attended therapy at university clinics were surveyed using a questionnaire about their own religiosity and spirituality, about their preferences to have religion and spirituality addressed, and whether they perceived their therapist addressed religion and spirituality in the therapy process according to their desires. Results show these family therapists did rather well at addressing the religious and spiritual aspects of their clients' lives. Demographic correlations showed that the gender of the client and whether the university clinic they attended was affiliated with a religious denomination were each positively correlated to whether the clients wanted religion and spirituality addressed and whether their therapist adequately addressed these issues. Detailed limitations are noted.     

Therapists' and clients' experiences of alliance ruptures: A qualitative study

Abstract

Aim: We explored therapists' and clients' experiences of alliance rupture events for the first 15 sessions of each of eight cases; therapists were each paired with one client who had a personality disorder. Method: All sessions were videotaped and rated with the Rupture Resolution Rating System. Approximately 1 week after a rupture, clients and therapists were individually interviewed about the causes of the rupture, how the rupture evolved, the impact of the rupture on the therapeutic process, and experiences during the event. The interviews were analyzed by five judges using consensual qualitative research (CQR; Hill, 2011). Results: Typically, rupture events involved a repetition of a previous rupture event, the rupture emerged when the client was not prepared to respond to the therapist's intervention, both therapists and clients felt confused and ambivalent, and confrontation events activated intense and negative feelings. We discuss the implications for practice, training, and research.     

Transgender people’s reflections on identity,faith, and Christian faith communities in the U.S.

Abstract

Relational therapists have limited access to resources and information about transgender people’s faith beliefs and experiences in Christian communities of faith, which is largely absent from the professional literature. The purpose of this article is to examine the Christian religious and spiritual experiences of transgender people located in the U.S. Seven self-identified transgender people participated in in-depth interviews. Results of the study indicated that participants had various experiences in faith communities, with both supportive and discriminatory responses from others. The results also suggest that participants maintained their faith beliefs even when they experience rejection from faith communities. Moreover, participants reported feeling a connection with a higher power, and specifically viewed themselves as made transgender by God. Findings from this study may be particularly relevant for relational therapists who work within Christian faith communities and organizations. Implications for transgender inclusive and supportive therapy are discussed.     

Wisdom and psychotherapy: Studying expert therapists' clinical wisdom to explicate common processes

Objective: This research study explores the concept of clinical wisdom. Method: Seventeen psychologists who were nominated multiple times by their peers as wise clinicians participated in an interview on clinical wisdom, analyzed using grounded-theory methods. Results: Participants described clinical wisdom as accepting that the best answers to clients' problems often were not immediately accessible and instead using their sense of their clients, their theory of psychotherapy, and their own experiences of adversity, diversity, and intimate relationships to help clients explore the ambiguities and vulnerabilities they experienced to craft idiosyncratic answers. Conclusions: An understanding of clinical wisdom is put forward, characterized by markers and principles for practice, to guide therapy processes within therapists' intentionality and direct research on common factors.     

Pourquoi et comment aborder la spiritualité et la religiosité des patients souffrant de troubles mentaux sévères : une étude de terrain

ObjectivesThere is evidence that psychiatrists are rarely aware of how religion may intervene in their patient's life. That is particularly obvious concerning patients with psychosis. Yet, even for patients featuring delusions with religious content, religious activities and spiritual coping may have a favourable influence. Indeed, patients with psychosis can use religion to cope with life difficulties related to their psychotic condition, in a social perspective but also in order to gain meaning in their lives. Also, religion may be part of explanatory models about their disorder with, in some cases, a significant influence on treatment adhesion.Patients and methodsThis paper describes a prospective randomized study about a spiritual assessment performed by the psychiatrists of patients with schizophrenia. The outpatient clinics in which the sample was collected are affiliated with the department of psychiatry at the university hospitals of Geneva. Eighty-four outpatients with psychosis were randomized into two groups: an experimental group receiving both traditional treatment and spiritual assessment with their psychiatrist and a control group of patients receiving only their usual treatment. Psychiatrists were supervised by a clinician (PH) and a psychologist of religions (PYB) for each patient in the spiritual assessment group. Data were collected from both groups before and after 3 months of clinical follow-up.ResultsSpiritual assessment was well-tolerated by all patients. Moreover, their wish to discuss religious matters with their psychiatrist persisted following the spiritual assessment. Even though clinicians acknowledged the usefulness of the supervision for some patients, especially when religion was of importance for clinical care, they reported being moderately interested in applying spiritual assessments in clinical settings. Compared to the control group, there were no differences observed in the 3 months’ outcome in terms of primary outcome measures for satisfaction with care, yet the attendance at the appointments was significantly increased in the group with spiritual assessment. The same result was found when restricting analyses to patients for whom an intervention was suggested or patients who invested more in religion. Areas of potential intervention were frequent both in a psychiatric and psychotherapeutical perspective.ConclusionsSpiritual assessment appears to be useful for patients with psychosis. This is in accordance with the recommendations of the World Psychiatric Association which promotes considering the whole person in clinical care. Spiritual assessment is quite simple to perform, providing that clinicians do not prescribe or promote religion, and that no critical comments are made concerning religious issues. Clinicians do not need to know in depth the religious domains of each of their patients, as it appears that each patient accommodates his/her religious background his/her own way.     

Ethical considerations in the integration of religion and psychotherapy: three perspectives.

The authors maintain that the integration of religion in psychotherapy is, at best, problematic and requires a respect for boundaries, but that the integration of a nonreligious but spiritual psychotherapy consisting of the three elements identified above (attention to the person, not the disease, considering one's work as vocation, and the pursuit of empathic understanding) is a therapeutic necessity and an ethical duty. The authors speak with distinct voices in the three major sections of the article but come to remarkably similar conclusions: (1) the ability to inquire into the religious and spiritual life of patients is an important element of psychotherapeutic competency; (2) information about the religious and spiritual lives of patients often reveals extremely important information; (3) the inquiry process must communicate respect and curiosity for this dimension of the patient's life even (and perhaps especially) when the content is at variance from that of the therapist; and (4) there is significant potential for therapeutic abuse when the therapist communicates in a manner reflecting a personal agenda that abandons the principle of psychotherapeutic neutrality. One area of potential disagreement came as the authors considered the possibility of different combinations of faith disciplines and therapy in designated religious settings that all parties recognize as such. One author (G.P.M.) believes that such combinations in these settings may be ethically permissible. The other two authors are concerned about such combinations because of the powerful but covert factor of transference in healing relationships. The authors eventually decided that this question was beyond the scope of the article and limited themselves to discussions about psychotherapy in secular settings. They each advocate the systematic inclusion of spiritual assessment as a core competency for psychotherapy education. In a way similar to the exploration of any deeply personal dimension of human experience, integrating spiritual and religious dimensions of our patients' lives into their treatment requires consummate professionalism, the highest quality of knowledge, skills, and attitudes, and thorough grounding in a sophisticated biopsychosocial model.     

The relationship between psychiatry and religion among U.S. physicians

OBJECTIVE: This study compared the religious characteristics of psychiatrists with those of other physicians and explored whether nonpsychiatrist physicians who are religious are less willing than their colleagues to refer patients to psychiatrists and psychologists. METHODS: Surveys were mailed to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. Physicians were queried about their religious characteristics. They also read a brief vignette about a patient with ambiguous psychiatric symptoms and were asked whether they would refer the patient to a clergy member or religious counselor, or to a psychiatrist or a psychologist. RESULTS: A total of 1,144 physicians completed the survey, including 100 psychiatrists. Compared with other physicians, psychiatrists were more likely to be Jewish (29% versus 13%) or without a religious affiliation (17% versus 10%), less likely to be Protestant (27% versus 39%) or Catholic (10% versus 22%), less likely to be religious in general, and more likely to consider themselves spiritual but not religious (33% versus 19%). Nonpsychiatrist physicians who were religious were more willing to refer patients to clergy members or religious counselors (multivariate odds ratios from 2.9 to 5.7) and less willing to refer patients to psychiatrists or psychologists (multivariate odds ratios from .4 to .6). CONCLUSIONS: Psychiatrists are less religious than other physicians, and religious physicians are less willing than nonreligious physicians to refer patients to psychiatrists. These findings suggest that historic tensions between religion and psychiatry continue to shape the care that patients receive for mental health concerns.     

Constructing a grounded theory of young people's recovery of musical identity in mental illness

Musical identity is a highly relevant, yet little researched area within mental illness. In this study, the researchers explore how 11 young people's musical identities changed during their experiences of, and recovery from mental illness. The researchers use a constructivist grounded theory approach to collect and analyse in-depth interviews with young people attending a music therapy programme at a youth mental health service. Findings are presented as a constructivist grounded theory of young people's recovery of musical identity. This interpretation illustrates how aspects of these young people's pathology presents as ‘musical symptoms’ during acute illness and the ways in which young people engage in processes of ‘bridging’ and ‘playing out’ musical identity in the community. The role of music therapy in supporting young people's recovery from mental illness is presented, and the need to consider community-based music services is discussed.     

“Conversion Therapy” Experiences in Their Social Contexts: A Qualitative Study of Sexual Orientation and Gender Identity and Expression Change Efforts in Canada

Objective:To describe in what forms, with whom, where, when, and why Canadians experience sexual orientation and gender identity and expression change efforts (SOGIECE).Methods:This qualitative study is grounded in a transformative paradigm. We conducted semi-structured interviews with a purposive sample of 22 adults recruited from across Canada who have experienced “conversion therapy.” Directed content analysis was used, employing deductive and inductive coding approaches, to synthesize the findings and address 5 policy-relevant questions.Results:What are SOGIECE? Formal and informal methods of SOGIECE were used, including pharmacologic interventions, denial of gender-affirming care, and coaching to repress sexual orientation and/or gender identity and expression. With whom did SOGIECE occur? Practitioners included religious leaders, licenced health-care professionals (e.g., psychiatrists and psychologists), peers, and family members. Where did SOGIECE occur? SOGIECE occurred in 3 predominant settings: faith-based, health care, and social life. When did SOGIECE occur? SOGIECE rarely occurred over a restricted time frame; often, SOGIECE began while participants were adolescents or young adults and continued multiple years under various forms. Others described SOGIECE as a context in which their life was embedded for many years. Why did people attend SOGIECE? Cisheteronormative social and religious expectations taught participants that being non-cisgender or non-heterosexual was incompatible with living a good and respectable life.Conclusions:SOGIECE are not a circumscribed set of practices. Our study shows that SOGIECE are a larger phenomenon that consists of intentional and explicit change efforts as well as heterosexual- and cisgender-dominant social norms expressed and enforced across a wide range of settings and circumstances. This study provides critical context to inform contemporary social and health policy responses to SOGIECE. Policies should account for the overt, covert, and insidious ways that SOGIECE operate in order to effectively promote safety, equity, and health for sexually diverse and gender-diverse people.     

The Two-Way Mirror in My Therapy Room

Abstract

The mirror of self-reflection allows therapists to monitor our responses to clients' stories. This hallmark of supervision and clinician education is particularly necessary for work with families experiencing illness and loss, experiences that are universally shared by therapists and their clients. This paper exemplifies the integration of a therapist's experience of family illness with ongoing work with a family coping with AIDS.     

Religion,Spirituality, and Psychosis

This review discusses the relationships between religion, spirituality, and psychosis. Based on the DSM-IV, we comment on the concept of spiritual and religious problems, which, although they may seem to be psychotic episodes, are actually manifestations of nonpathological spiritual and religious experiences. Studies reporting that hallucinations also occur in the nonclinical population and thus are not exclusive to the diagnosed population are presented. Then, other studies pointing to the strong presence of religious content in psychotic patients are also presented. Finally, the criteria that could be used to make a differential diagnosis between healthy spiritual experiences and mental disorders of religious content are discussed. We conclude that the importance of this theme and the lack of quality investigations point to the necessity of further investigation.     

Making meaning of the virginity experience: young men's perceptions in the United States

ABSTRACT

A qualitative grounded theory approach was used to analyze 34 narratives from young men about their experience of retaining, losing, or giving away their virginity, where 7 said they were virgins, 26 said they were non-virgins, and one did not mention his virginity status. We found that virginity is a multidimensional concept, with two distinct dimensions: the experiential and the developmental. The experiential dimension refers to young men's perception and understanding of their virginity in four overlapping areas: physical, spiritual, relational, and emotional. The developmental dimension refers to young men's perception of their underlying sexual identity growth processes and the gendered and sexual double standards that influence this understanding. Clinical implications of this study are useful in education and counseling. They seek to empower young men with information relating to the multidimensional nature of virginity experience, and minimize the negative effects on romantic relationships, sexual adjustment, and self-identity development. The findings are helpful in designing interventions for young men and women who are at high risk for sexually transmitted infections and can help them negotiate mutually safe and pleasurable experiences regarding their virginity.     

Identification of caregivers at greatest risk of major depression in two prevention studies

Abstract

After an introductory course in experiential-integrative psychotherapy, 21 graduate students provided personal narratives of their experiences, which were analyzed using the grounded theory method. Results produced 37 hierarchically organized experiences, revealing that students perceived multiple changes in both professional (i.e., skill acquisition and learning related to the therapeutic process) and personal (i.e., self growth in a more private sphere) domains. Analysis also highlighted key areas of difficulties in training. By adding the personal accounts of graduate trainees, this study enriches and extends Pascual-Leone et al.'s (2012) findings on undergraduates' experiences, raising the number of cases represented in the model to 45. Findings confirm the model of novice trainee experiences while highlighting the unique experiences of undergraduate vs. graduate trainees.     

Extraordinary experiences in its cultural and theoretical context

Abstract

The growing complexity, opaqueness and specialization of many areas of life and – above all – a booming psychological and esoteric market create the necessity for counselling and advice for individuals who encounter so-called ‘paranormal’ experiences. These experiences are often interpreted as ‘transpersonal’ or ‘spiritual’, depending on the cultural background and religious traditions. The term ‘spiritual crisis’ has become a fashionable diagnosis with some transpersonal psychotherapists. Paranormal experiences, regardless of their acceptance of academic psychology and psychiatry, are still a taboo subject in society. The Parapsychological Counselling Office in Freiburg is a professional unit with governmental support, which helps individuals to cope with such experiences adequately. The work and responsibilities of the counselling centre are presented. A large collection of cases in the form of letters, which were sent in by individuals wanting to communicate their unusual or extraordinary experiences have been analysed. Some of the results are reported here. Finally, we discuss a special form of ‘inexplicable experiences’ based on a theoretical model. Its recommendations seem counter-intuitive but are ultimately successful. The model starts from a system-theoretical viewpoint and uses concepts such as complementarity and entanglement of generalized quantum theory (GQT) and the model of pragmatic information (MPI). Since it turned out that individuals who contact the counselling centre also offer their own interpretations and ‘explanation’, the question arises, how these resources can be used to help clients.     

Sexual counselling with Catholics: how to cope with sexual issues with Catholic clients?

Sexual health is an integral part of the multifaceted human experience that is driven both by biological factors and psychological facets. Sociocultural aspects including religious beliefs can influence sexual mores and how one perceives oneself as a sexual being. The authors present some of the key tenets of Catholicism that are relevant for the sexual health professional, concentrating on the most important issues focused in the literature as interesting for the influence that religious beliefs have on sexual health. Counselling about chastity, contraception usage and HIV/STIs risk, homosexuality and homophobia, and sexual therapy will be discussed in their correlation with the Catholic doctrine. The literature analysis shows that when working with clients facing tensions and conflicts between sexual and religious identity development, counselors should view their work as aiding them in finding points of connection between religious and sexual identities. Professionals should use all available resources to learn about the beliefs and religious practices of their patients. An attempt to understand the personal belief system is critical for overall success in the sexual health treatment paradigm. Clinicians need to be sensitive to the members' attachment to Catholicism or other religions and potential need community for social support and spiritual guidance.     

Recognizing and Raising Spiritual and Religious Issues in Therapy

Abstract

Religious and spiritual experiences and practices comprise some of the most important aspects of many people's lives. Yet, for various reasons, mental health practitioners have been hesitant to bring these issues into overt discussions in therapy. This article proposes a four-part framework to assist therapists in addressing religion and spirituality in therapy. The four areas include spiritual issues raised by either the client or therapist, and religious issues raised by either the client or therapist. Guidelines for therapeutic conversation and clinical examples are offered for each of the four areas.     

Of Doors Locked and Unlocked

This discussion of Charles B. Strozier's “Heinz Kohut and the Meanings of Identity” amplifies Strozier's work by underscoring the history of Austrian anti-Semitism that constitutes the background of Kohut's biography and by relating this history to Kohut's self-psychological analysis of religious experience. Kohut's central contribution, the study of narcissism, may be understood as having its origins in Kohut's deep feelings of shame and self-hatred regarding his Jewishness and the vertical splitting and dissociation of this aspect of his religious identity. What made Kohut a great psychoanalytic theorist was his ability to transform his own psychological struggles into a theory and treatment approach that transcended the limitations of his own life and that continues to shed light on the tragic and heroic dimensions of all human experience.     

Dominance and Nurturance in the Figurative Expressions of Psychotherapy Clients

It has been recognized that clients' figurative expressions can be a window into the central themes of therapy and can reveal much about clients' affective experiences, thought processes, and perceptions of self and others. However, there have been few attempts to study the use of figurative expressions within a theoretical or conceptual framework that links the content of clients' figurative expressions to therapy outcome. In this article, we present the results of a study in which all client-generated figurative expressions relating to interpersonal actions from 21 cases of psychotherapy were selected and coded on Kiesler's (1985) Acts Version of the Interpersonal Circle. Results revealed a fairly clear and theoretically consistent relationship between therapy outcome and the location on the interpersonal circumplex of clients' figurative expressions of self actions.     

Assessing problems with religious content: a comparison of rabbis and psychologists

This study measured distinctions made by a sample of clergy and mental health professionals in response to three categories of presenting problems with religious content: mental disorder, religious or spiritual problem, and "pure" religious problem. A national, random sample of rabbis (N = 111) and clinical psychologists (N = 90) provided evaluations of three vignettes: schizophrenia, mystical experience, and mourning. The participants evaluated the religious etiology, helpfulness of psychiatric medication, and seriousness of the presenting problems. The rabbis and psychologists distinguished between the three diverse categories of presenting problems and concurred in their distinctions. The results provide empirical evidence for the construct validity of the new DSM-IV category religious or spiritual problem (V62.89). Use of the V code allows for more subtle distinctions among the variety of problems that persons bring to clergy and mental health professionals. These distinctions may also provide a foundation for the initiation of co-professional consultation.