Religion and Spirituality in Psychiatry

368 Philippe Huguelet and Harold G. KoenigWhat can programs such as WindhorseTherapy bring to patients with severe mental disorders?The goal of current secular approachesfor these disorders is recovery. With this kindof care, aiming at recovery is not always an easytask, because motivating patients often involvesrepetitive activities that are often felt to be stigmatizing.Also, antipsychotic medications, evensecond-generation antipsychotics, are sometimespoorly tolerated by patients. Environments likeWindhorse can bring together the conditionsthat are likely to help patients initiate activitiesand reduce stress, which in turn is likely to reducemedication needs. As with Christian or Muslimpsychotherapy, this treatment should only beused after explaining the underlying Buddhistprinciples on which it is based, and it should onlybe suggested for patients who would be willing toembark on such a therapy.22. PSYCHIATRIC EDUCATIONBeyond reading books and papers, there shouldbe education about religion for psychiatrists, aswell as education about psychiatry/psychologyfor clergy and chaplains. Rationales for teachingreligion-spirituality are detailed throughout thisbook. Currently, educational guidelines for psychiatryresidents recommend teaching sensitivityto religious and cultural issues and trainingthat ensures a minimum degree of competencyin these areas. Education on this topic shouldtake place early in the training curriculum forstudents and post-graduate trainees, to form lifelongattitudes and habits. Training programs forpsychiatrists, medical students, or psychologistsexist in North America, in some parts of Europe,and in Australia. There is little information abouttraining programs in most countries in Africa,the Middle East, and Asia.All clinicians involved in mental health careshould receive training on religion/spirituality.Three broad goals are: (1) to recognize and distinguishpathological from normal religious and spiritualexpressions, (2) to acquire therapeutic skills,knowledge, and attitudes to deal with religionspiritualityissues in mental health care, and (3) toacquire clinical competence in addressing religion/spirituality in actual treatment settings. Essentialcontent should include: (a) general informationabout research relating to religion/spirituality inhealth and (b) gathering and interpreting informationabout the religious/spiritual history. If possible,the curriculum could include more specificnotions such as religious/spiritual developmentover the lifetime and techniques of addressingthis topic in psychotherapy. Didactic courses andseminars are the most common formats, but otherbrief teaching formats can also be implemented,such as intermittent in-service training.When trying to implement a training programon religion/spirituality, one may expect torun into some resistance from students, faculty,program directors, or entire institutions, mostresistance being due to ignorance or countertransferenceissues.REFERENCES1. Hol loway F . Is t here a s c ienc e of re c over y and do es itmatter? Advan Psychiatr Treat. 2008 ; 14 : 245– 247.2. Pa louzi an RF , Park C L . Handbook of the Psychologyof Religion and Spirituality . New York : GuilfordPress; 2005 .3. Bur ton R . Anatomie de la Mélancolie, trad. fr. parB. Hoepffner, préface de J. Starobinsky, postface de J .Pigeaud, Paris: José Corti; 2000 .4. C a lton T , Fer r iter M , Hub and N , Sp and ler H . Asystematic review of the Soteria paradigm for thetreatment of people diagnosed with schizophrenia. Schizophr Bull. 2008 ; 34 : 181– 192.5. L inehan MM . Cognitive Behavioral Treatmentof Borderline Personality Disorder . New York :Guilford Press; 1993 .