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.     

Conceptualizing psychosis in Uganda: the perspective of indigenous and religious healers

A qualitative study, investigating the representations and explanatory models of ;madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood ;madness' as spiritual or physiological, whereas religious healers also held psychological models. Healers' understandings of ;madness' are inextricably linked with the historical and sociopolitical context and may be useful to individuals with psychotic experiences, however, it is likely that these models are dynamic and continually changing.     

Psychotic experiences,sexual minority status,and suicidal behavior among young adult college students in the United States

Psychotic experiences significantly predict suicidal behaviors; however, it is unknown whether these associations are conditional on sexual minority status. We analyzed cross-sectional data from the Healthy Minds Study (N = 109,975), which was collected between September 2020 and June 2021 from young adult (aged 18–34) students from across 140 colleges across the United States. Having psychotic experiences and sexual minority status were associated with significantly greater odds of reporting suicidal ideation, suicide plan, and suicide attempt, adjusting for sociodemographic characteristics. We found significant interactions between psychotic experiences and sexual minority status, such that the relations between psychotic experiences and suicidal behaviors were stronger among heterosexual students than among sexual minority students. However, the interactions disappeared for suicidal ideation and plans after adjusting for socio-behavioral risk factors. Future research can explore whether psychotic experiences predict suicide attempts among sexual minority status behavior socio-behavioral risk factors.

     

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.     

Fathering,Faith, and Family Therapy

Summary

This article presents the major conceptual and clinical ideas on fathering, religion, and counseling developed by David C. Dollahite and his colleagues. The concepts of generative fathering and generative narrative therapy are presented and illustrated with narratives of religious fathers. These ideas address a number of issues believed important to consider in family therapy with fathers-particularly religious fathers. Concepts are illustrated with personal narratives from two samples of Latter-day Saint (Mormon) fathers of children with special needs. Although the narratives are non-clinical, implications for family therapy from these and related theories and stories are suggested. The article emphasizes father strengths, the power of religion to assist fathers in challenging circumstances, and the importance of therapists' sensitivity to spiritual and religious matters.     

Psychotic Depression and Suicidal Behavior

Objective: This study investigated how severely depressed individuals experienced the relationship between psychotic symptoms and suicidal ideation and behavior. Method: Semi-structured qualitative interviews were conducted with a purposive sample of nine inpatients from a psychiatric university hospital between September 2012 and May 2013 fulfilling diagnostic criteria for a psychotic depressive episode as part of a unipolar or bipolar disorder. Analysis was conducted using systematic text condensation. Results: Participants experienced (1) being directed to perform impulsive potentially fatal actions, (2) feeling hounded to death, (3) becoming trapped in an inescapable darkness, and (4) being left bereft of mental control. They described how impulsivity directed by delusions and hallucinations resulted in unpredictable actions with only moments from decision to conduct. Suicide was seen as an escape not only from life problems but also from psychotic experiences and intense anxiety. Participants reported being in a chaotic state, unable to think rationally or anticipate the consequences of their actions. Their ability to identify and communicate psychotic symptoms and suicidal ideation and behavior was compromised, leaving them to struggle alone with these terrifying experiences. Conclusions: Suicide risk assessments based on verbal reports from individuals with psychotic depression may not always be valid due to potential impulsivity and underreporting of suicidal ideation. It may be important for clinicians to explore the delusional content of such patients’ experiences to assess the possibility of suicide as a result of shame, guilt, remorse, or altruistic intentions to save others from harm.     

Loneliness and the psychosis continuum: a meta-analysis on positive psychotic experiences and a meta-analysis on negative psychotic experiences

Abstract

There is an increase in interest in the relationships between loneliness and psychosis. The notion of psychosis continuum implies that psychotic experiences extend from clinical populations with psychotic disorders to non-clinical populations. This meta-analytic review aimed to examine the respective associations of loneliness with positive and negative psychotic experiences along the psychosis continuum. A systematic database search was conducted and a total of 30 studies were included in the first meta-analysis and 15 studies were included in the second meta-analysis. There was a medium association between loneliness and positive psychotic experiences (r?=?0.302, p?<?0.001). In particular, the association between loneliness and paranoia was robust (r?=?0.448, p?<?0.001). The second meta-analysis revealed a medium association between loneliness and negative psychotic experiences (r?=?0.347, p?<?0.001). The associations between loneliness and both positive and negative psychotic experiences were found to be smaller among clinical than non-clinical samples. The above findings provided evidence for the associations between loneliness and the two core dimensions of psychotic experiences along the phenomenological continuum. Future research should examine the dynamics of these relationships in both clinical and non-clinical samples, preferably using a single-symptom approach.     

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.     

A 22-year retrospective analysis of the changing frequency and patterns of religious symptoms among inpatients with psychotic illness in Egypt

Background: The aim of the present study was to assess the changes in frequency and pattern of religious symptomatology in a sample of psychiatric inpatients in Egypt suffering from some form of psychotic illness over the time span from 1975 to 1996. Method: A sample of 5275 files of psychotic inpatients at Behman psychiatric hospital in Cairo, Egypt, admitted between 1975 and 1996, were scrutinized for the presence or absence of “religious” symptoms. All the files with religious symptoms from this sample (n=632) and an additional 281 comparison files were analyzed. Results: Significant fluctuations in the frequency of religious symptoms over the period of the study were noted. The frequency of religious symptoms peaked in the mid-1970s to early 1980s, and again in the early and mid-1990s, relative to other time periods. Further analyses of changes in the frequency of specific religious themes or symptoms revealed that religious behaviors (i. e., increased reading of religious texts, preaching, and other types of overt religious expression), in particular, showed significant and consistent patterns of change. Conclusions: These findings were interpreted in light of the fluctuating emphasis on religion and religious affiliation in everyday life in Egypt during the period of the study. While the overall frequency of religious delusional themes in Egypt is sensitive to societal changes across time, the specific content of these delusions remains stable. On the other hand, the relative salience of behavioral modes of pathological religious expression is highly influenced by changing patterns of religious emphasis in Egyptian society. Accepted: 30 April 2001     

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.     

Daily spiritual experiences in a biracial,community-based population of older adults

Objectives: The objectives of this study were to describe the levels of daily spiritual experiences (DSEs) in community-dwelling older adults, to compare the levels of spiritual experiences with the levels of prayer and religious service attendance, and to examine the demographic and psychosocial correlates of spiritual experiences. The data came from 6534 participants in the Chicago Health and Aging Project, an ongoing population-based, biracial (65% African American) study of the risk factors for incident Alzheimer's disease among older adults. A 5-item version of the Daily Spiritual Experiences Scale (DSES) was used in the study. Multivariable linear regression models were used to examine the relationship between sociodemographic and psychosocial factors and DSES scores.

Results: The majority of the participants reported having spiritual experiences at least daily. In the bivariate analyses, African Americans and women had higher DSES scores than Whites and men, respectively (p's < 0.001). Prayer and worship were moderately associated with DSES scores. In the multivariable analyses, African American race, older age, female gender, better self-rated health, and greater social networks were associated with higher DSES scores, while higher levels of education and depressive symptoms were associated with lower DSES scores.

Conclusion: We observed high levels of spiritual experiences and found that the DSES is related to, but distinct from the traditional measures of religiosity. We found associations between DSES, demographic, and psychosocial factors that are consistent with the findings for other religiosity and spirituality (R/S) measures. Future research should test whether DSES contributes to our understanding of the relationship between R/S and health in older adults.     

Spiritual well-being of people with psychiatric disabilities: the role of religious attendance, social network size and sense of control

The influence of psychiatric symptoms, religious attendance, social network size, and sense of control on spiritual well-being were investigated in a cross-sectional study using the Spirituality Index of Well-being. Forty-seven participants with psychiatric disabilities from six consumer-run organizations participated. A factor analysis result revealed two domains of spiritual well-being for people with psychiatric disabilities: self-perceptions regarding making sense of life (developing life purpose) and self-efficacy in obtaining life goals. Based on our regression analyses, religious attendance, expanding social network size, and having a sense of control over important areas of life may enhance spiritual well-being in spite of severity of psychiatric symptoms. Supporting mental health consumers who hope to be fully integrated into social and spiritual communities is important. Given the increased attention to consumers’ internal spiritual experiences in a recovery process, this study adds to knowledge about spirituality in the mental health field.     

Daily Spiritual Experiences,Systolic Blood Pressure,and Hypertension among Midlife Women in SWAN

Background  

There is reasonable evidence that religious beliefs and activities are associated with lower blood pressure and less hypertension. It is not known if daily spiritual experiences have similar effects.     

Religioese Erlebnisse Bei Schizophrenen

Two cases of the schizophrenia are reported with phenomenological discussion of their religious experiences of Christian nature that appeared in the course of the illness. These experiences are so similar to the conversion and continue in the subsequent spiritual life of these patients and exert influences deeply upon the healing process of the illness. Their experiences of Christian nature didn't appear suddenly, but arose as consequence of a concentration of conflicts that had been accumulated up to that time similar to the phenomena of thc conversion. The problem of the insight into the illness was also refereed; the attitude toward the illness changed after the religious experiences into an “affirmative attitude with positive acceptance of one's own illness.”     

Hearing impairment and psychosis revisited

The previously reported but still poorly investigated link between deafness or hearing impairment (DHI) and the onset of positive psychotic experiences was investigated prospectively in a general population sample. Of the 109 DHI subjects at baseline, 11 (10.1%) displayed psychotic experiences at T(2) versus 137 (2.9%) of the non-DHI subjects (OR=3.8, 95% CI: 2.0, 7.2). This effect size was only slightly attenuated after adjustment for baseline psychotic experiences (OR=3.2, 95% CI: 1.6, 6.5) and after adjustment for T(0) psychotic experiences and a range of other confounders (OR=3.0, 95% CI: 1.4, 6.2) These results confirm previous findings of an association between hearing impairments and psychosis and show that this association can also be found prospectively in a nonclinical population.     

Affective processes in the onset and persistence of psychosis

AbstractObjectives Cognitive models suggest that beliefs and appraisal processes are crucially important in the onset and persistence of psychosis. This study investigated whether (i) neuroticism increases the risk for development of psychotic symptoms, and (ii) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the onset of psychotic disorder.Method A general population sample with no lifetime evidence of any psychotic disorder was interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder.Results Baseline level of neuroticism increases the risk for incident psychotic symptoms. Given the presence of hallucinatory experiences at baseline, the increase in risk of having the psychosis outcome was much higher in the group with delusional ideation or depressed mood at year 1 than in those without delusional ideation or depressed mood.Conclusion A cognitive style characterised by a tendency to worry increases the risk for newly developed psychotic symptoms. Individuals who report hallucinatory experiences and react to these with a delusional interpretation and/or negative emotional states have an increased risk for developing clinical psychosis.     

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.     

Ethnicity,social disadvantage and psychotic‐like experiences in a healthy population based sample

Objective:  We sought to investigate the prevalence and social correlates of psychotic‐like experiences in a general population sample of Black and White British subjects. Method:  Data were collected from randomly selected community control subjects, recruited as part of the ÆSOP study, a three‐centre population based study of first‐episode psychosis. Results:  The proportion of subjects reporting one or more psychotic‐like experience was 19% (n = 72/372). These were more common in Black Caribbean (OR 2.08) and Black African subjects (OR 4.59), compared with White British. In addition, a number of indicators of childhood and adult disadvantage were associated with psychotic‐like experiences. When these variables were simultaneously entered into a regression model, Black African ethnicity, concentrated adult disadvantage, and separation from parents retained a significant effect. Conclusion:  The higher prevalence of psychotic‐like experiences in the Black Caribbean, but not Black African, group was explained by high levels of social disadvantage over the life course.     

Religious, spiritual, and traditional beliefs and practices and the ethics of mental health research in less wealthy countries

This discussion article contributes to ethics reform by introducing the contribution of religious, spiritual, and traditional beliefs and practices to both subject vulnerability and patient improvement. A growing body of evidence suggests that religious, spiritual, and traditional beliefs and practices may provide positive benefits, although in some cases mixed or negative consequences to mental and physical health. These beliefs and practices add a new level of complexity to ethical deliberations, in terms of what ignoring them may mean for both distributive justice and respect for persons. International ethical guidelines need to be created that are expansive enough to cover an array of social groups and circumstances. It is proposed that these guidelines incorporate the religious, spiritual, and/or traditional principles that characterize a local population. Providing effective mental healthcare requires respecting and understanding how differences, including ones that express a population's religious, spiritual, or traditional belief systems, play into the complex deliberations and negotiations that must be undertaken if researchers are to adhere to ethical imperatives in research and treatment.     

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.