Transcript File
When Issues Become Emergencies: Assessment and Treatment of Spiritual Problems Nadine Duckworth University of Lethbridge Introduction F Spiritual practices have beneficial effects on health F For healing of illnesses F Psychological growth F Self-actualization F Spiritual problems F Can emerge spontaneously or during intense spiritual practice F Can resemble a variety of mental disorders F Can lead to disruption in social and psychological functioning Introduction Misdiagnosis can result in inappropriate treatment and intensification of distressful symptoms If properly diagnosed and treated, can result in personal growth and healing Spiritual practices are gaining popularity worldwide Spiritual problems are likely to increase as well Therapists should be “spiritually-sensitive” Increased awareness and understanding Appropriate treatment approach DSM Diagnosis 1994 DSM IV - “Religious or Spiritual Problem” (Code V62.89), is used to diagnose a religious or spiritual crisis that is usually a brief reactive response to specific religious or spiritual experiences Designated as a “V code”, acknowledging a category of distressing religious and spiritual experiences that are nonpathological in nature A religious or spiritual problem is not a mental disorder, but is a condition that requires clinical attention Traditional psychiatry has not differentiated mysticism from psychosis often misdiagnosed as psychotic disorders typically treated with psychotropic medication and hospitalization Spiritual Issues Spiritual issues or concerns are not as sudden or as intense as spiritual emergencies Include things like: Loss or questioning of faith Conversion to new religion or denomination Moral or ethical issues Personal identity issues Existential issues Trauma Relationship and family problems Grief and loss Physical or terminal illness Substance abuse Extremes of thinking or living Psychological disturbance Burnout and working with other people in crisis Spiritual Emergency Spiritual emergency/crisis - when one’s Self becomes overwhelmed by an infusion of spiritual energies or new realms of experience which it is not yet able to integrate The practice of personal or spiritual transformation can become a crisis, resulting from a process of growth or change that has become chaotic or overwhelming It has been described in the sacred literature of all ages, and is recognized as being the result of meditative practices and the mystical path Individuals may experience: self identity disintegrating old beliefs and values no longer hold true reality is radically changing new realms of spiritual experiences appear suddenly and dramatically immense confusion, anxiety, and sometimes impaired functioning worry that they are going crazy, or experiencing psychosis Spiritual Emergencies Anomalous experiences: deviate from the usually accepted explanations of reality can involve intense emotions, visions, perceptual disturbances, unusual thought processes, tremors, and sensations of heat and energy Examples include: intense kundalini awakening mystical or “peak” experiences near-death experiences psychic openings or psi-related phenomena past-life experiences shamanic journeys UFO/alien encounters or abductions communicating with spirits or channeling possession states Assessment 1. Brief Mental Status Exam: general description and appearance of client mood and affect perception thought processes level of consciousness orientation to time, place, and people memory impulse control Disturbances in perception, consciousness, or orientation may indicate: spiritual emergency psychotic symptoms organic brain disorder 2. Subjective Units of Disturbance Scale (SUDS) Assessment 3. Clinical Interview Listening to client’s story Building rapport History-taking Checklist of symptoms physical, behavioural, cognitive, emotional frequency, intensity, and duration 4. Global Assessment of Functioning Scale (GAF) 5. Psychological Tests SCID-I and SCID-II - for Axis I and II MMPI-III and MCMI-2 - for Axis I and II SIRS - Structured Interview of Reported Symptoms Assessment 6. Religious and Spiritual Assessment gain an understanding of the client’s worldview determine whether the client’s religious-spiritual orientation is healthy or unhealthy, and what impact it has on the presenting problem determine whether the client’s beliefs and community can be used as a resource determine whether the client has unresolved spiritual doubts, concerns, or needs that should be addressed in therapy To aid in assessment and help identify client’s goals: Spiritual Transcendence Scale Spiritual Well-Being Scale Theistic Spiritual Outcome Scale Differential Diagnosis Important to distinguish spiritual emergencies from psychotic-like symptoms/disorders http://www.spiritualcompetency.co m/dsm4/lesson5_1.asp Spiritually-Sensitive Approach Promote a positive context for client’s experience Provide them with information about the spiritual emergence process Move away from the concept of disease, and focus on the potential healing and transformative nature of the experience Involve client’s social support network if possible Goals for Treatment 1) Respond to crisis situation Aim to reduce frequency, duration, and/or intensity of distressful symptoms 2) Normalize the experience Provide information and resources to the client 3) Encourage emotional release/catharsis through creative expression art therapy 4) Psychotherapy to integrate the experience narrative therapy existential, contemplative/transpersonal, integrative approach 5) Enhance positive spiritual outcomes as identified by assessment and client goals 6) Facilitate the transformational process Promote holistic well-being Encourage psychological and spiritual healing, learning, and growth Interventions for Spiritual Emergencies For clients in a state of crisis: 1) Use the therapy session to help ground/center the patient • “here and now” 2) Create a therapeutic container • therapist presence is key - warmth, compassion, non-judgment 3) Normalize and educate 4) Help patient to reduce environmental and interpersonal stimulation 5) Have patient temporarily discontinue spiritual practices 6) Suggest the patient eat a diet of "heavy" foods and avoid vegan diet and fasting 7) Evaluate for medication - refer to psychiatrist Interventions for Spiritual Emergencies After the immediate crisis has subsided: 8) Encourage the patient to become involved in calming activities • 9) gardening, walking, relaxation Encourage the patient to express their experience through creative and artistic mediums • • art, music, dance, writing, poetry, drama, etc. symbol and metaphor for nonverbal expressions and integration Psychotherapy Along with these immediate responses, a more generalized psychotherapeutic intervention should be used to help the client integrate the experience This involves a narrative approach, including 3 phases: 1) telling the story of the experience 2) tracing its symbolic/spiritual heritage 3) creating a new personal mythology Prevention Strategy Learning stress management skills might also be useful for the client to help prevent a re-occurrence of the spiritual crisis: Self-monitoring of anxiety De-escalation of symptoms through relaxation therapies Knowledge gained from the therapeutic interventions previously listed Spiritual Interventions For other less severe spiritual issues and concerns, examples of major therapeutic techniques include: spiritual relaxation or guided imagery meditation and/or prayer journaling about spiritual feelings study of scripture or spiritual texts using the client’s support system participating in religious services or spiritual gatherings encouraging the client to seek guidance from a compassionate religious or spiritual leader giving/receiving blessings encouraging forgiveness and/or repentance cognitive restructuring of irrational religious or spiritual beliefs (discernment required) http://www.youtube.com /watch?v=z9nOD6foI64& feature=related Mystical Experience http://www.youtube.com/watch?v=UQ44lJ-eItw