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.

Some mental health professionals identify their religious affiliations or beliefs in their advertising, on their cards, or in their informed consent paperwork. Others develop specific specialties in areas dealing with religious concerns . Although a generic clinical interview includes religion as an aspect of the whole person, the interviewer must gently bring the dialogue back to problem areas and sources of distress. Also, treatment planning may certainly include consultation with religious leaders or authorities .

390 Interviewing Special PopulationsTHE IMPORTANCE OF CONTEXT Interviewing in a multicultural setting involves a delicate balance between awareness and understanding of broad cultural group characteristics and the individual internalization and expression of those characteristics. As unique cultural beings, people must interact with an environment that exhibits its own cultural qualities and requires certain qualities of individuals. For example, a Mexican American student quickly learns that mastery of the English language is required to be successful in public schools. This is a contextual requirement that requires adaptation for success. In the process of adapting, the student makes many decisions about other aspects of his or her cultural background that either ?t, don’t ?t, are useful or not useful, in this new context. The essential task of the interview becomes understanding the uniqueness of ethnocultural individuals within their various contexts. As Swartz Kulstad and Martin state, “. . . the ?eld is in need of a functional method to assess the interactive in?uences of all three levels-universal, group and individual-and to determine how these in?uences have an impact on the individual’s successful adaptation to his or her psychosocial environment” .

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.

-Henri J. M. Nouwen, The Living Reminder For a deeply religious person, seeking help from a secular mental health professional may feel like a contradiction of faith-or at least a very risky thing to do. Therefore, the interviewer needs to be particularly sensitive to behaviors suggesting a challenge to religious authority. Mental health issues and problems are obviously very connected to religious concerns. Finding a comfortable middle ground that denies neither perspective can be challenging. As Samuel M. Natale says in the article Psychotherapy and the Religiously Committed Patient: Multicultural and Diversity Issues 389There are few problems more demanding in psychotherapy than dealing with a client’s religious beliefs. This is so for a number of reasons, which include not only a lack of sensitivity and understanding on the part of the therapist but also a hesitation, avoidance, and even downright fear on the part of the therapist to explore distinctly religious values with a client.

In keeping with the trend to look at the whole picture when working with individuals, families, or couples, religion and/or spirituality can often be integrated into the counseling process . However, although this may be true with regard to more liberal thinking religious clients, fundamentalists and deeply committed people from most organized religions generally prefer not to seek secular help for their problems . Therefore, similar in some ways to working with Asian American families, the ?rst visit may be because of a family or personal crisis. Their entry into the professional mental health world generally is not a casual inquiry into the potential use of psychotherapy to expand and grow. More likely, it is an expression of desperation.

When was your last ?ght? Have you ever used a weapon in a ?ght? What is the worst you have ever hurt someone physically? 12. Medical and health Did you have any childhood diseases? history Any medical hospitalizations? Any surgeries? Do you have any current medical concerns or problems? Are you taking any prescription medications? When was your last physical examination? Do you have any problems with eating or sleeping or weight loss or gain? Have you ever been unconscious? Are there any major diseases that seem to run in your family ? Tell me about your usual diet.

What kinds of foods do you eat most often? Do you have any allergies to foods, medicines, or anything else? What are your exercise patterns? How often do you engage in aerobic exercise? 182 Structuring and Assessment Table 7.

Content Areas Questions

13. Psychiatric or Have you ever been in counseling before? counseling history If so, with whom and for what problems, and how long did the counseling last? Do you remember anything your previous counselor did that was particularly helpful ? Did counseling help with the problem? If not, what did help? Why did you end counseling? Have you ever been hospitalized for psychological reasons? What was the problem then? Have you ever taken medication for psychiatric problems? Has anyone in your family been hospitalized for psychological reasons? Has anyone in your family had signi?cant mental disturbances? Can you remember that person’s problem or diagnosis? 14. Alcohol and drug When did you have your ?rst drink of alcohol ? history About how much alcohol do you consume each day ? What is your “drink/drug of choice”? Have you ever had any medical, legal, familial, or work problems related to alcohol? Under what circumstances are you most likely to drink? What bene?ts do you believe you get from drinking? 15. Legal history Have you ever been arrested or ticketed for an illegal activity? Have you been issued any tickets for driving under the in?uence? Have you been given any tickets for speeding? How many or how often? Have you ever declared bankruptcy? 16. Recreational history What is your favorite recreational activity? What recreational activities do you hate or avoid? What sport, hobby, or leisure time pursuit are you best at? How often do you engage in your favorite activity? What prevents you from engaging in this activity more often? Whom do you do this activity with? Are there any recreational activities that you’d like to do, but you’ve never had the time or opportunity to try? 17. Developmental Do you know the circumstance surrounding your conception? history Was your mother’s pregnancy normal? What was your birth weight? Do you know whether you were nursed or bottle fed? When did you sit, stand, and walk? When did your menses begin? 18. Spiritual or religious What is your religious background? history What are your current religious or spiritual beliefs? Do you have a religious af?liation? Do you attend church, pray, meditate, or otherwise participate in religious activities? What other spiritual activities have you been involved in previously?orientation . Psychoanalytic and interpersonal psychotherapists base their therapy approaches on the assumption that individuals behave in highly consistent ways, depending on their personality or interpersonal style . In contrast, cognitive and behavioral psychotherapists are more likely to reject the concept of personality and claim that behavior is a function of the situation or a person’s cognitions about the situation .

Emotional difficulties appear to fall into the same category as racial and religious prejudice.

Judging from the politics of running for public office, the events of recent years suggest that society has done better in overcoming its racial and religious phobias than it has with psychology. We elected John Kennedy. But we have learned from the electoral process in recent years that any hint of a psychological history is still the kiss of death for someone running for high public office.

Cruel paradox, for the contemporary political scene suggests that many politicians would profit greatly from psychotherapy. Under the circumstances it is very unlikely that a politician would acknowledge having TMS.

Similarly, most athletes would reject the diagnosis since psychological syndromes are equated with weakness, and athletes have an image of strength and indomitability to preserve. I know of a few who have been referred to me but have never come.

Of course, the same prejudice is strong in medicine. Doctors prefer to treat physical disorders; they feel insecure when confronted with patients who have emotional symptoms. Their usual response is to prescribe a medication and hope that the patients will feel better. Even the field of psychiatry now has a large segment of practitioners who prefer to treat primarily with drugs.