Religion and Spirituality in Psychiatry

Integrating Spiritual Issues into Therapy 257struggles, forgiveness, and hope. The interventionwas designed to provide new informationabout spirituality to participants and to allowthem to share experiences and knowledge thatthey felt might be of value to others. An additionalgoal was to present a more inclusive set ofspiritual topics to clients with SMI than has previouslybeen described.Group members were recruited throughreferrals from mental health workers at a localcommunity mental health center. Potentialmembers participated in individual interviewsto determine whether their needs, expectations,and level of functioning were appropriate for thegroup. The interview examined their religious/spiritual background, the role that religion/spirituality has played in their experience withmental illness, and their expectations for thegroup.There were ten participants, all Caucasian, and70 percent were female. One-third of the groupmembers reported a diagnosis of schizophrenia,one-third indicated a diagnosis of depression,and one-third reported personality disorders astheir primary diagnosis. In terms of religiousaffiliation, 30 percent identified themselves asRoman Catholic while all others were affiliatedwith Protestant denominations. Two doctoralstudents in clinical psychology served as ongoingfacilitators for each group session. Furthermore,each week (with the exception of the first and lastweeks) an additional graduate student joined thegroup to introduce discussion on a specific topic.Therefore, on most weeks, three facilitators werepresent. The group took place once a week for 1.5hours over the course of seven weeks.Week One: Introduction. The facilitators gavegroup members an overview of the group formatand what topics would be discussed. In addition,the group rules were reviewed and group membersshared their “personal spiritual journey.”( 62)Questions revolved around the theme of theirpast and present spirituality, how their spiritualitywas affected by their mental illness, and viceversa.Week Two: Spiritual Resources. This sessionwas intended to elicit members’ ideas ofpersonal and community spiritual resources. (20)The session began by providing the group withdefinitions and examples of spiritual resources.Multiple resources were generated by participants,including prayer, reading religious literature,prayer groups, going to religious services,journaling, listening to spiritual music, burningcandles, doing artwork, and just socializingwith friends. In addition, potential barriers tousing these resources were also explored, such asavoiding church when experiencing high levelsof symptoms.Week Three: Spiritual Strivings. The primaryobjective was to have group members exploreways to create and achieve meaningful, realisticgoals related to their spiritual journey. Emmons(71) has discussed the importance and positiveimplications of spiritual strivings. The facilitatorfirst discussed the importance of having strivings.To facilitate the discussion, group membersgenerated personal lists of their strivings. Theselists were based on what participants foundmeaningful.Week Four: Spiritual Struggles. The overallgoals were to emphasize the importance ofexpressing thoughts and feelings about spiritualstruggles, validate and normalize anger withGod or the church, and reframe struggles as atime of potential personal growth and change.Group members were given a list of commonstruggles with God (for example, feeling abandoned,spiritual emptiness, feeling sinful, andfeeling frustrated) and church (for example, notfeeling welcomed, feeling abandoned, stigma,and paranoia) and asked to circle ones that theyhave experienced. They then shared with othergroup members ways in which they have dealtwith these struggles.Week Five: Forgiveness of Others. The primarygoal was to examine how forgiveness related tothe members’ lives. First, group members discussedthe definition of forgiveness. They thenexplored what forgiveness is not; that is, forgivenessis not forgetting, reconciliation, acceptanceor tolerance of injustice, letting go of anger, condoning,excusing, or legal pardon. Next, groupmembers generated ideas about the costs and