When Issues Become Emergencies: Assessment and Treatment of Spiritual Problems - PowerPoint PPT Presentation


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When Issues Become Emergencies: Assessment and Treatment of Spiritual Problems


When Issues Become Emergencies: Assessment and Treatment of Spiritual Problems Nadine Duckworth University of Lethbridge * Stanislav and Christina Grof (1989 ... – PowerPoint PPT presentation

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Title: When Issues Become Emergencies: Assessment and Treatment of Spiritual Problems

When Issues Become EmergenciesAssessment and
Treatment of Spiritual Problems
  • Nadine Duckworth
  • University of Lethbridge

  • Spiritual practices have beneficial effects on
  • For healing of illnesses
  • Psychological growth
  • Self-actualization
  • Spiritual problems
  • Can emerge spontaneously or during intense
    spiritual practice
  • Can resemble a variety of mental disorders
  • Can lead to disruption in social and
    psychological functioning

  • Misdiagnosis can result in inappropriate
    treatment and intensification of distressful
  • If properly diagnosed and treated, can result in
    personal growth and healing
  • Spiritual practices are gaining popularity
  • 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
  • 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 ones 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

Spiritual Emergencies
  • Anomalous experiences
  • deviate from the usually accepted explanations of
  • 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

  • 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)

  • 3. Clinical Interview
  • Listening to clients 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

  • 6. Religious and Spiritual Assessment
  • gain an understanding of the clients worldview
  • determine whether the clients religious-spiritual
    orientation is healthy or unhealthy, and what
    impact it has on the presenting problem
  • determine whether the clients 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 clients
  • 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.com/dsm4/lesson5_1.

Spiritually-Sensitive Approach
  • Promote a positive context for clients
  • 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 clients social support network if

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
  • Use the therapy session to help ground/center the
  • here and now
  • Create a therapeutic container
  • therapist presence is key - warmth, compassion,
  • Normalize and educate
  • Help patient to reduce environmental and
    interpersonal stimulation
  • Have patient temporarily discontinue spiritual
  • Suggest the patient eat a diet of "heavy" foods
    and avoid vegan diet and fasting
  • Evaluate for medication - refer to psychiatrist

Interventions for Spiritual Emergencies
  • After the immediate crisis has subsided
  • Encourage the patient to become involved in
    calming activities
  • 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

  • Along with these immediate responses, a more
    generalized psychotherapeutic intervention should
    be used to help the client integrate the
  • This involves a narrative approach, including 3
  • telling the story of the experience
  • tracing its symbolic/spiritual heritage
  • 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
  • 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 clients support system
  • participating in religious services or spiritual
  • 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)

Mystical Experience http//www.youtube.com/watch?v
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