Ethical considerations in the integration of religion and psychotherapy: three perspectivesJames W Lomax 2nd 1, Rabbi Samuel Karff, Gerald P McKenny
pubmed.ncbi.nlm.nih.gov/12232969/PMID: 12232969 DOI: 10.1016/s0193-953x(01)00015-6
Abstract
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.
Spirituality in Psychiatry?www.ncbi.nlm.nih.gov/pmc/articles/PMC2993530/Spirituality and religion—How are they different? In several circumstances we see the terms religion and spirituality being used in an interchangeable manner. Let us examine some definitions of religiosity and spirituality. Religiosity refers to “participation in or endorsement of practices, beliefs, attitudes, or sentiments that are associated with an organized community of faith.”1 Spirituality refers to “personal views and behaviors that express a sense of relatedness to a transcendental dimension or to something greater than the self.”2 There is obviously a wide overlap, but spirituality seems more clearly a personalized, internalized version—a composite of both.
Can spirituality or religion mix with science? It was Albert Einstein (1950) who said, “Science without religion is lame; religion without science is blind.” Science always searches for what can most easily be measured. Science and ethics have become increasingly secular. Freud saw religion as “universal obsessional neurosis;” Jung differed and discussed the search for spiritual enlightenment as the central core of human experience. This difference of opinions is one of the reasons Freud and Jung parted company.3
Spirituality in health. We know that faith and religion play important roles in the lives of many patients and physicians, but such concepts are yet to be incorporated into routine clinical care.
The World Health Organization defines health as , “a state of complete physical, mental, and social well-being and not merely absence of disease or infirmity,” and also suggests spiritual well being as a fourth dimension to health.
Religion and spirituality in psychiatry. Despite unprecedented levels of longevity, physical health, relative affluence, social freedom, and advances in technology, there is an increasing incidence of depression in the 21st century. This seems paradoxical but may reflect increased recognition by patients and/or physicians rather than an absolute increase in prevalence. Stress, real or perceived, among people living a rushed Western lifestyle, has risen by 45 percent over the last 30 years.4
Many studies have linked a lack of religious beliefs to depression. Religious commitment is associated with reduced incidences of depression5 and quicker recovery from depressive illness for the elderly.6 The reasons why religiously committed individuals are less likely to become depressed may include feelings of social connectedness, messages of healthy living, perhaps reduced drug-seeking behavior, beliefs that justice prevails at the end, belief that adverse events always have a message and a meaning, and that there is a caring, ever-present God.3
Negative effects of religion make headlines (e.g., when a parent's religious views delay medical care resulting in a child's death). Spiritual and religious protective factors, which may unlock the secrets of preventive psychiatry—the extent of which are yet to be determined—have been less publicized.3
It is said that mainstream psychiatry, for nearly five decades, has ignored religious and spiritual issues brought by patients into treatment. While less than 10 percent of psychiatrists believe spirituality is important in their practices, Janelle reports that 65 percent of patients with depression, anxiety, and other psychiatric conditions indicate that they want spirituality to play a part in their treatment.7
Likewise, in a study to examine attitudes about spirituality, a group of medical students were exposed to didactic material on spirituality. They reported greater understanding of the spiritual issues compared to students who did not receive this didactic instruction. There was no difference, however, in their clinical performance. The two comparative groups received identical scores for their spiritual history.8
Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophreniapubmed.ncbi.nlm.nih.gov/17074947/Abstract
Objective: Spirituality and religiousness have been shown to be highly prevalent among patients with schizophrenia. However, clinicians are rarely aware of the importance of religion and understand little of the value or difficulties it presents to treatment. This study aimed to assess the role of religion as a mediating variable in the process of coping with psychotic illness.
Method: Semistructured interviews about religious coping were conducted with a sample of 115 outpatients with psychotic illness.
Results: For some patients, religion instilled hope, purpose, and meaning in their lives (71%), whereas for others, it induced spiritual despair (14%). Patients also reported that religion lessened (54%) or increased (10%) psychotic and general symptoms. Religion was also reported to increase social integration (28%) or social isolation (3%). It may reduce (33%) or increase (10%) the risk of suicide attempts, reduce (14%) or increase (3%) substance use, and foster adherence to (16%) or be in opposition to (15%) psychiatric treatment.
Conclusions: Our results highlight the clinical significance of religion in the care of patients with schizophrenia. Religion is neither a strictly personal matter nor a strictly cultural one. Spirituality should be integrated into the psychosocial dimension of care. Our results suggest that the complexity of the relationship between religion and illness requires a highly sensitive approach to each unique story.
Integrating Religion and Spirituality into Mental Health Care, Psychiatry and Psychotherapywww.mdpi.com/2077-1444/2/4/611/htmAbstract
Integrating spirituality into mental health care, psychiatry and psychotherapy is still controversial, albeit a growing body of evidence is showing beneficial effects and a real need for such integration. In this review, past and recent research as well as evidence from the integrative concept of a Swiss clinic is summarized. Religious coping is highly prevalent among patients with psychiatric disorders. Surveys indicate that 70–80% use religious or spiritual beliefs and activities to cope with daily difficulties and frustrations. Religion may help patients to enhance emotional adjustment and to maintain hope, purpose and meaning. Patients emphasize that serving a purpose beyond one’s self can make it possible to live with what might otherwise be unbearable. Programs successfully incorporating spirituality into clinical practice are described and discussed. Studies indicate that the outcome of psychotherapy in religious patients can be enhanced by integrating religious elements into the therapy protocol and that this can be successfully done by religious and non-religious therapists alike.
Keywords: mental health care; religious/spiritual coping; religious psychotherapy
Integrating Spirituality and Religion into Psychotherapy Practicesocietyforpsychotherapy.org/integrating-spirituality-religion-psychotherapy-practice/It may be easy for psychotherapists to overlook or avoid addressing our clients’ spirituality and religion in psychotherapy. Such issues may not have been addressed in our training and thus may not be seen as relevant to our clinical work with clients. After all, we are mental health professionals, not members of the clergy.
Those who seek out psychotherapy under our care may also not view a focus on spirituality and religious issues as a part of what occurs in psychotherapy and what psychotherapists do. Other than those who seek out faith-based counseling, it is common for psychotherapy clients to perceive that psychotherapists address mental health issues and that members of the clergy are the ones to address religious and spiritual issues.
Some Definitions
Religion has been defined by Dew and colleagues (2008) as an “organized system of beliefs, rituals, practices, and community, oriented toward the sacred” (p. 382). Religion tends to focus on formal organizations with specifically defined and widely accepted beliefs, practices, and traditions.
Spirituality, in contrast, can be thought of as a “search for the sacred, a process through which people seek to discover, hold on to, and, when necessary, transform whatever they hold sacred in their lives” (Hill & Pargament, 2008, p. 4). This can be a very private experience and need not be part of experiences in organized religion. But, one can be religious but not spiritual, spiritual but not religious, neither religious nor spiritual, or both spiritual and religious.
The Integration Of Spirituality In Psychiatric Teaching:
The Lesson To Be Learned From Our Patients www.rcpsych.ac.uk/docs/default-source/members/sigs/spirituality-spsig/robert-lawrence-1-11-03-the-integration-of-spirituality-in-psychiatric-teaching.pdf