Spirituality and Psychotherapy

[David Baxter PhD]

Using Spirituality To Ease the Mind
December 27, 2007
By Michael Craig Miller, M.D.
Harvard Medical School

As December leads into a new year, enthusiastic holiday preparations are supposed to lead to joyful family celebrations. Typically, however, this time brings as much stress as pleasure.

Given that all the major holidays of the season have spiritual origins, it may be worth thinking about how to use spirituality and religion for support, particularly if you are considering seeing a therapist or are already seeing one.

Many people assume that spirituality and religion have to be kept out of the therapist's office. But more and more clinicians realize that it can be helpful for patients to talk about their spiritual and religious beliefs.

Religion and Spirituality in America
Certainly, religion is an important part of American life. The Pew Forum on Religion and Public Life reports that 87% of Americans consider themselves to be religious, while 57% attend some type of worship service on a regular basis.

Likewise, a Newsweek/Beliefnet poll found that 88% of Americans who responded described themselves as spiritual, religious or both.

There's no way to know how many respondents were struggling with their mental health, but I assume that many of them turned to their spiritual practices for comfort, particularly if they were working hard to manage severe and ongoing problems such as addiction, unusual stress or mental illness. Moreover, as a way to enhance psychotherapy, understanding a person's spirituality may provide helpful insights into his or her value system or relationships.

Spirituality in Mental Health Treatment
Clinicians working in hospitals, mental health centers and other participating organizations are required by The Joint Commission ? an independent organization that accredits and certifies more than 15,000 health care organizations and programs in the United States ? to do a "spiritual assessment" of patients' spiritual beliefs and practices. The information is intended to improve treatment and services.

Critics of the regulation say that a spiritual assessment may not be as important in highly technical aspects of medical care ? for example, cardiac surgery ? as it is in primary care or mental health. Moreover clinicians in private practice don't have to adhere to The Joint Commission requirements.

Many patients receiving counseling may want their spiritual beliefs to be taken into account as part of their treatment. If this is important to you, it's helpful if the person treating you:

• Asks about your spiritual beliefs without judging them. Then your spiritual beliefs can become part of the treatment plan, according to The Joint Commission. A therapist doesn't have to come from the same religious community as you. What's more important is that the clinician is comfortable discussing these matters, takes your views seriously and can discuss them with you sympathetically.
• Is curious about your spiritual beliefs, is willing to learn about them, and ? when it's helpful ? to consult with clergy. If your therapist doesn't know very much about your particular religious practice, it's more difficult for him or her to know how best to help you. If the clergy or spiritual leaders that you have a relationship with would be willing to talk with your therapist, suggest to your therapist that he or she speak with them.
• Is prepared to make spirituality part of the treatment plan. It's very helpful for the therapist to find a way to make spirituality part of your recovery plan along with support, medication and psychotherapy. For example, if you are a practicing Catholic who is struggling with an addiction, you may find it helpful to attend Mass on a daily basis rather than weekly.

Starting the Discussion
If you're wondering how to get the conversation about spirituality going with your therapist or doctor, it may help to start by explaining your religious practices. Of course, it is up to your therapist or doctor to put you at ease so you can talk about these things. If religion is an important part of your life and your therapist is not interested in hearing about it, consider consulting someone else who is.

Here are some useful topics to talk about:

• How you express your spirituality
• How important prayer is to you
• Who, as a spiritual leader or clergy member, is particularly important to you and can be a resource if the therapist has questions
• How often you attend some type of religious service and how the practice of religion fits into your daily life
• How you find inner strength to deal with suffering and adversity; if you rely on a particular person, or follow a specific practice to gain strength
• Your specific spiritual goals
• How faith helps you cope with illness and suffering
• What type of spiritual support you want as part of your treatment plan

If spiritual matters are meaningful to you, you probably won?t want to talk about them only during the month of December. With a little planning, your religious practice does not have to compete with your mental health treatment. Instead, you and your therapist can find the best ways to use it as a tool to enhance your life all year long.

Michael Craig Miller, M.D. is Editor in Chief of the Harvard Mental Health Letter. He is also associate physician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School. He has been practicing psychiatry for more than 25 years and teaches in the Harvard Longwood Psychiatry Residency Program.

 

[MollyK]

Interesting post David .. thank you! My own view is that traditional therapies err when they leave the spirituality of a person out of the equation in terms of healing. Even those non-religious amongst us can recognise that a small grey mass of matter underneath a skull bone is not all that that person is.

The dogmatic, organised religion aspect does not sit comfortably with me as its invariably politics but I am very liberally Christian although first and foremost I believe in a supreme power and the innate goodness, love and spirituality of all living things, regardless of what appears on the surface .. and that is non-denominational. Leaving this out of the equation however with regards to who I am, the world around me and healing feels like living only a tiny section of what I am and ignoring the rest.

When I think about it, its only in moments of connection to a higher power and the innate goodness within myself, albeit fleetingly, that I have gained ground and moved towards healing that has been retained, other avenues of support have helped sporadically but my inner growth and sustenance has been a kind of spiritual renewal.

I wish therapy or therapists took this on board more!

 

[poohbear]

In the hospital setting, we have a standard admission packet that includes a few questions about religious preferences, but I see no difference in the care given, unless the patient makes the request for special consideration. Most times, if a person is truly devout in their professed faith, they will practice it no matter which setting they are in, or someone from the church will come to visit on a regular basis. But many people are "private" about their religion, or do not want to impose upon others. Nor do medical personnel want to be reprimanded for "prying" or violating personal rights for saying a prayer with the patient before surgery. I have seen patient and/or family get "ugly" about this.

In Nursing School, students are taught a more "holistic" approach to healing. We were reminded, over and over, that people don't just heal from the body; a positive influence and outlook can sometimes be more beneficial than the best medicines and surgeons. We were reminded to take into consideration ALL aspects of the patient: his medical history, his personal history AND his spiritual history. A patient's life is to be considered as a whole, not just the unhealthy part.

However, I see that the medical personnel are sometimes so overworked and stressed, that they do not have the time to look at a(n acute care) patient's FULL history, prior to deciding which Nursing Diagnoses to apply (RN Diagnoses are not medical diagnoses-- they center around the patient and what may hinder his healing process, no matter the origin). Not every condition or preference will be listed on the chart for every admission. When taking report on a new patient, many times, an oncoming shift nurse does not have the time to look at the full chart for that patient. She may only look at the current situation/ diagnosis and/or medications. I see this many times. Unless it is a very prominent disease process such as schizophrenia or alzheimers that is evident in day to day behavior and interactions, psychological and social/ religious issues are often ignored, but only in an effort to care for the physical needs of the patient on the shift.

I don't mean to say that a severely depressed woman would be sent home with her newborn, unless a psychiatric team had evaluated her. What I mean is that that very same woman, who shows no current signs of post partum depression, may not get the help she needs, four weeks later--when the signs and symptoms are truly prevalent and her strict upbringing makes it difficult for her to reach out for help, because the "women" in her family take care of the children -- and because the nurse had no idea that post partum depression runs in her family or that 17 years ago she attempted to commit suicide. Or the elderly man admitted for pneumonia-- who has lost his wife and home, all in the same year and who is now in a nursing home because his family has grown weary of caring for him, could easily be assessed for mild to moderate depression. If only someone would take the time to talk to him, and actually ASK him questions about his life and his feelings. They might realize that his cursing and combativeness stem from feelings of hopelessness and feeling helpless, or that he misses going to mass every Wednesday and Sunday-- would someone please call his church to let them know he's here?

It has become taboo to talk about religion, unless it directly relates to the care received. For example, a Jehovah's Wittness might not want to receive blood, should a transfusion be necessary, we would use an expander. Or the dietary requirements of certain religious or cultural sects might require special preparations. People are so scared of being "Politicaly In-Correct" . We have left everything that might be objectionable OUT of day-to-day converstaion and work practice, unless it is directly related to patient care.

I am not disputing the information here at all. On the contrary, I totally agree with it. If medical personnel were vigilant about assessing people more thoroughly about their personal and religious preferences, I believe that many times, certain issues can be brought to light that might be addressed-- before they become a "problem".

I guess what I mean to say is that Psychological evaluation (and not just the bare minumum: are you considering hurting yourself, do you have any religious beliefs that might interfere with your medical care...) should be STANDARD, in ANY medical setting. I could go on and on. I suppose I am a bit jaded. But it is really frustrating for me to see that the future generations of medical specialists are TAUGHT to care about religion and spirituality, yet we are not PERMITTED to act upon it!

 

[David Baxter PhD]

I think inquiries about spirituality do come into play in grief counselling and sometimes in working with suicidal indiivduals, and at times when addressing other issues in therapy like guilt or an existential crisis or major life change.

In some cases, it's also a matter of how long the therapy continues. The first priority is frequently to deal with a crisis where spirituality may or may not be critical and may or may not change how one would proceed. Sometimes, a patient lacks the will or the energy (or the funds) to continue further once the immediate crisis is resolved.

 

[David Baxter PhD]

Most Psychiatrists Open to Discussing Spiritual Concerns

Most Psychiatrists Open to Discussing Spiritual Concerns
December 28, 2007
Revolution Health courtesy HealthDay News

Many doctors avoid issues of spirituality and faith when interacting with patients, but that's not true for most psychiatrists, a new study finds.

In fact, more than 90 percent of psychiatrists surveyed said it's always or usually appropriate to ask patients about their religious faith or spirituality, while just 53 percent of other doctors thought so.

On the other hand, psychiatrists were much more likely to report that crises of religious faith can worsen a patients' suffering.

"Although psychiatrists are not [typically] religious themselves, they are the doctors most comfortable with talking about spiritual issues," said study lead author Dr. Farr Curlin, an assistant professor of medicine at the University of Chicago.

According to Curlin, there has long been a tension between psychiatry and people of faith, in no small part because the father of modern psychology, Sigmund Freud, was deeply skeptical of religion. In addition, psychiatrists have "for a long time tended to associate religious belief and practice as being a sign of, if not mental illness, at least delusional behavior," Curlin contended.

The study does support the notion that, compared to other types of clinicians, psychiatrists are more dubious of religion. For example, 18 percent of psychiatrists surveyed said they were not religious, compared to 10 percent of other doctors. And, on a measure of "intrinsic religiosity," 47 percent of psychiatrists were rated as "low," compared to 36 percent of other doctors.

There have, however, been efforts to repair this "breach" between spirituality and psychology, said Curlin, who studies the roles of religion and spirituality within the context of medicine.

In the new study, researchers randomly surveyed 2,000 physicians about patients and religion, including 100 psychiatrists. A total of 1,144 doctors responded.

The findings were published in the December issue of The American Journal of Psychiatry; other findings from the survey were reported earlier this year.

"We found that if you look at doctors in general, the less religious they are, the less likely they think it's appropriate for them to address spiritual issues at all," Curlin said. "The opposite seems to be the case among psychiatrists. They're the least religious doctors, but they're the ones who basically see this is as part of their bailiwick, part of what they do."

Eighty-two percent of psychiatrists thought religion leads to increased suffering in some cases, compared to 44 percent of the other doctors.

"We observe that some patients really go through existential crises when they get sick -- they wonder if they've been abandoned by God, and they relive old sins," Curlin said.

On the other hand, about three-quarters of both groups said religion can help patients cope with and endure sickness.

Also in the survey, 36 percent of psychiatrists and 28 percent of other doctors said patients "sometimes" used religion or spirituality as a reason to avoid taking proper care of themselves.

Curlin believes it's appropriate for doctors to bring up religion or spirituality "anytime they think it's relevant to the patient's experience of illness or decision-making regarding course of treatment or response to that illness."

But to some doctors, he said, "there's still a strong sense that the spiritual is personal and that the practice of medicine is professional, and those two domains ought to be kept apart as far as possible."

Richard P. Sloan, professor of behavioral medicine at Columbia University, said it is disturbing that doctors believe that spiritual beliefs can lead patients to delay or refuse treatment.

Should doctors ever ask about religion in the first place? Sloan, who's written skeptically about the study of religion's role in medicine, said it can be appropriate in certain contexts.

"You need to know what characteristics of your patients might interfere with your ability to treat them well," Sloan said. Patients who are fasting during Ramadan, for example, might not be able to take four doses of a pill per day.

"The concern that I have is a number of physicians who go way beyond what's necessary and run the risk of manipulating their patients, even coercing them, invading their privacy, taking on spiritual matters as objects of intervention," he said. According to Sloan, appropriate inquiries are fine, but proselytizing has no place in the doctor's office.

 

[MollyK]

I also think a distincton should be made between someones professed religion which I think may be as relevant as asking them what political party they follow and seeing them as a "whole" person, emotional, physical ... and spiritual beings.

I also think there is a distinction between medical professionals and psychotherapists. The latter being essential for me that if they are to work with me effectively then my spirituality should be taken into the equation. I dont mean in any big obvious way really but just something about me that is real and acknowledged

Very often emotional illness arises through some trauma that leaves someone with a lack of connection and alienation from themselves and the world around them. Throwing anti depressants at them in isolation or treating them as blobs of matter to be treated seldom brings around a deeper and more permanent healing, usually because a therapist believes that "if you cant see it or cant touch it then it doesnt exist" and has no conception of the spirituality of a person or indeed in the universe. I not only believe that such therapists dont help their clients long term but can actually do them more harm

 

[David Baxter PhD]

I also think a distincton should be made between someones professed religion which I think may be as relevant as asking them what political party they follow and seeing them as a "whole" person, emotional, physical ... and spiritual beings.

To me personally this is a very important distinction.