Religion and Spirituality in Psychiatry

Community Psychiatry and Religion 219minister, I work to value both cultures (knowingneither is perfect). It is helpful to identify andacknowledge other people who serve as boundaryspanners in the community: people who arecredentialed mental health providers but mightalso be ministers or religious leaders.Some health professionals have advancedtraining in mental health and spiritual practice.Chaplains, pastoral counselors, and faith leaderswho also serve in professional behavioral healthagencies are potential “boundary-spanners” whoare trusted and recognized in the community,while able to “translate” languages (clinical andreligious). The term pastoral counselor refers toan individual who blends insight from theology,spirituality, and behavioral health in ministry. Insome areas, you will find pastoral counselors credentialedthrough professional organizations likethe American Association of Pastoral Counselors(described at the end of our chapter). Otherregions might have individuals who describetheir ministry as pastoral counseling and mightnot even know of a professional category outsidetheir own congregation or religion. In a similarway, chaplains are usually individuals who servein (sometimes hired by) institutions to serve thespiritual needs of people within the institution,including families and staff members. Manychaplains have professional training and seetheir lifelong work in this specialized ministry.Yet many see their role in chaplaincy amendingtheir other religious duties in the community. Itis best to become acquainted with chaplains andpastoral counselors locally to better understandhow they might work to serve patient/client spiritualand mental health needs. In many ways, theopportunity to provide holistic care lies in the artof translating those two powerful cultures.Boundary spanners will likely know aboutthe delicate issue of using their background andunderstanding in ways that assist care rather thandrive a religious agenda. We encourage forumsthat invite leaders in the spiritual, psychiatric, andmedical communities together to consider modelsof referral and collaboration. Maybe periodictalks can be arranged on aspects of each community’sapproach to healing that would be helpfulto everyone. An individual practice (not as a partof a group or institution) might consider offeringto lecture on some evening to a local placeof worship on a common issue in mental health.Even a brief talk followed by lively discussion canincrease mutual understanding of what peoplebelieve helps and potentially reduce stigma.Like the mental health and addiction fields,those in the spiritual field have increasingly“ specialized” into a more stratified system overthe years. For example, institutional spiritual professionalsare held to different bodies of accountabilitythan those in worship or congregationalsettings. Others are accountable to their own religiousbody only and may not have any counselingoversight. Yet their role remains critical becausethey are commonly chosen by congregants whenseeking help. We are cautious not to call all of this“counseling.” But let’s be honest: Whatever wecall it, people are attending to emotional needs.Consider the variety of “providers of care” in thespiritual community and the implications for thecare of patients.One way to increase awareness of a patient’ssupport system is to offer a more in-depth spiritualassessment that would include a questionlike “who provides you with personal spiritualsupport?” This will likely elicit a more meaningfulresponse than the typical spiritual assessmentquestions that are important but incomplete fromthe “every day” experience of a client. Sometimespeople will offer a neighbor’s name, a laypersonin their religious congregation, or possibly a clergyperson.Their answer will reveal their chosenspiritual provider of care. The closer we get to the“personal” support the client is using, the morewe will understand and support their healing.We found in our pastoral counseling trainingprograms that many people asking for trainingwere coming at the permission of their religiousauthority (pastor, priest, imam, denomination)but who, long beforehand, had discovered theywere the “kind of people everyone sought out forhelp.” A more formal role for these individualsnaturally followed. I am mindful that “titles” maynot convey sufficiently the role spiritual leadersserve. But if we are collaborating, it is helpful