Religion and Spirituality in Psychiatry

346 Elizabeth S. Bowman5. WHAT SHOULD BE TAUGHT?5.1. Educational GoalsThe content of a curriculum depends on its educationalgoals, which are determined by the targetlearner population. I offer recommendationsfrom my experience teaching a religion-spiritualitycourse to psychiatry residents and from theModel Curriculum. (19) Three broad goals are keyfor all student clinicians who will provide psychologicalassessments and psychotherapy: (1) torecognize and distinguish pathological fromnormal religious and spiritual life; (2) to acquireskills, knowledge, and attitudes enabling themto deal therapeutically with religion-spiritualityin mental health care; and (3) to acquire clinicalcompetence in addressing religion/spiritualityin actual treatment settings. Although the broadeducational goals are identical for all disciplines,tailoring of content is indicated. Education ofpsychiatry residents should include religious attitudestoward medication and somatic treatmentsof mental illness, as well as toward psychologicaltherapies. Marriage and family therapy studentsespecially need education about religious grouppractices and beliefs about marriage, families,and sexuality. In the education of all mentalhealth clinicians, knowledge, but also skills andattitudes, need to be taught.Undergraduate course work in psychology,social work, and counseling also should requireeducation about religion-spirituality. The goalsfor undergraduates should be: (1) raising awarenessof the central role of religion and spiritualityin human life and society (sociology of religionspirituality);(2) communicating respect and basicknowledge about diverse religious traditions andspiritual practices (world religions); and (3) teachingevidence-based interrelationships betweenpsychology and religion- spirituality (psychologyof religion).5.2. Curricular Content“If there is one law of curricular development, itis that the material always exceeds the allottedcurricular time” (5) (p. 369). The amount of trainingtime given to religion-spirituality in a residencycurriculum is likely to be small, so prioritizingcontent is critically important. Content prioritiesshould be guided by the overall goal of assistingtrainees in recognizing normal and pathologicalreligious and spiritual life and assisting them indeveloping ethical and sensitive assessments andresponses. I recommend setting priorities andteaching in order of decreasing importance.Several approaches to teaching this topichave been published. Israeli psychiatrist Blass(75) , advocates a pragmatic teaching framework.He holds it is more effective to focus onteaching knowledge of phenomenology andinformation-gathering skills rather than broadknowledge of many religions. For instance, hesuggests teaching trainees the components thatdefine a delusion and the skills to seek collateralinformation from local informants (family,clergy, and other believers) on normativereligious beliefs. Blass’s approach to educationwould not include didactics on the content ofmajor faith groups.Canadians Grabovac and Ganeson (30) advocateteaching basics of major world religions andindigenous religion in their proposed elevensessionacademic curriculum for Canadian psychiatryresidents. Their recommendations forteaching on indigenous religion could be adaptedto African, South American, or Middle Easternsettings, but their curriculum, like the ModelCurriculum (19) is best suited to Europe andNorth America.Puchalski and Romer (79) suggest a simpleformula of content that fits into a single sessionof education and applies to medical students andprimary care health professionals: FICA. This is afour-question assessment of Faith , its Importance ,whether the person has a religious-spiritualCommunity , and how the person wants the providerto Address these issues as part of health care.Sample questions of the FICA model are availableat http://www.gwish.org. This approach canbe adapted for single or in-service CME presentationsor brief education for nurses and primarycare residents. Psychiatrists and psychologists