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Spiritually Integrated Treatment of Depression: A Conceptual Framework
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Spiritually Integrated Treatment of Depression: A Conceptual Framework
Amazon Inspire Digital Educational Resources. Hospital chaplains often refer to the challenge of helping adults who are facing a crisis to call upon a conception of God that goes beyond what they took from Sunday School and is more consonant with their state of emotional maturity. James Fowler in his controversial book Stages of Faith [ 33 ] pioneered consideration of the ways that faith development, like moral development, is a developmental process.
The world views of religious and nonreligious individuals tend to differ most sharply on the question of their relationship to an ultimate authority.
Is there an authority whom one can trust for care and direction, or does one need to rely on oneself? Clinicians can help patients to look at what kind of intimacy with God and others is possible. Is there a community that is more welcoming of the patient than he can see? Interpersonal therapeutic approaches and attention to the ways that spiritual communities address the dynamics of relationships with others and the Other are particularly apt here. Whereas insight-oriented and cognitive behavioral approaches can help depressed individuals to distinguish distressing emotions from their actual basis in life experience, spiritually oriented interventions can help them use their knowledge and experience of their spirituality in its ultimate sense, where God or morality are involved to put these experiences into a larger perspective.
Its symptoms are familiar: It also fits popular descriptions of depression by sufferers such as Solomon The Noonday Demon: A Memoir of Madness [ 3 ] , whose individual illnesses seemed to take on a life of their own, eventually depriving them of rational perspective and a sense of control. However, a number of investigators have questioned whether this model may be overly simplistic. Viewed from a stress diathesis perspective, it seems clear that several conditions confer a vulnerability to a depressed mood and that they differ in their etiologies as well as in their therapeutic implications.
Obviously, the core concerns e. Table 2 suggests ways that specific spiritually informed interventions can address the existential dimension of depressive concerns. For example, patients whose existential concerns center around identity, and who are therefore vulnerable to experiencing doubt or disorientation when depressed, may benefit from a humanistic emphasis on connecting with what most fulfills and best defines them. If religious, they may also benefit from grounding their identity in their relationship to God, for example, through a process of spiritual direction.
Patients with difficulty maintaining ultimate hope because their experience of the world is fragmented, and who are mistrustful when in despair, would be expected to benefit from achieving a more integrated spirituality through, for example, exploration of unresolved trauma, CBT that brings their core beliefs more in line with their experience, and interpersonal therapy or spiritual direction that focuses on their doubts about trusting God, or the future. Depressed patients who struggle to find a sense of meaning, or who feel their life has lost its purpose would be expected to benefit from meaning-centered therapy, mindfulness, and meditation.
Patients concerned with moral questions, such as those who feel overwhelmed by guilt when depressed, would be expected to benefit from forgiveness promoting therapy and the emphasis of positive psychology on virtues such as love. Patients whose existential concerns center on their relationship to ultimate authority, and who feel isolated or rejected when depressed, would be expected to benefit from feeling accepted and loved by God.
For example, the individual who feels loved by God, worshipful, and continually surrendered to his will may be less prone to worship lesser gods such as power or pleasure that will disappoint and leave him depressed. There are a number of venues in which integrated treatment can be provided, ranging from the office of a clinician in a secular office or hospital, to that of a religiously committed therapist in a faith-based clinic, to that of a pastoral counselor in a church. Each presents its own challenges and opportunities for collaboration, referral, and sharing of expertise [ 19 , see pages — ].
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Elsewhere, I have distinguished four possible roles of a psychotherapist in approaching spiritual problems such as a crisis of faith, paralyzing guilt, or religious objections to taking medication [ 40 ]. In the most familiar and straightforward of these, a therapist would acknowledge the problem, but limit discussion to its psychological or strictly medical dimension.
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A second possible approach would be to clarify the spiritual as well as the psychological aspects of the problem, suggest resources for dealing with the former, and consider working with an outside resource such as a religious community or other authority. This might include enlisting a hospital chaplain or clergy person to offer needed spiritual help or referring a patient to a therapist of a similar tradition. This might include exploring ways the patient can make better use of his resources and tradition e.
Here it is helpful for therapists to appreciate how different world views and spiritual traditions address existential concerns, such as identity. For example, in the Judeo-Christian tradition each individual is contingent as created , broken sinful and in need of healing forgiveness and transformation , and loved unconditionally; in the Buddhist tradition, each individual is at one with the universe, unhappy but capable of self-emptying and of enlightenment; in a secular Western view, each individual is limited by bias but evolving, ultimately alone but capable of living with integrity.
This fourth approach requires particularly careful attention to transference, countertransference, boundary, and consent issues. A number of factors are relevant in deciding which of these approaches to take. This in turn influences the nature, primary aims, and timing of the work—for example, psychological insight into a maladaptive pattern or resolution of a conflict. These in turn influence the degree of direct support needed and the amount of interpersonal closeness that is appropriate. Dual relationships, for example, being a treater as well as a fellow member of the same religious community, complicate the transference, countertransference, and boundary aspects of taking one or another approach.
The framework for integrated treatment suggested here raises a number of challenging questions: What is the relationship of the important biological and genetic components of serious depression to its spiritual dimension [ 41 ]?
Depression Research and Treatment
What are the pitfalls of either neglecting or overemphasizing spirituality? Partial answers are emerging from the literature on addressing spiritual issues generally in psychotherapy [ 42 ]. Fuller answers, still emerging from work with patients struggling with depressive concerns, are needed to elucidate more clearly the mechanism of action of spiritually oriented interventions and to establish best practices in providing integrated, whole person care.
The framework suggested here emphasizes the need for clinicians to consider a broad range of diagnostic categories and dynamic concerns arising in depressive conditions, to recognize the existential dimension of these concerns in areas such as identity and hope that are causing emotional distress, to identify corresponding goals for an appropriately helpful spirituality, and to select interventions accordingly, so as to provide individualized, comprehensive treatment. Depression Research and Treatment. Subscribe to Table of Contents Alerts. Table of Contents Alerts. The Spiritual Dimension of Depression Literature on caring for the whole person recognizes that human suffering includes not only cognitive, emotional, and volitional but also existential and spiritual dimensions.
The relationship of spiritually oriented interventions to depressive concerns. Smith, Where the Roots Reach for Water: Solomon, The Noonday Demon: Koenig, Faith and Mental Health:
Related Depression and the Soul: A Guide to Spiritually Integrated Treatment
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