As Published in the June 2008 Honor Cord) (non-working link); as published by Phi Theta Kappa; and as published by the NASW Specialty Practice Section in January 2008. Please contact the respective publishers for information on how to locate the archives.
By: Kurt D. LaRose
While considering the use of spirituality in the treatment of mental health disorders is controversial (some states have outlawed the practice for example), there are times when its use may be relative, supported and indicated (there are other ways to treat creatively as well). Besides the legal issue, a key consideration for mental health providers is whether or not the person seeking mental health services desires clinical input related to spiritual matters. If so, a question for the consumer to consider is whether or not the provider is competent to assist in a given set of faith related variables.
Obviously, it’s difficult to fully and universally answer such questions, in part because it is hard to articulate exactly what defines “spirituality” or “faith” from one person to the next. Either way, the mental health consumer and the provider of services would likely address such complex variables in the initial interview.
People increasingly ask me about alternatives to mental health. I tell them that getting away “from it all” to focus on nutrition, exercise, self care and simple fun can help. Other creative options people can look at include hypnosis, retreats, coaching, mindfulness – and more creative methods.
When a mental health provider completes a comprehensive assessment and includes a written treatment plan the goal is to find out what areas of psycho-social functioning are impaired (and/or to find areas of strength). Most providers will attempt to review of all aspects of human functioning, including multi-faceted aspects of the human condition: family history, substance use, sexual behavior, lifetime experiences and memories, employment, interpersonal relationships, financial matters, as well as spirituality.
Mindfulness, as this video practices it, can be an alternative to spiritual approaches.
Research in the medical model suggests that people who are dealing with various physical ailments, who also report having an active spiritual belief system, generally recover differently than those without an active spiritual life1. In some of the literature patient responses to various medical issues were measured in relationship to faith2, whereas in other literature curative outcomes were measured in relationship to no faith or in the absence of a spiritual belief system3. What about mental and emotional issues?
Similar to those in the medical model for example, social scientists have also found that active spiritual beliefs and behavior impact stress, attitudinal perspectives and outlook4. Higher levels of active spiritual exercises have been correlated to better mood and reduced stress during difficult times4. Research related to spiritual influence on mental health, such as with various addictions for example7, also provides a basis on which some providers treat patients using certain spiritual methods (for example, involving a 12-step model of recovery).
The term “active” (referencing spiritual beliefs and behavior) is defined in different ways, depending on what literature is reviewed. Prayer, meditation, reading scripture, helping others and attending weekly services are some examples4. General behavior that is often considered a spiritual act such as meditation, slow breathing, and reading5 is included in what helps to define “spiritual activity,” whereas other literature assesses and compares certain faith models (Christianity, Buddhism, and even Atheism).
But it is noteworthy to say that there is evidence to support eclectic treatment modalities that include spirituality and faith. The various research literature relative to spirituality and mental health varies in scope and definition, but generally speaking, hundreds (nearly 500 different studies) support spirituality and mental health as positively associated6. But the consumer of mental health services may also want to note that the research is not absolute; different scientific literature reveals 1) faith matters in certain studies, 2) faith does not matter in certain studies, and 3) faith has no impact on psychological well-being in other studies3. What does the mental health consumer do, when spirituality is a point of interest?
To begin, it is important to remember that there are some states in the US who have outlawed the practice of faith and spirituality in conjunction with mental health services (violations can lead to serious professional sanctions). But in the case where such legal prohibitions are not a factor, what some providers might do if a client asks for a faith/spiritually designed treatment method is ask for informed consent. The written consent would likely include alternative treatment interventions that are clinically supported in the absence of faith, while identifying the controversial nature of a method that incorporates faith and clinical aspects; and it would probably include a statement that indicates your desire to proceed using the requested method.
The mental health/spirituality debate can be neutralized somewhat in the following example: an expert who changes automobile oil, builds houses, or designs clothes might be just as effective in performing the specialized tasks with (or without) faith. Some consumers however, will only trust those with some kind of a similar faith, and some consumers will not care, whereas others will trust those who have no faith. In the final analysis of treatment related to mental health issues and disorders, outcomes are the most basic consideration, in the interest of and from the perspective of the client (the mental health consumer).
To be sure, the research regarding mental health treatment is controversial, not only in matters related to issues as complex as faith and spirituality. The mental health consumer is encouraged to question the mental health provider as to his/her approach in treatment modalities, and to make informed decisions based upon personal needs and wishes.
Whether a person is exercising to improve overall health (such as losing weight and building muscle), recovering from operations, dealing with terminal illness, and even if attempting to deal with mental health issues such as depression or chemical dependency the research literature consistently provides evidence that faith related activity can positively impact treatment outcomes. Alternatively, faith is not a pre-requisite to therapeutic intervention. What clients and practitioners might agree upon is this: every client who seeks counseling services has the option and right to refuse such methods—and– to request them.
*This article addresses some of the literature that exists discussing matters of faith (both positive and negative). The information is based upon the relativity of spirituality in the mental health arena. It is not intended to address the common debates that might occur within and in between various faith communities and/or belief systems. Certain professionals espouse that there is only one way to deal with mental health issues and that spirituality “should” be included. Other providers argue that spirituality is too difficult to measure and validate that its use in mental health is questionable8. This article is not intended to substitute face-to-face appointments between mental health consumers and mental health providers. Readers are encouraged to contact a local professional when considering mental health services, in order to obtain clinical input that is based upon your particular situation.
Publishing note: An alternative to this article titled, Approaches to Mental Health Treatment and Spirituality, was published in the Mental Health Section Connection (Vol. II, December, 2008) by the National Association of Social Workers, Specialty Practice Sections, Washington, D.C. Persons who wish to have a paper copy of the article, if one cannot be located/purchased on the NASW website archives, may get a copy by contacting the author for a PDF version as it originally appeared in the 2008 NASW SPS publication.
- Tu, M. (2006). Illness: An opportunity for spiritual growth. The Journal of Alternative and Complementary Medicine, 12(10), 1029-1033.
- Hull, S. K., Daaleman, T. P., Thaker, S. & Pathman, D. E. (2006). A prevalence study of faith-based healing in the rural southeastern United States. Southern Medical Journal, 99(6), 644-653.
- Hackney, C. H. & Sanders, G. S. (2003). Religiosity and mental health: A meta-analysis of recent studies. Journal of Scientific Study of Religion, 42(1), 43-55.
- Oman, D., Hedberg, J. & Thoresen, C. E. (2006). Passage meditation reduces perceived stress in health professionals: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(4), 714-719.
- Moss, D. (2002). The circle of the soul: The role of spirituality in health care. Applied Psychophysiology and Biofeedback, 27(4), 283-297.
- Koenig, H. G. (2004). Religion, spirituality and medicine: Research findings and implications for clinical practice. Southern Medical Journal, 97(12), 1194-1200.
- Brown, E. J. (2006). The integral place of religion in the lives of rural african american women who use cocaine. Journal of Religion and Health, 45(1), 19-39.
- Sherman, A. C., Simonton, S., Latif, U., Spohn, R. & Tricot, G. (2005). Religious struggle and religious comfort in response to illness: Health outcomes among stem cell transplant patients. Journal of Behavioral Medicine, 28(4), 359-367.
Other website reference information.