Religion and Spirituality in Psychiatry

124 Alyssa A. Forcehimes and J. Scott ToniganTh is is not to suggest that it is definitelyharmful to explore spirituality early on in treatment.This was a population with severe drugdependence, and alternative explanations forwhy the treatment effect was null are also plausible.Perhaps a discussion of spirituality is helpfulearly on in treatment, but encouragementto begin practicing specific spiritual disciplineswas too burdensome during the early stages ofrecovery.6.5. Case StudiesAs we move into case studies of spirituality inaddiction treatment, we offer three examples ofhow spirituality may play a part in treatment. Thefirst is an example of how assessing a patient’sspirituality can actually be considered treatmentin and of itself. A second example is a vividdescription of a spiritual transformation, whichclinicians are likely to encounter and thus shouldbe aware of the nature and magnitude of sucha profound change.(21) Finally, the third casestudy describes a scenario in which it is appropriatefor the clinician to refer the patient out foradditional spiritual guidance.Assessment as Treatment. In a recent clinicaltrial (53) designed to increase patients’ practice ofspiritual disciplines, an unexpected finding wasthat those assigned to the control condition stillreported spiritual growth stemming only fromthe baseline assessment. The baseline assessmentincluded several instruments designed to assessthe patients’ spiritual and religious backgroundand beliefs. Unexpectedly, during the follow-upassessment, patients would often report thingssuch as the following:I really started thinking about things after Idid this first batch of paperwork. You know,since then, I realized how much I used topray and how I’d really gotten away fromthat and I’ve started doing that again, youknow, just praying to say thanks that I madeit through another day, and asking God towatch over my kids, and stuff like that.It seems then, that even though therapists maynot directly explore issues of spirituality with apatient, the act of completing an assessmentthat included questions about the frequencyof spiritual practices and religious attendanceand involvement can increase levels of spiritualpractice.Understanding Profound Spiritual Transformations.Up to 54 percent of treatment- seekingindividuals experience a profound spiritual experiencethat results in a magnitude of change.(21)Transformations are manifested dramatically,usually in a vivid, surprising manner without asalient external event. These events are highly significantfor the individual experiencing them, andthere is often a desire combined with a fear in discussingthem with a professional. Understandingthe nature of these experiences can assist in clinicalwork. Here is one such story:Jack had a troubled background, includingsexual and physical abuse, exposureto gang violence, heavy drug and alcoholuse, and financial struggles. He was a frequentdrunk driver, but had never beengiven a DUI (driving under the influenceof alcohol or an illicit substance).His transformational experience was adream, which to him was more real thanany dream he had ever experienced. Inhis mind’s eye, he saw himself driving onthe freeway after a long night of drinking.He hit the rail, the car spun, and hewas involved in a head-on collision withanother car. He could see himself gettingout of the car, uninjured, to examinethe damages. In the car, he saw thebloody wreckage of a family of four: themother, in the passenger seat, was theonly one breathing. The two small childrenhad been thrown from the car, theirsmall bodies distorted on the pavement,surrounded by pools of blood. The fatherhad not been wearing his seatbelt and hishead had gone through the windshield.Immediately sobered by the realization of