Religion and Spirituality in Psychiatry

122 Alyssa A. Forcehimes and J. Scott ToniganAnonymous. The context of a spiritual communitymay be the protective factor, or it may bethe community that is supportive of spiritualitythat accounts for the lower substance use. Forinstance, Kaskutas, Bond, and Humphreys (47)examined one-year outcomes in relation to AAparticipation and found that, although generalsupport from others was associated with improvementin functioning, only specific support fromAA members mediated abstinence. Additionally,having a greater number of sober individuals inone’s social network was predictive of abstinenceamong alcohol-dependent persons.(48, 49)6. SPIRITUALITY IN THE CLINICALCONTEXT6.1. Why Should Spirituality Be Discussedwith Patients with Substance UseDisorders?Within the larger framework of cultural sensitivity,spirituality is an issue that should not becompartmentalized as outside the psychotherapydomain. The separation between psychology andreligion/spirituality stems from a long-standingantagonism between these fields.(50) Parallelingthe recent increased attention spirituality isreceiving in substance use research, it is also fairlyrecent in the clinical context that spirituality hasbeen emphasized in the inclusive model of treatingall the aspects of a person’s experience. Thiscomplementary relationship is viewed as bothhelpful and respectful to the patients with whompractitioners work.The word religion (re-ligare) is Latin for “toconnect again,” and this broadened definitionexpands the boundaries of organized religion toencompass a broader definition of spiritualityand the emphasis on connection and meaning.Also, returning to the model described above,if addiction leads to disconnection (AmericanPsychiatric Association, 1994) (7) followingJung’s aphorism spiritus contra spiritum , spiritualityis the natural path toward reconnection andis a particularly important consideration in thetreatment of addictions.6.2. Who Should Discuss Spirituality?Although most clinicians regard their spiritualityas important and regard religion as beneficial topsychological well-being, mental health practitionersremain much less religious than the generalpopulation.(50) Although patients often will regardspiritual and religious issues as directly relevant totheir substance abuse problem, the therapist oftenwill not be an expert in the spiritual/religious traditionof the patient and hence may not be qualifiedto offer advice within that tradition.Many believe that leaders or experts in religionor spirituality are chosen or ordained to thesepositions after lengthy training and prayerful consideration.Research on the treatment of addictionsuggests that practitioners delivering treatmentdo not need to have personal experience of addiction;rather the practitioner can use empathy in anattempt to understand the patient’s situation.(51)Client-centered approaches, in particular, supportthe use of empathy as a way to create a collaborativerelationship between the patient and practitioner.Thus, the skillful use of client-centered methodsto draw out the patients’ own meanings andunderstanding is perhaps more critical regardingpatients’ spiritual or religious journey than manyother aspects of their psychological experience.One consideration in determining who isqualified to discuss spiritual and religious issueswith the patient concerns the difference betweenwithin-faith and between-faith interventions.Client-centered approaches are suitable forbetween-faith interventions, in which the therapistand patient’s spiritual and religious beliefsare not necessarily convergent. When, however,a patient is seeking within-faith advice, it is thenimportant for the therapist to recognize the needfor expertise in this area and discern whetherconsultation is necessary or whether it is appropriateto refer the patient to someone moreexperienced and knowledgeable in this area. Itis important to determine whether the patient’sissue concerns a theological question that wouldbe best addressed through a within-faith provideror a psychological issue that can be addressedusing client-centered methods appropriate for