Spirituality and religion in Canadian psychiatric residency training.

OBJECTIVE: Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. METHODS: We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. RESULTS: We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. CONCLUSION: Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.     

Spirituality in psychiatry residency training programs

Spirituality has been receiving increased attention in health care in recent years. Surveys have identified that patients want their spiritual beliefs addressed in the clinical setting. Data suggests that spirituality may be helpful to people as they cope with serious illness and life events. Medical educators are recognizing spirituality as a core patient need. Courses in medical schools and in psychiatric residency programs are being developed to address this important issue.The Accreditation Council for Graduate Medical Education (ACGME) guidelines underscore the importance of addressing religious/spiritual issues in psychiatric training. The John Templeton Spirituality and Medicine Award Program administered by GeorgeWashington University recognizes psychiatric residency programs that address spirituality and health. This award has stimulated the development of relevant, novel curricula in this area. In addition, a consensus group of psychiatrists has developed a model curriculum that addresses key concepts of a psychiatric residency training programs in spirituality and medicine.     

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.     

Toward a more culturally sensitive DSM-IV. Psychoreligious and psychospiritual problems.

In theory, research, and practice, mental health professionals have tended to ignore or pathologize the religious and spiritual dimensions of life. This represents a type of cultural insensitivity toward individuals who have religious and spiritual experiences in both Western and non-Western cultures. After documenting the "religiosity gap" between clinicians and patients, the authors review the role of theory, inadequate training, and biological primacy in fostering psychiatry's insensitivity. A new Z Code (formerly V Code) diagnostic category is proposed for DSM-IV: psychoreligious or psychospiritual problem. Examples of psychoreligious problems include loss or questioning of a firmly held faith, and conversion to a new faith. Examples of psychospiritual problems include near-death experiences and mystical experiences. Both types of problems are defined, and differential diagnostic issues are discussed. This new diagnostic category would: a) improve diagnostic assessments when religious and spiritual issues are involved; b) reduce iatrogenic harm from misdiagnosis of psychoreligious and psychospiritual problems; c) improve treatment of such problems by stimulating clinical research; and d) encourage clinical training centers to address the religious and spiritual dimensions of human existence.     

Psychoanalytic practice and the religious patient: a current perspective

Via a national survey and in-depth interviews, the author investigated training psychoanalysts' views on religion and spirituality and the impact of such views on their treatment practices. The training analysts surveyed described being appreciative of a patient's religious or spiritual worldview when it allowed for flexibility in its theological tenets or when it played a psychologically supportive role. In most instances, empathy for a suffering human being together with the desire to enter a patient's subjective field of experience overrode analysts' personal and professional biases vis-à-vis religious involvement, when these were present.     

The cure of souls: psychiatric dilemmas

Misunderstandings quite frequently occur between patients and their doctors because psychiatrists may be unable to comprehend and therefore accept their patient's experience. 'Soul' and 'spirit' are essential characteristics of human life: soul ultimately means 'quick moving', the principle of life; spirit etymologically refers to breath and is also the animating or vital principle.The spiritual aspects of a person include his or her aims and goals, the interrelatedness of human beings, wholeness of person in which spirit is not separate from body or mind, moral aspects of goodness, beauty and enjoyment and an awareness of God. Psychiatrists have historically had difficulties with the spiritual realm, some of the roots of psychiatry have been anti-ecclesiastical and currently psychiatrists are well aware of the harmful effects of some religious groups upon vulnerable patients.However, religious people, those who regard faith, religious practice and spiritual issues as important, have had distrust for some psychiatrists and their publications.There has also been a degree of professional rivalry between clergy and psychiatrists who share some of the same goals for their parishioners/patients. Patients feel themselves sometimes to have been caught in the cross-fire and this has resulted in reluctance to talk about spiritual issues to their psychiatrists or mental health problems to their priest.In practice there is considerable evidence for the benefit of religious belief in achieving good mental health and recovery from mental illness.It is important for the psychiatrist to be aware of patients'religious beliefs and spiritual aspirations, to understand these and know about patients' backgrounds. It is harmful for psychiatrists to try and impose their own views and understandings upon their patients.     

Religious and spiritual assessment of the child and adolescent

Assessment in child and adolescent psychiatry is a complex process that involves developmental, environmental, and experiential perspectives. Recently, there has been interest in including spiritual and religious assessment in the psychiatric assessment of children, but no well-recognized guidelines for such an assessment have been established. This article proposes an approach to spiritual assessment of children and adolescents that begins with developing an understanding of the family's spiritual and religious life, followed by a developmentally informed method of observing and talking with children and adolescents about their spiritual and religious beliefs. The article concludes with a discussion of ethical issues involved when the psychiatrist addresses issues of spirituality and religion with child and adolescent patients and their families.     

Challenges to neurology residency education in today's health care environment

Residency training has had to adapt to higher patient volumes, increased complexity of medical care, and the commercialized system of health care. These changes have led to a concerning culture shift in neurology. We review the relationship between the emerging health care delivery system and residency training, highlighting issues related to duty hours and work‐life balance, the changing technological landscape, high patient volumes, and complex service obligations. We propose that the current challenges in health care delivery offer the opportunity to improve neurology residency through faculty development programs, bringing teaching back to the bedside, increasing resident autonomy, utilizing near‐peer teaching, and rewarding educators who facilitate an environment of inquiry and scholarship, with the ultimate goal of better alignment between education and patient care. Ann Neurol 2016;80:315–320     

Post-traumatic growth and spirituality in burn recovery

For decades, research on long-term adjustment to burn injuries has adopted a deficit model of focusing solely on negative emotions. The presence of positive emotion and the experience of growth in the aftermath of a trauma have been virtually ignored in this field. Researchers and clinicians of other health and trauma populations have frequently observed that, following a trauma, there were positive emotions and growth. This growth occurs in areas such as a greater appreciation of life and changed priorities; warmer, more intimate relations with others; a greater sense of personal strength, recognition of new possibilities, and spiritual development. In addition, surveys of trauma survivors report that spiritual or religious beliefs played an important part in their recovery and they wished more healthcare providers were comfortable talking about these issues. Further evidence suggests that trauma survivors who rely on spiritual or religious beliefs for coping may show a greater ability for post-traumatic growth (PTG). This article reviews the literature on these two constructs as it relates to burn survivors. We also provide recommendations for clinicians on how to create an environment that fosters PTG and encourages patients to explore their spiritual and religious beliefs in the context of the trauma.     

Religious and spiritual aspects of family assessment

Childhood emotional and behavioral problems have increased over the past several decades, and the consequences of these behaviors have an impact on the entire family. The role of the family in these problems is clearly an important consideration for the child psychiatrist. A specific understanding of how the family's spiritual worldview or religious convictions impact clinical problems has been underappreciated. The religious orientation or spirituality of parents influences various aspects of family life, from ideals about marriage and family to specifics regarding child rearing. This article reviews the goals of assessment of family religious or spiritual worldview, which include empathically engaging the family of a child in treatment, developing a formulation of how these spiritual factors impact general family functioning, and determining whether the family's religion and spirituality are a resource for treatment or a contributor to disorder. The spiritual and religious assessment of the family facilitates the development of a treatment plan.     

The association between spiritual and religious involvement and depressive symptoms in a Canadian population

Data from a large epidemiologic survey were examined to determine the relationship of religious practice (worship service attendance), spiritual and religious self-perception, and importance (salience) to depressive symptoms. Data were obtained from 70,884 respondents older than 15 years from the Canadian National Population Health Survey (Wave II, 1996-1997). Logistic regression was used to examine the relationship of the religious/spiritual variables to depressive symptoms while controlling for demographic, social, and health variables. More frequent worship service attendees had significantly fewer depressive symptoms. In contrast, those who stated spiritual values or faith were important or perceived themselves to be spiritual/religious had higher levels of depressive symptoms, even after controlling for potential mediating and confounding factors. It is evident that spirituality/religion has an important effect on depressive symptoms, but this study underscores the complexity of this relationship. Longitudinal studies are needed to help elucidate mechanisms and the order and direction of effects.     

Grenzmethoden und Grenzbereiche des Heilens von Körper und Seele in der psychotherapeutischen, ärztlichen, seelsorgerischen und religionspädagogischen Tätigkeit

This study is based on 51 semistructured interviews with "experts" on alternative or borderline methods and borderline areas in psychotherapeutic, medical, spiritual guidance, or religious instruction settings. Practicing psychotherapists, physicians, and spiritual advisers comment on spiritual, esoteric, Asian, and other methods that are not part of the training and practice of their professions. The study concerns the question which potentially "healing" and "beneficial" methods are perceived by the three professional groups as alternative or borderline methods and how they are appraised by them. Furthermore, the study examines which alternative or borderline methods are requested by clients and patients and how the professionals concerned respond to these requests in their work. Expectations placed in those representing the profession are also described. Finally, the role of religion in the context of body and soul healing is discussed.     

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.     

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.     

Do faith-based residential care services affect the religious faith and clinical outcomes of homeless veterans?

Data on 1,271 clients in three residential care services funded by the Department of Veterans Affairs was used to examine: (1) how religious-oriented programs differ in their social environment from secular programs, (2) how religious-oriented programs affect the religiosity of clients, and (3) how client religiosity is associated with outcomes. Programs were categorized as: secular, secular now but religious in the past, and currently religiously oriented. Results showed (1) participants in programs that were currently religious reported the greatest program clarity, but secular services reported the most supportive environments; (2) participants in programs that were currently religious did not report increases in religious faith or religious participation over time; nevertheless (3) greater religious participation was associated with greater improvement in housing, mental health, substance abuse, and quality of life. These findings suggest religious-oriented programs have little influence on clients' religious faith, but more religiously oriented clients have somewhat superior outcomes.     

Religious beliefs in schizophrenia: their relevance for adherence to treatment

The study examined how religious beliefs and practices impact upon medication and illness representations in chronic schizophrenia. One hundred three stabilized patients were included in Geneva's outpatient public psychiatric facility in Switzerland. Interviews were conducted to investigate spiritual and religious beliefs and religious practices and religious coping. Medication adherence was assessed through questions to patients and to their psychiatrists and by a systematic blood drug monitoring. Thirty-two percent of patients were partially or totally nonadherent to oral medication. Fifty-eight percent of patients were Christians, 2% Jewish, 3% Muslim, 4% Buddhist, 14% belonged to various minority or syncretic religious movements, and 19% had no religious affiliation. Two thirds of the total sample considered spirituality as very important or even essential in everyday life. Fifty-seven percent of patients had a representation of their illness directly influenced by their spiritual beliefs (positively in 31% and negatively in 26%). Religious representations of illness were prominent in nonadherent patients. Thirty-one percent of nonadherent patients and 27% of partially adherent patients underlined an incompatibility or contradiction between their religion and taking medication, versus 8% of adherent patients. Religion and spirituality contribute to shaping representations of disease and attitudes toward medical treatment in patients with schizophrenia. This dimension should be on the agenda of psychiatrists working with patients with schizophrenia.     

Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD

One of the most pervasive effects of traumatic exposure is the challenge that people experience to their existential beliefs concerning the meaning and purpose of life. Particularly at risk is the strength of their religious faith and the comfort that they derive from it. The purpose of this study is to examine a model of the interrelationships among veterans' traumatic exposure, posttraumatic stress disorder (PTSD), guilt, social functioning, change in religious faith, and continued use of mental health services. Data are drawn from studies of outpatient (N = 554) and inpatient (N = 831) specialized treatment of PTSD in Department of Veterans Affairs programs. Structural equation modeling is used to estimate the parameters of the model and evaluate its goodness of fit to the data. The model achieved acceptable goodness of fit and suggested that veterans' experiences of killing others and failing to prevent death weakened their religious faith, both directly and as mediated by feelings of guilt. Weakened religious faith and guilt each contributed independently to more extensive use of VA mental health services. Severity of PTSD symptoms and social functioning played no significant role in the continued use of mental health services. We conclude that veterans' pursuit of mental health services appears to be driven more by their guilt and the weakening of their religious faith than by the severity of their PTSD symptoms or their deficits in social functioning. The specificity of these effects on service use suggests that a primary motivation of veterans' continuing pursuit of treatment may be their search for a meaning and purpose to their traumatic experiences. This possibility raises the broader issue of whether spirituality should be more central to the treatment of PTSD, either in the form of a greater role for pastoral counseling or of a wider inclusion of spiritual issues in traditional psychotherapy for PTSD.     

Religion and Spirituality as a Resource in Marital and Family Therapy

ABSTRACT

Today's therapists are faced with a myriad of challenges in their quest to provide the best and most appropriate care for each of their clients. In our training, for the most part, religion and spirituality are left out of the equation. Knowing that many individuals are searching for some type of meaning in their lives and that religion and spirituality are important issues to a large number of people, it follows that to become a truly effective therapist one needs to become more knowledgeable and comfortable in dealing with religious and spiritual issues. This article explores various aspects of religion and spirituality as a part of marital and family therapy including definitions, attitudes and beliefs, ethical issues, culture, and training.     

Religiosity, psychosocial adjustment, and subjective burden of persons who care for those with mental illness

OBJECTIVE: The purpose of this study was to characterize the nature of religious and spiritual support received by family caregivers of persons with serious mental illness and to test hypotheses that religiosity would be associated with caregiver adjustment. METHODS: Eighty-three caregivers who participated in a study of the Family to Family Education Program of the National Alliance on Mental Illness were assessed at baseline in terms of their religiosity and receipt of spiritual support in coping. They also completed measures of depression, self-esteem, mastery, self-care, and subjective burden. Hierarchical regression was used to test hypotheses that religiosity would be associated with better adjustment, with confounding variables controlled for. RESULTS: Thirty-seven percent of participants reported that they had received spiritual support in coping with their relative's illness in the previous three months. When age, race, education, and gender were controlled for, religiosity was associated with less depression and better self-esteem and self-care. Personal religiosity was a stronger predictor of adjustment than religious service attendance. CONCLUSIONS: Family caregivers of persons with serious mental illness often turn to spirituality for support, and religiosity may be an important contributor to caregiver adjustment. Collaborative partnerships between mental health professionals and religious and spiritual communities represent a powerful and culturally sensitive resource for meeting the support needs of family members of persons with serious mental illness.     

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.