Religion and Spirituality in Psychiatry

140 Harold G. Koenigby focusing on the person’s image of God andsubstituting a relationship with God for missingor disordered parental attachments. Theophostictherapy is a Christian counseling method used tohelp patients recall suppressed or hurtful memories(often involving relationships with parentalfigures) so they can be healed in the present.(40)7. ENCOURAGING/PRESCRIBINGRELIGIONIn rare instances, the psychiatrist may gentlyencourage religious beliefs or activities thatpatients may not be currently engaged in, buthave been involved in previously. Such encouragementshould focus on the patient’s faith tradition.Considerable care needs to be taken, however,because encouragement or prescription is a muchmore aggressive approach. It is quite possible thatthe patient will see this as coercive (which is notacceptable). Most psychiatrists will not feel comfortableencouraging religion, and it is questionableas to whether this activity is even ethicallypermissible. However, if the anxious patient issocially isolated and in need of support, wasonce involved in religious practices, and there arepotentially removable barriers to resumption ofreligious involvement, then the psychiatrist maybring this up in therapy and consider encouragingthe patient to re-engage in such activity. Beforedoing so, the psychiatrist would be wise to checkwith an expert in pastoral care and counseling.Nevertheless the problems that can result frommental health professionals trying to evangelizepatients of no religion or a different religion fromtheir own are legion, given the personal nature ofreligious belief and the power differential in therelationship between patient and psychiatrist.(41)Furthermore, the focus of therapy should alwaysbe on the patient, not on the therapist or the therapist’sneed to share his or her faith.8. CHALLENGING UNHEALTHYRELIGIONAs noted above, religious beliefs may not alwaysbe helpful for patients with anxiety disorder, orthe patient may be using religion in a harmfulor unhealthy way. For example, the patient withgeneralized anxiety disorder may be focusing onreligious scriptures that warn about the dangersand agonies of hell. Anxious patients may fearthat their failure to live up to religious ideals hasdestined them for an eternity of pain and sufferingin the afterlife, and their anxious temperamentmay cause them to dwell on such fears.William is a 56-year-old teacher who hassuffered from generalized anxiety for mostof his life. He has found great comfortin his religious beliefs, in attending hisBaptist church and spending time with thefriends he has made there, and in readingthe Bible that gives him hope and courage.However, he sometimes worries aboutwhether he is really “saved,” and whetherhe has lived a good enough life to make itto heaven. He had a dream the other nightthat he was in hell, and he woke up in acold sweat. He could not get this off hismind all day. When he went in to see hispsychiatrist for his usual appointment, hetold the psychiatrist about the dream. Thepsychiatrist listened carefully and helpedthe patient explore his feelings about thedream.In other cases, the anxious patient may copewith anxious feelings by taking on an air of superiorityor self-righteousness, and then condemnothers whom he or she views as not living rightor believing correctly. Such attitudes may interferewith social relationships, lead to isolation, oreven result in paranoid thoughts about others.Stephanie is a 35-year-old wife and motherof three. She is the member of a fundamentalistreligious group, which sheencouraged her family to join. She is a perfectionistin her expectations of herself andothers. Stephanie believes that only thosein her religious group possess the truth,and others are wrong and going to hell,even those within her own congregation