Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 211religious activity in church that he or she neglectsdependent family members, causing social strife.Another example might be the refusal of psychotherapybecause of a desire to rely entirely on religioustherapies.13.4. Acquire Psychodynamic InsightsTaking a detailed and thorough spiritual historycan provide psychodynamic insights that maybe useful in psychotherapy. Although less of anissue for the medical patient than for the psychiatricpatient, in medical patients with a historyof psychiatric problems, this will be relevant. Thestress of medical illness may trigger deep-seatedpsychological conflicts, especially those regardingdependency, which could cause agitation andirritability sufficient to interfere with medicalcare (or may even precipitate suicide).Religious issues related to image of God, derivedfrom unhealthy parental relationships, may needto be addressed. Religious guilt over past lapses injudgment may surface at this time, as patients fearretribution in the next life. Childhood abuse maygive rise to shame and feelings that patients arenot “good enough” to receive God’s love, mercy,and blessings. Some religious patients may bedistressed over thoughts that God is punishingthem, has deserted them, or is powerless to makea difference in their situation. Research shows thatreligious conflicts of this nature may affect themedical condition of the patient and even lead topremature mortality.(52)13.5. Respect Religious BeliefsThe psychiatrist should always and at all timesshow respect for patients’ religious beliefs. This iseven true for patients whose religious beliefs areconflicting with medical or psychiatric care. Bearin mind that these beliefs are usually intensely heldand serve a variety of psychological functions, somehealthy and some unhealthy. Even if unhealthy,however, the psychiatrist must establish a therapeuticalliance with the patient before attemptingto change or alter those beliefs. Showing respect forpatients’ religious beliefs will facilitate the developmentof that alliance and allow the psychiatrist tolater challenge unhealthy beliefs if necessary.13.6. Support Religious BeliefsIf the patient’s religious beliefs are generallyhealthy (and the vast majority of nonpsychiatricmedical patients’ religious beliefs will be healthyand adaptive), then the psychiatrist should considersupporting those beliefs. Bear in mind thatthe psychiatrist is being asked here to support thepatient’s religious beliefs, not introduce new beliefsor proselytize his or her own beliefs. Support forpatients’ religious beliefs can be conveyed in manyways, both verbally and nonverbally. Efforts toensure that patients’ spiritual needs are being metand that religious resources are made available areimportant ways of demonstrating support.13.7. Use Religious Beliefsin CounselingSome psychiatrists with pastoral training maydecide to use the patient’s religious beliefs as partof therapy. This is particularly true with medicalpatients who are dealing with overwhelming situationalstressors related to illness, disability, pain,and other medical symptoms (and the patient’spsyche is relatively healthy). Integrating religiousbeliefs into psychotherapy should only be donewith religious patients and would not be usefulfor nonreligious patients in most circumstances.Research shows that such integration (as in religiouscognitive-behavioral therapy) is most effective forreligious patients, (53) and may not be effectivein the nonreligious.(20) The religious patient willlikely be quite responsive and appreciative to suchintegration, whereas the nonreligious patient maybe offended. On the other hand, integrating religioninto psychotherapy can be done whether thetherapist is religious or not. In fact, some researchshows that religious cognitive therapy is moreeffective if delivered by nonreligious therapists thanby religious therapists.(53) The reasons for this arenot entirely clear. Perhap nonreligious therapistsin this study were more objective, more acceptingand less judgmental, or more rigorously applied the