Mental Health & Spirituality?
Kurt LaRose, MSW
While using spirituality in treating mental health disorders is controversial (some states have outlawed the practice, for example), at times its use may be relevant, supported, and indicated. 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 with faith-related matters.
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.
When a mental health provider completes a comprehensive assessment the goal is to find out what areas of psycho-social functioning are impaired (and/or to find areas of strength). Most providers will review all aspects of human functioning, including multi-faceted aspects of the human condition: family history, substance abuse, sexual behavior, lifetime experiences and memories, employment, interpersonal relationships, financial matters, as well as spirituality.
Spirituality and Recovery
Research in the medical model suggests that people who are dealing with various physical ailments and who also report having an active spiritual belief system generally recover differently from those without an active spiritual life (Tu). In some of the literature patient responses to various medical issues were measured in relationship to faith (Hackney, Sanders), whereas in other literature curative outcomes were measured in relationship to no faith or in the absence of a spiritual belief system (Hull, Daaleman, Thaker, Pathman). But what about mental and emotional issues?
Similar to the medical model, social scientists also have found that active spiritual beliefs and behavior affect stress, attitudes, and outlook (Koenig). Higher levels of active spiritual exercises have been correlated to better mood and reduced stress during difficult times (Koenig). Research related to spiritual influence on mental health, such as with various addictions for example (Sherman, Simonton, Latif, Spohn, Tricot), also provides a basis on which some providers treat patients using certain spiritual methods (for example, a 12-step model of recovery).
What the Consumer Should Consider
The phrase “active spiritual exercises” is defined in different ways, depending on what literature is reviewed. Prayer, meditation, reading scripture, helping others, and attending weekly services are some examples (Koenig). General behavior that is often considered a spiritual act such as meditation, slow breathing, and reading (Moss) is included in what helps to define “spiritual activity,” whereas other literature assesses and compares certain faith models (Christianity, Buddhism, and even Atheism).
It is noteworthy to say that there is evidence supporting treatment methods, which include spirituality and faith. The research literature relative to spirituality and mental health varies in scope and definition, but nearly 500 different studies support a positive association between spirituality and mental health (Oman, Hedberg, Thoresen). The consumer of mental health services may want to note that the literature 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 studies (Hull, Daaleman, Thaker, Pathman). What does the mental health consumer consider, if spirituality is a point of interest?
To begin, it is important to remember that there are some states who have outlawed using faith and spirituality in conjunction with mental health services (violations can lead to serious professional sanctions). Where legal prohibitions are not a factor, what some mental health providers might do if a client asks for a faith/spiritually designed treatment method is ask the client for informed consent. The written consent likely would include alternative treatment interventions that are clinically supported in the absence of faith, while identifying the controversial nature of a method that incorporates faith into clinical models of intervention; the "informed consnet" document might also include a statement granting formal permission for the provider 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 trust only those who profess some kind of a similar faith, some consumers will not care, and still others will trust only 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.
To be sure, the research on mental health treatment is controversial in general, not just 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 treatment approach 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, or 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 affect treatment outcomes. Alternatively, faith is not a prerequisite 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.
NOTE: This article addresses some portion of the literature that exists discussing matters of faith (both positive and negative) in relationship to mental health services. The information is based upon the relativity of spirituality in the mental health arena; it is not intended to address common debates that can 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; its use in mental health services, the argument goes, is therefore questionable. 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 to obtain clinical input that is based upon your particular situation.
References
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.
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.
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.
Koenig, H. G. (2004). Religion, spirituality and medicine: Research findings and implications for clinical practice. Southern Medical Journal, 97(12), 1194-1200.
Moss, D. (2002). The circle of the soul: The role of spirituality in health care. Applied Psychophysiology and Biofeedback, 27(4), 283-297.
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.
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.
Tu, M. (2006). Illness: An opportunity for spiritual growth. The Journal of Alternative and Complementary Medicine, 12(10), 1029-1033.
Kurt LaRose is a Clinical Social Worker and Therapist working in private practice in Florida assisting individuals and families in crisis. He also develops, implements, and maintains counseling programs and contracts with school districts to provide counseling services to youth ages four to eighteen. LaRose is an Adjunct Professor and Field Liaison Faculty member for the Division of Social Work at Thomas University.