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.     

Formulation and treatment: integrating religion and spirituality in clinical practice

Developing scientifically sound and clinically meaningful case formulations is so challenging that it may verge on becoming a "lost art." Pressures (scientific, economic, and cultural) remain that prevent child and adolescent psychiatrists from getting a complete understanding of the patient and family. Including a strong consideration of data related to religion, spirituality, and worldview may seem only to complicate an already arduous task. The clinician who includes these factors in treatment is faced with decisions of when to discuss these issues, how to discuss them and in what depth, and finally, when to refer to a religious/spiritual professional. Nonetheless, the importance of these factors in the lives of many children and families leaves no option but to address them as directly as possible. It is well worth the effort and, in many cases, will open new areas for clinical improvement in patients.     

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 Catholic child, adolescent, and family

This article identifies core features of Catholic spiritual and religious tradition and worldview. It reviews clinical implications of this worldview in working with the psychiatric problems of Catholic children and adolescents. Core Catholic beliefs and practices are discussed, with case examples illustrating principles of assessment and treatment. Collaboration between child and adolescent psychiatrists and Catholic clergy and counselors is encouraged, and recommendations for successful collaborative efforts are offered.     

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.     

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.     

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.     

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.     

Child and adolescent psychopathology: spiritual and religious perspectives

This article addresses the relationship between children's religious beliefs and spiritual practices and the presence of psychopathology. Study of this subject represents a formidable task due to the complexity and diversity of the constructs involved, heterogeneity in religious beliefs and practices, and the difficulty in discriminating between the independent effects of religion and culture. Nevertheless, broad links between child psychopathology and spiritual/religious beliefs and practices are proposed. On the whole, the available empiric data suggest that religion is primarily health promoting in direct, positive benefits for children and in indirect, positive effects through parent and family functioning, although there are isolated exceptions. When spirituality and religious beliefs/practices are associated with negative mental health outcomes in children or their families, evidence points to "poorness-of-fit," based on an interaction between the child's psychopathology and aspects and religious beliefs/practice. Clinical implications of the findings and proposels are outlined.     

Child and adolescent psychiatric emergencies: family psychodynamic issues

Given the impact of the family on the etiology, identification, and treatment of child mental health problems, this article addresses the role of the family in psychiatric emergencies. This article covers relevant aspects of family evaluation in an emergency context, factors that determine the family's role in disposition, and planning of family considerations in several specific clinical emergencies. Improved understanding of the family's contribution leads to a more accurate diagnostic consideration and more appropriate disposition recommendations. A correct diagnosis and appropriate discharge plan lead to an improved prognosis for overall follow-up care and treatment.     

Spirituality in children and adolescents: research findings and implications for clinicians and researchers

Spirituality is a powerful force in the lives of children. Although spirituality has only recently begun to be a focus for psychiatric research, initial qualitative data suggest that children experience themselves as spiritual beings and that understanding and connecting with them around their spiritual lives can be an important adjunct to treatment. Clinicians should feel free to ask about a child's spiritual life and to work with the family using their spiritual resources if they are perceived to be beneficial in helping the child and family cope with their current situation. Because the work with children's spirituality is in its preliminary stages, qualitative methodology is still the recommended research method for investigating questions in this research area.     

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).     

Religion,spirituality, and chaplains in the biomedical literature: 1965-2000

In recent years, several prominent medical journals have published articles addressing the relationship between religion/spirituality and medicine, and recognizing the importance of religion in the lives of most Americans, especially in times of illness. We hypothesized that the publication of these articles reflected a trend in the biomedical literature in which greater attention is being given to the role of religion and spirituality in health-care. A correlational design was used, based on an electronic survey of all articles in MEDLINE for the years 1965 through 2000. The search terms used were: 1) religion or religious; 2) spiritual; and 3) chaplain. The number of articles per 100,000 that mentioned religion (religion or religious), spirituality, or chaplains each year was determined. Statistically significant upward trends across years were found for the rates of articles addressing religion (r = .59, p < .001) and spirituality (r = .89, p < .001) and a non-significant trend was found for chaplains (r = .31). The rising rates of articles on religion and spirituality in biomedical journals suggest a growing recognition of the need to address spiritual and religious issues in health-care.     

Development and implementation of a spiritual issues psychoeducational group for those with serious mental illness

Recent research has suggested that religion and spirituality can be a resource or a burden for those with serious mental illness (SMI). Investigators have begun to explore the nature and impact of interventions that focus on spiritual issues in this population. This study describes an innovative program for people with SMI who are dealing with spiritual/religious issues. The program was a seven-week semi-structured, psychoeducational intervention in which participants discussed religious resources, spiritual struggles, forgiveness, and hope. This paper also reviews participants' feedback about the group intervention. Suggestions are made that may add to the clinical utility of this program in the future.     

Spiritual Assessment in Mental Health Recovery

Mental health recovery-oriented and strengths model proponents recognize spirituality to be a key aspect of the recovery process. In order to incorporate spirituality in practice, practitioners need to know how to conduct spiritual assessment effectively. Although implicit and explicit spiritual assessment approaches have been identified as useful frameworks for conducting spiritual assessment, there is a gap in knowledge about what constitutes effective approaches and questions for addressing spirituality in the lives of people with psychiatric disabilities. To address this gap, focus group interviews were conducted with providers and consumers of mental health services in order to develop practical guidance for spiritual assessment. Focus group participants provided feedback about a list of sample spiritual assessment questions and then suggested principles and questions for practitioners to use. Collective insights from the focus groups formed the basis for recommendations for spiritual assessment.     

Spiritual issues in psychiatric care

This article differentiates between the concepts of spirituality and religion and analyzes the strengths and weaknesses of the research findings related to spirituality, religion, and mental health. To discuss the importance of clarifying values and becoming self-aware in relation to implementing spiritual and religious interventions. The components of spiritual assessment are presented as well as spiritual coping practices and interventions the nurse might use when working with clients. Review of literature from MEDLINE, CINAHL, and current texts. Spirituality and religion are too often neglected foci of psychiatric mental health assessment and intervention. In order to maximize therapeutic effectiveness, nurses should be aware that for many patients spirituality is a critical life factor. Accordingly, they should screen patients and strive to meet patient needs for spiritual expression, while recognizing that there are important boundary and ethical issues in psychiatric mental health settings.     

Spirituality and psychiatry in Canada: psychiatric practice compared with patient expectations.

OBJECTIVE: This study compares psychiatrists' and psychiatric patients' practice, attitudes, and expectations regarding spirituality and religion. METHOD: We mailed surveys to all Canadian psychiatrists registered with the Royal College of Physicians and Surgeons of Canada (n = 2890). The response rate was 42% (n = 1204). We recruited patients from a Canadian on-line survey (n = 67) and from a local mental health clinic (n = 90). RESULTS: Psychiatrists had lower levels of beliefs and practices than did patients and the general population. In both groups, 47% felt there was "often or always" a place to include spirituality in psychiatric assessment, although the perceived importance differed. Among patients, 53% felt it important to have this issue addressed, and 24% considered the psychiatrist's spiritual interest important in their choice of psychiatrist. Barriers to addressing the issue of spirituality and mental health related to psychiatrists' concern regarding its appropriateness and patients' perception that interest is lacking. Psychiatrists' own beliefs and practices were strong predictors of spiritual inquiry. CONCLUSIONS: Although psychiatrists report lower levels of spiritual and religious belief than do patients, they acknowledge that it is important to include this topic in patient care. Increased discussion and education may lower reported barriers to including spirituality and religion in routine psychiatric assessment.     

Contribution of spirituality to quality of life in patients with residual schizophrenia

There is increasing recognition that a person's spiritual or religious experiences contribute to quality of life (QOL). However, research exploring the relation between spirituality and QOL has mainly been in the context of chronic and life-threatening illnesses, and studies examining this important correlate of QOL in chronically mentally ill subjects are sparse. This study aimed to explore the relationship between spirituality and QOL, and to investigate if spirituality contributes to other domains of QOL (both physical and psycho-social) in subjects with residual schizophrenia. In a study with a cross-sectional design, 103 patients with residual schizophrenia were assessed with the Positive and Negative Syndrome scale, and their quality of life, spirituality and religiousness were assessed with the WHO Quality of Life-Spirituality, Religiousness and Personal Beliefs (WHOQOL-SRPB) scale. The SRPB domain and all its facets other than spiritual connection correlated significantly with all other domains of QOL and overall QOL. On regression analysis, the inner peace domain of spirituality explained 21.6 to 37.6% of variance of all QOL domains except the domain of level of independence. The spirituality domain explained 33.8% of the variance of the 'level of independence domain of QOL. Taken together, inner peace and spirituality facets explained 23 to 40% of the variance of the social relationships domain, the psychological domain and the level of independence domain of QOL. This study suggests that spirituality and religiosity have an important influence on overall QOL of patients with schizophrenia. Hence, besides pharmacological and non-pharmacological management for schizophrenia, clinicians should focus on this aspect and encourage their patients to follow their religious practices and spiritual beliefs.     

Addressing the needs of adolescent children when a parent becomes aphasic: one family's experiences

There are several reports of the psychosocial effects of aphasia on family members and of factors that may influence a family's emotional adjustment. Most of these, however, have included only spouses or the adult children of individuals with aphasia. Therefore, to address how children of adolescent age or younger react to and cope with parental aphasia, this article provides an account of one family's experiences with stroke and aphasia. Specifically, the impact of a father's aphasia on his adolescent daughter as well as how the parents attempted to help their daughter adjust during acute and chronic recovery phases are described.     

The influence of spirituality and religiousness on suicide risk and mental health of patients undergoing hemodialysis

BackgroundDespite the large amount of literature assessing how spiritual and religious beliefs have an impact on mental health and suicide risk in various groups of patients, few studies have investigated patients with chronic kidney disease (CKD). The purpose of this study is to investigate whether spirituality and religiousness (S/R) are associated with the presence of suicide risk as well as whether those beliefs are also associated with the presence of mental health problems in patients undergoing hemodialysis.MethodsCross-sectional study carried out in three Brazilian dialysis units involving hemodialysis patients. The study assessed religiousness (Duke Religion Index); spiritual well-being (FACIT-Sp 12); mental health - depression and anxiety (Mini International Neuropsychiatric Interview–MINI); and risk of suicide (MINI). For analysis, adjusted logistic regression models were applied.ResultsA total of 264 (80.7%) patients were included, 17.8% presented suicide risk, 14.0% presented current major depressive episode, and 14.7% presented generalized anxiety disorder. Concerning spiritual well-being (FACIT-Sp 12), the subscale of “Meaning” was associated with lower risk of suicide, depression, and anxiety. The subscale “Peace” was associated with lower depression and anxiety, whereas the subscale “Faith” was associated with lower suicide risk and depression. Religiousness measures were not associated with the study outcomes.ConclusionSpiritual beliefs were associated with lower suicide risk and better mental health among hemodialysis patients. Factors related to spiritual well-being, such as “meaning”, “peace” and “faith” were more associated with the outcomes studied than religious involvement. Further studies are needed to replicate our findings in different cultural and religious settings.