Spirituality and existential well-being as topics of research in medical psychology and psychiatry

Spirituality is introduced as a notion referring to a personal dimension of life sense donating self-reflection and includes religious thinking in this respect but, however, is by no means limited to religiousness. Different studies point out that there may be relevant connections between aspects of subjective life sense and variables like "neuroticism" and "negative" emotionality. In the Anglo-American psychological and even psychiatric literature this spiritual dimension is a topic of empirical research; programs of psychological treatment for chronical and terminal ill patients had been created and are mainly founded on aspects of spirituality as a relevant dimension in remaining life. Referring to the presented literature the hypothesis can be formed that a sense-donating contingency is related to different psychological and psychiatric topics not limited to aged people or those suffering from severe illness. Further research is needed; culture-dependent differences in the content and expression of spiritual dimensions may exist. The question becomes actualized by migration movements (fundamentalistic philosophies), a greater proportion of patients might be influenced by other religions and life sense-donating philosophies. In the existing psychotherapy literature indications are hardly found how these patients' characteristic features can be adequately integrated in design and execution of the psychotherapeutic process.     

Psychiatry,religion and cognitive science

OBJECTIVE: To see whether certain findings in cognitive science can serve to bridge the conceptual gap between psychiatry, particularly in its psychotherapeutic aspects, and religious/spiritual understanding. METHOD: A brief review is given of certain basic differences between psychiatric understanding in its psychotherapeutic aspects, and much of Western religious/spiritual understanding. Reference is then made to certain findings in contemporary cognitive science which might challenge the implicit mind-body split of Western religious tradition and its parallel in psychotherapeutic practice. Attention is also drawn to elements in religious/spiritual tradition that run counter to this dualistic point of view. RESULTS AND CONCLUSIONS: Much of contemporary religious/spiritual understanding, and of modern psychiatric understanding, especially in terms of psychotherapy, appear to exist in quite separate domains. Psychotherapy and the greater part of Western religious thinking, however, share a belief in the existence of a transcendent mind. Recent developments in cognitive science and certain spiritual traditions, challenge this implicit mind-body split, providing an opportunity for a renewed dialogue between psychiatry and religion and the possibility of collaborative research.     

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.     

Exploring the use of touch in the psychotherapeutic setting: A phenomenological review

This paper provides a synthesis of the literature concerning the duality of touch and talk between therapist and client in the psychotherapy setting. It discusses the ethical considerations, prohibitions, and attitudes about touch within the psychotherapeutic field. In addition, it looks at the client's perception of touch, types of touch, paradigms, rationales for the use of touch, religious and cultural considerations, the effects of touch, and research implications. Despite the reservations and lack of training around the use of touch in psychotherapy, there is a variety of literature to support its uses, benefits, effectiveness, and rationales, insomuch as there is a variety of literature about prohibitions, contraindications, and cautions of its use. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Psychotherapists' spiritual,religious, atheist or agnostic identity and their practice of psychotherapy: A grounded theory study

Abstract

In this present grounded theory study, 16 experienced psychologists, who practiced from varied theoretical orientations and came from diverse religious/spiritual/nonreligious backgrounds, explored their personal religious/spiritual/nonreligious identity development journeys, their experiences with clients' religious/spiritual content in psychotherapy sessions, and how their identity may have influenced the way they interacted with religious/spiritual material during sessions. Results revealed that psychologists' spiritual/religious/nonreligious identity is conflicted and complex and that their academic and clinical training did not provide sufficient opportunity to examine how this may affect their therapeutic work. A tentative grounded theory emerged suggesting that psychologists both identified with and were activated by clients' spiritual/religious conflicts and their internal experiences about the spiritual/religious content, both of which presented significant challenges to therapeutic work.     

Emotion-focused principles for working with borderline personality disorder

This paper discusses the function of emotion, its importance in the treatment of individuals with borderline personality disorder (BPD), and the integration of emotion-focused therapy (EFT) principles in the psychotherapeutic management of patients with BPD. EFT principles involve emotional assessment; a strong therapeutic alliance as a necessary context for treatment; the therapeutic relationship as a bond that regulates affect through empathy, emotional validation, and interpersonal soothing; emotion-regulation; psychoeducation about emotional processes; the therapist as an emotional coach; and transforming emotion schemes as primary mechanisms of change. The authors discuss how EFT principles can be viewed as primary intervention strategies in the treatment of patients with BPD and how they can be incorporated into various psychotherapy approaches. Based on our experience, the integration of EFT principles into the therapy of patients with BPD shows promise as it has been helpful in targeting BPD symptoms, and is feasible and acceptable to patients.     

Integrative psychotherapy

The main purposes of the article are to present the history of integration in psychotherapy, the reasons of the development integrative approaches, and the approaches to integration in psychotherapy. Three approaches to integration in psychotherapy exist: theoretical integration, theoretical eclecticism, and common factors in different psychotherapeutic trends. In integrative psychotherapy, the basic epistemology, theory, and clinical practice are based on the phenomenology, field theory, holism, dialogue, and co-creation of dialogue in the therapeutic relationship. The main criticism is that integrative psychotherapy suffers from confusion and many unresolved controversies. It is difficult to theoretically and methodologically define the clinically applied model that is based on such a different epistemological and theoretical presumptions. Integrative psychotherapy is a synthesis of humanistic psychotherapy, object relations theory, and psychoanalytical self psychology. It focuses on the dynamics and potentials of human relationships, with a goal of changing the relations and understanding internal and external resistances. The process of integrative psychotherapy is primarily focused on the developmental-relational model and co-creation of psychotherapeutic relationship as a single interactive event, which is not unilateral, but rather a joint endeavor by both the therapist and the patient/client. The need for a relationship is an important human need and represents a process of attunement that occurs as a response to the need for a relationship, a unique interpersonal contact between two people. If this need is not met, it manifests with the different feelings and various defenses. To meet this need, we need to have another person with whom we can establish a sensitive, attuned relationship. Thus, the therapist becomes this person who tries to supplement what the person did not receive. Neuroscience can be a source of integration through different therapies. We may say that both neuroscience and neurobiology offer yet another bridge for integration of different schools of thought and supports the importance of the developmental relational model during the developmental phases and relational process in psychotherapy in which the quality of therapeutic relationship is the primary healing process. Furthermore, the development of integrative psychotherapy in Croatia and the organization of the Croatian program, which is identical to the program of the European Association for Integrative Psychotherapy is shortly described.     

Reflections on psychodynamic psychotherapy supervision for psychiatrists in clinical practice

Much has been written about psychotherapy supervision for trainees in psychiatry. Psychiatrists are also encouraged to receive supervision when dealing with difficult patients or when involved in personal events that have the potential to have an impact on their psychotherapeutic work. Nevertheless, a literature search, conducted through Medline, revealed few publications dealing with supervision of psychiatrists who conduct psychotherapy in clinical settings after completion of training. This article discusses the issues involved in psychotherapy supervision for the supervisor, supervised psychiatrists, and their practice settings and patients. The author first discusses the benefits of psychotherapy supervision for psychiatrists in clinical practice, including helping psychiatrists maintain and improve psychotherapeutic skills, assistance in dealing with patients who have complex or especially challenging problems (e.g., personality disorders, intractable depression, difficulties with compliance, complex psychosocial problems), addressing ethical concerns, boundary issues, and transference and countertransference, and helping psychiatrists deal with personal issues that may cause difficulties in providing psychotherapy or issues that arise in working with a multidisciplinary team. The author then reviews key issues related to the supervisory process, including group versus individual supervision, the role of the supervisor, different supervisory styles, and factors that can contribute to feelings of shame or vulnerability in the supervisee. The author also discusses different supervisory styles, clarifies the distinction between therapy and supervision, and discusses issues that arise in the supervision of experienced psychodynamic therapists. Barriers that may keep psychiatrists from seeking psychotherapy supervision are reviewed. Finally the author discusses the supervision of those acting as supervisors for other clinicians.     

Spirituality and religion in psychiatric rehabilitation and recovery from mental illness

While mental health professionals frequently express concerns about the function of spirituality and religion in the lives of people diagnosed with severe mental disorders, there are both clinical and research bases for the increased acceptance of spirituality's potentially positive role in psychiatric rehabilitation and recovery. This paper first addresses issues of religious experience in diagnosis, including the importance of religiocultural context and overall functioning in diagnostic assessments. It then examines the roles of spirituality in recovery, exploring both positive and negative relationships between religion and consumers' well-being. Finally, it describes several specific ways in which spiritual and religious concerns may be integrated into psychosocial rehabilitation services: conducting spiritual assessments; offering spiritually-informed discussion groups; incorporating spiritual dimensions of psychotherapy; and facilitating linkages to faith communities and spiritual resources.     

Facilitating client change: Principles based upon the experience of eminent psychotherapists

Abstract

Eminent therapists across psychotherapy meta-orientations were asked to describe the processes by which they facilitate change in psychotherapy. A grounded theory analysis of these interviews was conducted. Safety within the psychotherapeutic relationship was identified as a central element in creating client change to the extent that in-session risk taking was important in that orientation. As well, common processes across orientation in structuring new awareness emerged as a core finding. Patterns were identified in how therapists balanced negotiating the client–therapist relationship while fostering new awareness. Principles based on therapists' common intentions are put forward to guide future research and psychotherapy integration efforts.     

A phenomenology of closeness and its application to sexual boundary violations: a framework for therapists in training

Sexual boundary violations remain a persistent problem in psychiatry despite increased attention, disciplinary activity, and educational efforts. Currently, therapists in training are often overwhelmed by a sense of danger in every direction, including the risk of false accusation. The authors present a framework for understanding experiences of closeness that can help overcome a trainee's paralyzing bewilderment and attendant longing to retreat from the practice of psychotherapy. Eight characteristics of ordinary psychotherapeutic engagement effectively maximize the intensity of interpersonal closeness between patient and psychotherapist while simultaneously reducing the experience of closeness outside the treatment setting for both patient and clinician. An important consequence is that drifts toward sexual boundary violations can arise from the everyday dynamics of closeness, even in the absence of individual pathology or intent. The implications for the practice of psychotherapy and personal lives of psychotherapists are explored.     

On learning from experience: personal and private experiences as the context for psychotherapeutic practice

The central idea in evidence-based practice is that it is the therapy that works and not the therapist. However, this article seeks to show how both our private and personal lives are an area for reflection when we are working as psychotherapists, and that personal and private experience can be an important framework for practising psychotherapy. Through looking at elements of the personal and private lives of three different therapists in the light of a therapy session conducted by each, I will try to demonstrate how personal and private experiences may influence clinical practice. The article builds on an ongoing grounded theory research project at the Tavistock Centre, London.     

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.     

Informed consent in psychotherapy

OBJECTIVE: The authors sought a rational approach to implementing informed consent within the practice of psychotherapy. METHOD: The history of informed consent in psychotherapy was reviewed to define a common synthesis that maximizes the potential benefits and minimizes the potential hazards. RESULTS: The benefits of informed consent in psychotherapy include fostering a positive treatment outcome through enhancing patient autonomy, responsibility, and self-therapeutic activity; lessening the risks of regressive effects and therapist liability; and helping the practice of psychotherapy extend beyond particular parochialisms by providing checks and balances on therapist judgments. The hazards include the unpredictability of interactional outcomes and the possibilities of replacing positive expectancy with negative suggestion, replacing a therapeutic alliance with a legalistic stance, and misimplying that patients are passive recipients. CONCLUSIONS: Practical implementation of informed consent in psychotherapy must balance such tensions in service of optimal treatment. As a guiding principle, the authors recommend that psychotherapists convey to a prospective patient information that is material to the particular patient's decision. The level of detail needed in informed consent discussions varies directly with the cost and risks of the proposed treatment, the presence of viable alternatives and their relative grounding in scientific data and professional acceptance, and the presence of significant controversy. Unresolved is the question of how to address problematic or controversial psychotherapeutic trends that temporarily enjoy wide professional support.     

Altered states of consciousness during psychotherapy: a historical and cultural perspective.

This paper reviews the frequent phenomenon of altered states of consciousness in disparate cultural psychotherapeutic contexts. The historical antecedents of contemporary Western psychodynamic psychotherapy are examined and the central importance of altered states in the therapeutic effects of religious institutions such as the Dionysian rite and the Asclepia is illustrated. The continued presence of this phenomenon in Western psychotherapy from Mesmerism to psychoanalysis is shown. The use of trance states in the healing rituals of non-Western societies is culturally variegated therapeutic settings. The ubiquitous nature of the altered state phenomenon in such widely varied cultural contexts suggests the possibility of its being a universal component of psychotherapy.     

The Pregnant Therapist: The Effect of a Negative Pregnancy Outcome on a Psychotherapy Patient

In psychiatry, pregnancy introduces an element into the treatment setting that is complex and may require exploration. Often, in the psychotherapeutic relationship, the psychiatrist may use therapeutic techniques and provide no self disclosure to the patient by Tinsley (Am J Psychiatry 160(1): 27–31, 2003). The patient reveals all of their innermost thoughts. This can bring about curiosity for the patient about the clinician’s life and result in asking personal questions which can at times be uncomfortable for the therapist, particularly for those still in training. This may feel like a boundary crossing which can pose a therapeutic challenge. The clinician is challenged to further enhance the therapeutic relationship and further help the patient on their journey to self exploration. While it is inevitable that patients will have reactions to their therapists, this can be played out in a number of ways, both at the conscious and unconscious level. While numerous studies have looked at the impact of the therapist’s pregnancy on the patient and their treatment, there is no information about the effect of a therapist having a negative pregnancy outcome. Negative outcomes include the therapist having a miscarriage, delivering a still-born or both the therapist and baby dying. This case report describes a clinical scenario in which a psychiatry resident in training delivered a stillborn baby at 37 weeks and the impact of that on a long term psychotherapy patient.     

The movement toward integrating the psychotherapies: an overview

There is a growing tendency among psychotherapists to ignore the ideological barriers dividing schools of psychotherapy and to define what is common among them and what is useful in each of them. After a brief introduction the authors provide a short glossary of terms often associated with psychotherapy integration. They then characterize integrative-eclectic therapists, describe the forces fostering their emergence, and outline recurrent themes of the movement and points of contention within it. The authors hope to encourage clinical thinking about the less ideological approaches to psychotherapy and to advance the integrative movement, which is likely to influence psychotherapeutic practice for decades to come.     

Therapists’ Attitudes Towards Psychotherapeutic Strategies in Community-Based Psychotherapy with Children with Disruptive Behavior Problems

Little is known about what individual treatment strategies therapists providing usual care psychotherapy consider the most valuable to their practice. The Therapeutic Strategies Survey (TSS) assesses therapists’ attitudes about the value of 27 individual treatment strategies in their practice with children with disruptive behavior problems in community-based outpatient psychotherapy. Findings indicate that therapists from multiple professional disciplines highly value many individual psychotherapeutic strategies, and consider strategies common to a majority of evidence-based practices (EBPs) for this population at least as important as strategies not emphasized in EBPs. Implications for developing therapist training and implementation of EBPs are discussed. Portions of this work were presented at the 2007 NIMH Conference on Mental Health Services Research in Washington, D.C.     

The different kinds of group psychotherapy with patients with different diagnoses

Group psychotherapy is a treatment method in which in addition to the therapist(s) the participating individuals are, autocentrically, active in attaining a therapeutic effect. The different kinds of group psychotherapy are described: 1) activity group psychotherapy, 2) analytic group psychotherapy, 3) directive-suggestive-group psychotherapy, 4) psychodrama, 5) accelerating/focal methods of group psychotherapy. Group psychotherapeutic techniques with patients of different diagnoses are discussed, e.g. group psychotherapy with drug dependants and alcoholics, in which it is not possible to use a pure analytic method of group psychotherapy. Their oral tendencies and narcissistic desires of undergoing a fusion with the therapist have to a certain degree to be fulfilled. Schizophrenics should encounter in group psychotherapy an unconditioned emotional response from the therapist. These patients on the one hand expect to be understood in their psychotic experience, but on the other hand they seem to be glad when the measures of the outside reality are maintained in the group. The relatives of schizophrenics wanting to co-operate are taken in a parallel group. Depressives, especially endogenous depressives, need a longer time to be integrated in a therapeutic group than other patients, but if they can be integrated, it helps them to tolerate their sufferings. To the neurotics, group psychotherapy offers insight and a chance to “translate” this insight into a new social behaviour. Analytic self-experience groups with staff members give them an opportunity to recognise from their own experience the conflicts and the behaviour patterns from which their patients suffer.     

The psychotherapeutic relationship and use of psychological methods

On a quotation from the early dialogue of Plato, Charmides, the author demonstrates that since the beginnings principle to treat man as a whole, as his psychic and bodily processes are closely interlinked. At the same time the irreplaceable role of psychotherapy in the prevention and treatment of impaired health is explained. Psychotherapy is implemented mostly by the relationship between the therapist and patient; its course depends on the behaviour of the therapist and his personality characteristics. Based on an almost hundred-year tradition of systematic psychotherapy and due to empirical research of processes and therapeutic results during the past forty years, it may be taken for granted that for a desirable psychotherapeutic relationship the following characteristics on the part of the psychotherapist are typical: unconditional acceptance of the patient and he therapists emotional affection, empathic understanding of the patient and authenticity--genuineness of the therapist's personality. Due to advances of knowledge various psychotherapeutic trends converge in the sphere of psychotherapeutic theory and practice. Finally the author quotes views of professor K. Weis, director of the Psychiatric University in Leipzig who considers psychotherapy the axis of treatment, surrounded by somatotherapy, sociotherapy and rehabilitation measures.