Religious and Spiritual Matters

Do accept the client’s beliefs regarding the sources of distress: ancestral disapproval, the evil eye, God’s wrath, or trouble because of misbehavior in another life. A strong relationship of trust must be established before one can determine the adaptive and maladaptive aspects of such beliefs and thereby work within the frame toward healing or growth.

Don’t assume you are being told the whole story regarding faith or belief systems early on.

Most are powerful and quite private and will not be easily or fully shared.

Do take advantage of any possible link to meaningful spiritual or religious beliefs or connections that may help address the current distress.

Don’t hesitate to allow input into the problem from religious or spiritual persons respected by the client.CULTURE BOUND SYNDROMES Because theories of human functioning are culture bound, our current diagnostic system for mental health problems is heavily culturally in?uenced . In addition, the manifestation of mental angst and distress occurs through different culturally speci?c symptom complexes that change over time. For example, in contrast to Freud’s era , not many women in the United States currently have vapors or fainting spells; however, eating disorders were almost unheard of a hundred years ago. Posttraumatic stress symptoms re?ect at least some common human responses to trauma across cultures, but the name of the disorder has varied over many centuries. In addition, to some extent, what is actually considered traumatic is culturally speci?c, and what to do in the face of trauma constitutes culturally informed advice.

Their personal or family con?icts have become too great; and the answers, cures, or solutions within their religious framework have failed.

Because religion represents both culture and personal choice, differences between counselor and client, though not visible, can still be pronounced and unsettling . You might be directly asked about your religious beliefs in an initial interview. We recommend a balanced response:

• First, as a professional, it is your job to explore both the cause for concern and the

concerns themselves as they relate to the client’s problems and needs.

• Second, have a truthful and carefully considered answer ready. Refusing to share

a brief summary of your own religious or spiritual orientation only exacerbates the concerns in most situations. After your summary, return the topic to how it feels for the client to work with you. Do not debate matters of faith.

One of our colleagues, a psychologist who is also an ordained minister, often provides religious clients with the following commentary about the relationship between religious and psychological well being: I understand it can be hard for a person with strong religious beliefs to consult a professional about personal problems. One way I look at it is like this: I know some people who are doing very well psychologically and very poorly when it comes to their religious adjustment. On the other hand, I know some people who are doing ?ne with their religious life, but they have some psychological or emotional work to do. Although many times religious and psychological well being are highly connected, being well in one area doesn’t necessarily mean you are feeling well in the other. I guess what I’m saying is that, if you want, I think we can work on the emotional and psychological concerns here, without violating issues of faith.

Word Salad: a series of words that seem completely unrelated. Word salad represents probably the highest level of thinking disorganization. Clients who exhibit word salad are incoherent. what of client thinking. What clients talk about can give interviewers valuable information about mental status.

Clients can talk about an unlimited array of subjects during an interview. However, several speci?c content areas should be noted and explored in a mental status exam.

These include delusions, obsessions, suicidal or homicidal thoughts or plans, speci?c phobias, and preoccupation with any emotion, particularly guilt . Although it is important in most mental status exams to ask a routine question regarding suicidal thoughts or impulses, we delay our discussion of suicide assessment until Chapter 9. The remainder of this section focuses on evaluating for delusions and obsessions.

Delusions are de?ned as false beliefs. They are deeply held and represent a break from reality; they are not based on facts or real events. For a particular belief to be a delusion, it must be unexplained by the client’s cultural, religious, and educational background. Examiners may ?nd it useful to record client reports of delusions verbatim. Examiners should not directly dispute clients’ delusional beliefs. Instead, a question that explores a client’s belief, such as the following, may be useful: “How do you know this [the delusion] is the case?” .

Clients may refer to many different types of delusions. Delusions of grandeur are false beliefs pertaining to a person’s own ability or status. Most frequently, clients with delusions of grandeur believe they have extraordinary mental powers, physical strength, wealth, or sexual potency. They are usually unaffected by discrepancies between their beliefs and objective reality. In some cases, grandiose clients begin to believe they are a speci?c historical or contemporary ?gure .