Religious beliefs and working with psychosis
Religious beliefs and working with psychosis
Issue 04 – July 2008
Author: Sarah Keenan (firstname.lastname@example.org)Key points
- Professional training and practice guidelines are often vague about how to work with religious beliefs.
- Religious beliefs influence coping strategies and recovery, therefore it is important to feel comfortable to sensitively ask clients about them.
- Research suggests that knowledge about the religious beliefs of a client may influence how empathic we are toward them.
- It is important to have the opportunity to have conversations about our own beliefs and how these influence our views of distress.
- Religious coping strategies can foster hope and can be an important resource in working toward recovery.
Setting the Scene:Working with clients and families for whom understandings of psychosis and religious beliefs are intertwined can be challenging. These beliefs can sometimes be obviously prominent within a client’s life, for example taking on a religious persona, or they can be more subtle, for example attending a religious institution. Therefore religious influences can interact at different levels and in more or less obvious ways. In the past there have been differences in theoretical perspectives about how helpful it is to work with religious beliefs in therapeutic practice. However it is now commonly agreed that it is important to ask about a client’s religious experiences and beliefs, and more than this, an open curiosity about these beliefs is essential in encouraging recovery and coping1.
Considering religious relationships:Regardless of whether clients and families speak openly about their religious beliefs it is likely that, if they are important to the individual and their community, they will influence coping. For example understanding distress as “religious suffering” can promote a less2, or more active approach to recovery3. Pargament (1997)4 suggested that different religious coping styles are the result of differing relationships between the person and their God. These differing relationships to God range from understandings that place responsibility to alleviate distress with God, to understandings that emphasise the individual’s responsibility to facilitate change. This research suggests that it can be just as important to ask about religious relationships as it is to consider the impact that all the other significant relationships have in the lives of clients.
Promoting open discussion:It is surprising given the importance and complexity of working with psychosis and religious beliefs that guidance is often absent from both professional training and guidelines. This seems to be due to religious beliefs being seen as outside of the medical and scientific understanding of mental health. In contrast, service users and carers often highlight the importance of their religious beliefs in dealing with distress5. Lack of professional guidance has encouraged health professionals to rely on their own experiences of religion to inform their approach. This has limitations, for example staff tend to have less empathy and see clients as being more “unwell” if they believe the client to be associated with a religious group6. Therefore, it seems important that we remain aware of and reflect on our beliefs, so that they do not negatively affect the care we provide. In order to facilitate this awareness, it would be helpful for mental health professionals to be able to have space and time to safely discuss these personal beliefs with each other.
Remembering the context:We frequently see clients within medical settings and therefore outside of their cultural and spiritual environment. This should not mean that we ignore the continued influence of beliefs and religious community membership. In addition, within different cultural and religious communities, religious understandings of distress often cause less concern when compared with mental health settings4. Therefore it is important to try and evoke some of this context within the therapy room or hospital. As mentioned before, there are often few guidelines about how to achieve this, but it seems that an open curiosity and a willingness to ask questions about cultural environment and history can help us to make some links between distress, psychosis and religious beliefs. This can be particularly important for clients who talk about their psychosis as having a spiritual cause, particularly if this understanding clashes with, or is pathologised by a more powerful mental health system. This is often most noticeable in conversations about clients whose religious beliefs are contributing to decisions regarding medication compliance.
Encouraging hope:One of the most common factors within religious coping is the provision of hope7; we also know that hope is an important factor in recovery8. Asking clients about how their beliefs influence their understanding of distress can help us preserve hope in clients and families. Through encouraging every day conversations about religious coping we can start to tap into additional sources of support and understanding and help clients make sense of their lives within a culturally sensitive and supportive framework.
- Mental Health Foundation. (2007). Keeping the faith: Spirituality and recovery from mental health problems. London: Mental Health Foundation.
- Corrigan, P., McCorkle, B., Schell, B. & Kidder, K. (2003). Religion and spirituality in the lives of people with serious mental illness. Community Mental Health Journal, 39, 487.
- McIntosh, D. N., Silver, R. C. & Wortman, C.B. (1993). Religion’s role in adjustment to a negative life event: Coping with the loss of a child. Journal of Personality and Social Psychology, 65, 812 – 821.
- Pargament, K. (1997). The psychology of religion and coping: Theory research and practice. London: The Guildford Press.
- Koenig, H. G. & Larson, D. B. (2001). Religion and mental health: Evidence for an association. International Review of Psychiatry, 13, 67 – 78.
- Gartner, J., Harmatz, M. & Hohmann, A. (1990). The effect of client and counsellor values on clinical judgement. Counselling and Values, 35, 58 – 62.
- Rammohan, A., Rao, K. & Subbakrishna, D. K. (2002). Religious coping and psychological wellbeing in carers of relatives with schizophrenia. Acta Psychiatrica Scandinavica, 105, 356 – 362.
- Repper, J. & Perkins, R. (2003). Social inclusion and recovery: A model for mental health practice. London: Bailliere Tindall.
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