Religion and Spirituality in Psychiatry

Integrating Spiritual Issues into Therapy 255role in psychiatric rehabilitation. One participantwith a thirty-year history of agoraphobiaand daily panic attacks shared that she was ableto “push away” the symptoms by using a combinationof prayer and relaxation techniques.Another group member with bipolar disorderand a history of risky sexual behaviors sharedthat by returning to God, he had stopped hisbehaviors for over a year. A third participantsaid that her hope in Christ empowered her tojourney through her depression. Finally, a fourthgroup member said, “By remembering that Jesussuffered more than I ever did kept me fromself-pity and on the course to getting better.”Participants as a group stated that sensing God’spresence helps lessen feelings of sadness, calmsfears and anxieties, and helps in dealing withforgiveness and resolving daily problems.The findings from the Wong study encourageinclusion of spirituality in psychiatric rehabilitationas a promising approach. Participants’ selfreportand goal-attainment outcomes point tothe positive effects that spirituality has for peoplein recovery.4.3. “Spirituality Matters Group”at the Nathan Kline Institute, New YorkThe Spirituality Matters Group (SMG) was developedin 2001 at the Clinical Research EvaluationFacility (CREF) of the Nathan Kline Institute forhospitalized persons with persistent psychiatricdisabilities,( 67) following the rationale thatspiritual support fosters the recovery process.SMG is distinct from comparable groups ( 68)in its multidisciplinary leadership that focuseson integrating spiritual/religious, psychological,and rehabilitative perspectives over an extendedtreatment period. Staff concerns about potentialdeleterious effects (for example, increased psychopathology)were discussed in the context ofstaff resistance encountered by proponents ofthis treatment format. (62) SMG’s purpose wasdescribed as strength-based, offering individualspersonal choice, respect, and peer support, correspondingto accepted core principles for mentalhealth recovery (www.samhsa.gov). The SMG ismade up of self-referred persons who join threegroup co-leaders (representing psychology, pastoralcare, and rehabilitation) in exploring nondenominationalreligious and spiritual themesdesigned to facilitate comfort and hope, whileaddressing prominent therapeutic concerns.Patients are told this group “focuses on the use ofspiritual beliefs for coping with one’s illness andhospitalization.”The one-hour weekly SMG has had continuousenrollment over the last five years. Attendanceranges from six to eight members, withparticipants making a commitment to the groupfor the duration of their hospitalization at CREF,typically twelve to forty sessions. Group membershipdemographics during an evaluation periodin SMG’s second year included ( n = 20): averageage 35 years, education 11 years, first hospitalizationage 21, and current inpatient stay 255 days.Seventy-nine percent were male; 33 percent black,42 percent white, 12 percent Hispanic; 72 percentdiagnosed with schizophrenia, 28 percent schizoaffectivedisorder; 80 percent had past substanceabuse and 5 percent a history of pathologicalreligious ideation. Participants identified themselvesas Protestant, 25 percent; Catholic, 35percent; Jewish, 2.5 percent; Muslim, 2.5 percent;other, 10 percent; multiple, 5 percent; and none,20 percent. The highly-structured group formataccommodates cognitive deficits and limitedsocial skills, prevalent in persons with persistentpsychiatric disabilities.During each session’s initial phase , membersare introduced, the group’s purpose reviewed,and seasoned group members orient newcomerson how the group can be used (for example,using spiritual beliefs to cope with daily stressorsand for support with behavioral change). Themultireligious and nondenominational natureof the group is affirmed. Spirituality is defined as“personal beliefs and values related to the meaningand purpose of life, which may include faithin a higher purpose or power.”In the middle phase , a topic with a relatedgroup activity or exercise is introduced, withwarm-up questions for personal sharing andreflection, followed by distribution of handouts,