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.     

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.     

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.     

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.     

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.     

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.     

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.     

Pression des nouvelles mentalités sur le DSM - le cas des problèmes religieux ou spirituels

Successive editions of the Diagnostic and Statistical Manual (DSM) punctuate the history of psychiatry since 1980, with each time a revision of classifications. The new axes and categories appear to vary depending on negotiations with social groups rater than on a scientific basis. The DSM then operate as a psychological mirror of the society in which it develops. This permeability to social field expectations and to pressures of new attitudes is examined through the category “religious or spiritual problems” created in the edition of the DSM-IV 1994. Pressed by the arguments of proponents of Transpersonal Psychology, the American Psychiatric Association has defined a category of distressing religious or spiritual experience that may appear as a mental disorder when out of its context, but is merely a “normal reaction” not to evaluate as a pathology. The arguments of transpersonal psychologists are here the subject of a critical analysis. When defining normality in relation to religions and spiritualities, the DSM has opened the door to a series of experiences with blurred contours in a very important reversal of the relation between psychiatry and beliefs. But there is concern that this approach of these experiences without pathology could encourage a psychic economy with confusing subjectivity and a narcissistic focus on fascinating experiences.     

The Protestant child, adolescent, and family

This article addresses Protestant Christianity as an often-overlooked but significant factor in clinical work with children and adolescents. Noting the wide range of beliefs and practices among Protestants, the article identifies key tenets of Protestant faith that shape the worldviews of children, adolescents, and their families. Clinical implications of these beliefs are explored, with particular attention to three potentially psychopathologic features: the religious legitimation of child maltreatment; paranormal, direct experiences of the divine through unusual perceptions such as trance states or visions deemed normal within their religious context but that may also evidence serious pathology; and sexuality issues of particular significance for adolescents. Research suggests that Protestant beliefs also constitute resources for clinical work because they appear to be protective factors in relation to depression, avoidance of high-risk behaviors, and other measures of resiliency among adolescents. Clinicians who do not take the Protestant Christian family's religious/spiritual worldview into consideration in case formulation risk misunderstanding or alienating them from treatment. The article concludes with suggestions for collaboration.     

Sleep paralysis as spiritual experience

This article presents an overview of the sleep paralysis experience from both a cultural and a historical perspective. The robust, complex phenomenological pattern that represents the subjective experience of sleep paralysis is documented and illustrated. Examples are given showing that, for a majority of subjects, sleep paralysis is taken to be a kind of spiritual experience. This is, in part, because of the very common perception of a non-physical 'threatening presence' that is part of the event. Examples from various cultures, including mainstream contemporary America which has no widely known tradition about sleep paralysis, are used to show that the complex pattern and spiritual interpretation are not dependent on cultural models or prior learning. This is dramatically contrary to conventional explanations of apparently 'direct' spiritual experiences, explanations that are summed up as the 'Cultural Source Hypothesis.' This aspect of sleep paralysis was not recognized through most of the twentieth century. The article examines the way that conventional modern views of spiritual experience, combined with medical ideas that labeled 'direct' spiritual experiences as psychopathological, and mainstream religious views of such experiences as heretical if not pathological, suppressed the report and discussion of these experiences in modern society. These views have resulted in confusion in the scientific literature on sleep paralysis with regard to its prevalence and core features. The article also places sleep paralysis in the context of other 'direct' spiritual experiences and offers an 'Experiential Theory' of cross-culturally distributed spiritual experiences.     

Regulation, religious experience, and epilepsy: a lens on complementary therapies

Complementary and alternative medical (CAM) therapies include chiropractic, acupuncture and traditional Oriental medicine, massage therapy, and herbal remedies; mind-body therapies (such as meditative practices and visualization); and folk practices and religious healing. Of these, modalities based on spiritual healing create a number of conundrums for the clinician, including legal, regulatory, and ethical issues. Further, the historic relationship between the study of epilepsy and religious experience suggests particular, potential associations between CAM therapies (and especially spiritual healing) and care for epileptic patients. There are at least two dimensions to this exploration: first, the widespread use of spiritual healing for treatment of epilepsy; and second, the hypothesized connection between epileptic seizures and mystical states. A number of legal rules help address potential abuse of authority by health care professionals, and include: (1) medical licensure; (2) scope of practice; (3) professional discipline; (4) malpractice; and (5) fraud. This article offers a preliminary resource for clinicians interested in these topics.     

Review of Religious Variables in Advance Care Planning for End-of-Life Care: Consideration of Faith as a New Construct

Religion and spirituality have long been considered important social determinants of human health, and there exists an extensive body of research to support such. End-of-life (EOL) may raise complex questions for individuals about religious and spiritual (R/S) values guiding advance care planning (ACP) and EOL care decisions, including the provision of spiritual care. This commentary will review the history and current national trends of ACP activities for EOL, principally within the United States. It will describe the relationship of religious variables and the attributes of selected research instruments used to study religious variables on ACP and EOL preferences. The review also summarizes unique ACP challenges for patients with neurocognitive disorders and severe mental illness. Findings disclose that higher levels of religiosity, reliance on religious coping, conservative faith traditions, and “belief in God's control over life's length and divine intervention have lower levels of ACP and more intensive EOL care preferences, although the provision of spiritual spiritual care at EOL mitigates intensive EOL care. Based upon the curated evidence, we propose an epistemological justification to consider “faith” as a separately defined religious variable in future ACP and EOL research. This review is relevant to geriatric psychiatrists and gerontological health care professionals, as they may be part of multidisciplinary palliative care teams; provide longitudinal care to patients with neurocognitive disorders and severe mental illness; and may provide diagnostic, emotional, and therapeutic services for patients and families who may struggle with EOL care decisions.     

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.     

J.L. Moreno,M.D.

You could call Moreno a composer of religion. He drew his religious and spiritual ideas from different sources and self-confidently created his world-view and an individual notion of God. In this article important stations of his religious biography are told and integrated. The abiding benchmark of Moreno’s religious thoughts is the message of Friedrich Nietzsche that god is dead. Moreno sees what a high price society pays for disposing of its gods too quickly and not in a consequent way: the price for an imperfect secularization. He does not accept that important issues like existential questions, sense and death or the position of man in the cosmos cannot be debated anymore. That is the reason why he claims a new theory of God. That is also the reason why he provides the axiodramatic scene to deal with those themes.     

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.     

Religious and spiritual issues in psychotherapy practice: Training the trainer

Psychology's interest in religion and spirituality has greatly increased over the past few decades, and it has inspired the development of substantial scholarship in these areas. However, there continues to be a paucity of efforts to integrate this emerging scholarship into training programs. The author explores the historical and ideological context of psychotherapists' reluctance to address religious and spiritual issues in their academic programs and clinical practices. The article also offers seasoned psychotherapists concrete suggestions regarding how to enhance their religious and spiritual competencies with the aim of facilitating both the training of emerging psychotherapists and the treatment of religious and spiritual clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

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 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.     

Stages of faith and identity: birth to teens

In closing, some of the strengths, limitations, and criticisms of faith development theory need to be acknowledged. Fortunately, there was gender balance in the formative sample of 359 interviews from which the theory of faith development derived (50% each of male and female respondents). In the original sample, Protestants made up 45% of the interviewees, Catholics represented 36.5%, 11.2% were Jews, and 3.6% were Orthodox Christians. A remaining 3.6% were "other." Given the growth in the numbers of adherents to other major traditions in the United States, interview research needs to be conducted to widen the sample to include Muslim, Buddhist, and secular respondents. Interviewees have not been studied longitudinally. Furthermore, most of the foundational research was conducted in the 1 980s and early 1990s. A new major round of faith development interviews could shed light on the impacts on peoples' faith of "globalization" and the features of experience that have come to be called the "postmodern condition." These phenomena reflect patterns of radical secularization and the erosion of religious and moral authority on the one hand and, paradoxically, the worldwide growth of fundamentalist and conservative faith practices on the other. Add to these phenomena the interest of many "nonchurched" persons in "spirituality" and we begin to grasp the richness and diversity that faith development research encounters today. Professor Heinz Streib of the University of Bielefeld is conducting the most significant research in the faith development tradition. The research he and his colleagues are conducting in Europe and in the United States promises to yield some tangible data and insights into these issues. To date, faith development theory has not been incorporated into child, adolescent, and family psychiatric interviewing and case formulation to any appreciable or measurable degree. These perspectives and inroads into the interior lives and thought processes of young people, however, may be helpful in the understanding of normal and pathologic development and of healthy and psychiatrically ill children and adolescents. Further collaborative work in this area is needed among psychiatrists, clinical psychologists, psychologists of religion, religious educators, and theologians.     

Religious experiences in epileptic patients with a focus on ictus-related episodes

Two hundred thirty-four epileptic patients were examined for ictus-related religious experiences. Of the 234 cases, three (1.3%) were found to have had such religious experiences. All three cases had temporal lobe epilepsy with post-ictal psychosis, while one exhibited a simple partial seizure. At the same time, interictal experiences with hyperreligiosity were recognized in all three cases. The incidence of religious experiences while in a state of post-ictal psychosis was 27.3%, which is regarded as high, indicating some influence by the religions that the patients had faith in. Patients who had ictus-related or interictal religious experiences did not believe solely in Buddhism, a traditional religion in Japan, but rather in a combination of Buddhism and Shintoism, new Christian sect, contemporary Japanese religions and/or other folk beliefs. This indicates that these experiences had some connection not only with the personality characteristic of temporal lobe epilepsy, but also with the general lack of religious conviction and activity in Japan. In addition, the cases having ictus-related religious experiences also had interictal religious experiences and an interaction was seen between them. In this paper, the importance of taking bio-psycho-social aspects into consideration is pointed out in the discussion of epilepsy and religion.