Q&A

Integrating spirituality into psychotherapy

How can spirituality be used in a treatment plan to benefit a patient's mental health? We asked spirituality and psychotherapy expert Dr David Rosmarin.

Is it okay for the therapist to be open about one's personal religious/spiritual beliefs if the client asks directly about it?

Spirituality/religion is a psychosocial variable similar to any other aspect of life. Therefore self-disclosure about spirituality/religion is “okay” in the same way that it may be appropriate for a clinician to speak about other aspects of his/her life with clients.

What have you found to be the most effective way to introduce spirituality into a session with a client?

Clinicians should start by assessing how spirituality may be connected to patients’ mental health by asking the question: how is spirituality relevant to your symptoms and/or treatment? This enables the clinician to keep the discussion focused on treatment-related aspects of the patient’s spiritual life.

What are your favoured approaches when a client is at a place where there current spiritual posture actually holds them in a "stuck" place, perhaps of diminished agency? such as "I guess this is G-d's will/G-d meant for this to happen"

Diminished agency isn’t always a bad thing. If a patient has benevolent spiritual beliefs (e.g., about a kind, loving, caring god), it may be adaptive and even helpful for them to believe in spiritual agency. With that said, it could be a double-edged sword, and the relevance of such beliefs to patients’ mental health needs to be assessed.

Does exploring concepts related to religion and spirituality only benefit patients who already have a strong spiritual/religious tie, or can it benefit those exploring these for the first time?

To my surprise, the statistical majority of patients presenting to a spiritual-cbt group that we've piloted throughout all of Harvard's McLean hospital (> 3000 patients) had no religious identity. In some ways, and in many cases, spirituality is even more important to discuss in mental health treatment for patients who are not religious since they may not have another avenue/context in life to explore such themes.

How can we reduce the stigma of psychotherapy for patients and their families who do no believe in psychology or psychiatry because of their religious beliefs?

The combined fields of mental health (psychology, psychiatry, counseling) have historically been anti-religious, and to this day, they are decisively secular. The phenomenon of people rejecting psychotherapy for religious reasons occurs in this context. Many people with spiritual/religious beliefs shy away from professional mental health approaches and services because they perceive the latter as incongruent with their life values. The best way to break the stigma is to treat spirituality/religion like any other area of life and bring it into the therapy room – just like we discuss sexuality, money, and other sensitive topics. We also need to see more research and more research funding to study spirituality and mental health.

Is there a specific therapeutic modality that you would recommend for most effectively exploring issues of spirituality and religion in psychotherapy? Does the spiritual beliefs and religious understanding of the therapist matter?

Spiritual psychotherapy can be practiced within any modality. However, a recent study I published suggests that Dialectical Behavior Therapy (DBT) is particularly suited for the integration of spirituality into treatment.

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