Psychiatry and religion circa 1978: Analysis of a decade,part I

Prior tensions between science and religion have dissolved and coalesced into new alliances based on ideology and philosophy. This general cultural pattern is reflected in the realignment of interests and interactions between psychiatry and religion. There are increasing numbers of mental health professionals with devout religious commitments and involvement in religiously oriented mental health activities; while clergy have developed new organizational structures to reflect many diverse mental health interests, including pastoral counseling, community mental health chaplains, hospital chaplains, and expanded parish ministries. Clinical and research literature has continued to rapidly proliferate, while a unique genre of pastoral care and counseling literature has emerged. A decade ago there was hope for an amicable alliance between specialists in psychiatry and in religion. That irenic quest has shifted into overlapping goals and roles, with tensions between those engaged in universalistic norms and those seeking to develop particularistic norms.Dr. Pattison is Professor of Psychiatry and Human Behavior, Social Science, Social Ecology; Acting Chairman, Department of Psychiatry and Human Behavior, University of California, Irvine; Deputy Director, Training, Consultation, Education Division, Orange County Department of Mental Health. His address is UCI Medical Center, 101 So. The City Dr., Orange, Ca. 92668. Part II of this article will be published inPastoral Psychology, Volume 27, No. 2.     

The Theological Contributions of Bishop K. H. Ting to Christian/Pastoral Counseling

As China enters an era of urbanization and change, mental health issues are increasingly becoming a concern of the Christian church. Pastoral counseling is taking new shape as people of faith respond to those in their midst in need of care. Bishop K. H. Ting, a long-time leader of the Chinese church, has stressed the importance of an indigenous Chinese Christianity. This article is based on an examination of Bishop Ting’s theological writing with the aim of eliciting themes that might be foundational in the construction of inherently Chinese models of pastoral counseling. Based on a survey of his work, six themes emerge with particular importance for pastoral counseling: the Three-Self church, God is Love, the Cosmic Christ, ethical responsibility, theological reconstruction, and religion in society. These themes are explored within their uniquely Chinese context and suggestions for application to the practice of pastoral counseling are discussed. Original publication: Wang, P. (Ed.) (2006). Seeking Truth in Love. Nanjing, China: Nanjing Seminary Press. This essay was originally published in a collection of essays honoring Bishop K. H. Ting on his 90th birthday. Bishop Ting has been the head of the Chinese Protestant church for over five decades and his leadership has profoundly shaped Chinese theology and church life. The purpose of this essay is to explore how his collected theological writings might inform a uniquely Chinese approach to pastoral counseling. This article is published with the permission of the original publisher.     

Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.     

The expanding role of the minister as community health services develop

Conclusion In summary, we have suggested in this brief discussion that (1) clinical pastoral training has established itself firmly in our culture and will be an important resource in the function of community mental health centers; (2) there will also be need for many clinically trained pastoral ministers who will serve importantly in the prevention of mental illness and promotion of mental health; (3) that standards of training in the clinical pastoral field are very much needed and should be nationally unified and coordinated; and (4) that the Association of Mental Hospital Chaplains might well exercise the leadership in developing a national resurgence of interest in a dynamic religion which will better meet the needs of our people as we move forward in this complex scientific age. For myself, I have no doubt that religion can provide many of the positive elements of good mental health, and I believe that this concept will grow to full maturity in the years ahead.Delivered at Annual Anton T. Boisen Banquet, Association of Mental Hospital Chaplains, Los Angeles, California May 6, 1964.     

From Mystical Moment to Therapeutic Method: Connections Between Psychology of Religion and Pastoral Counseling

Argues for a connection between psychology of religion, represented by William James, and pastoral counseling, especially as informed by the therapeutic methods of the brief therapy centers in Palo Alto and Milwaukee. Ludwig Wittgenstein, the philosopher, is seen as the key bridge figure between the two. Inspired by the film Six Degrees of Separation, the proposal is made for connective links between the philosophical and experimental interests of Benjamin Blood and William James in the mystical experience, Ludwig Wittgenstein's philosophical method in the Tractatus, and the therapeutic methods of Paul Watzlawick and Steve de Shazer. This transmission process is considered similar to that which occurs in religion itself, as transcendent experiences are routinized through liturgical and sacramental practices. The essay is viewed as an exercise in pastoral theological method.     

Pastoral theory and practice in the team approach to treatment of scrupulosity as a component of obsessive compulsive disorder

The statistical estimates of the prevalence of Obsessive Compulsive Disorder (OCD) in the general population have increased dramatically in recent years. "Blasphemous" obsessions and religious compulsions dominate the clinical picture of many sufferers of OCD. Freud proposed that religion might be a contributing factor for many patients with mental illness. He hedged, however, that observation--something that many of his followers have not done. Others have noted the pathoplasticity of strict religious upbringing and images of God as vindictive or otherwise harsh. Only recently--since the 1970s--has much clinical attention been focused on this disorder by the other disciplines within the mental health community. The church, however, is ahead of the curve in diagnosis and treatment of scrupulosity. It has long been a concern for pastoral counselors--particularly pre-Vatican II Roman Catholic priests. Pathological religion influences OCD and pastoral counseling, the author proposes, can contributes to recovery.     

Referrals to chaplains: The role of religion and spirituality in healthcare settings

Given the increasing importance of understanding how healthcare workers interact with the principal person designated to meet patients’ spiritual needs— the chaplain— the current study provides an inter-disciplinary perspective of the role of chaplains (and spirituality) in patients’ emotional, physical, and spiritual health. The study surveyed a randomly selected national sample of hospital directors in four disciplines: medicine (n?=?278), nursing (n?=?230), social services (n?=?229), and pastoral care (n?=?470). Participants rated the importance of referring patients to chaplains for four different areas: pain/depression, anxiety/anger, treatment issues, and loss/death/meaning. Results revealed significant differences in referral patterns for type of hospital, professional discipline, the hospital's religious affiliation, and self-reported spirituality. Results are discussed in relation to historical views of spirituality and religion within the different disciplines.     

Connection to Early Church Theologians: Canadian Ethnographic Study on the Similarities and Differences between Prayer and Theological Reflection in Pastoral Care and Counseling

What are the similarities and differences between prayer and theological reflection in the praxis of pastoral care and counseling? This qualitative study is ethnographic in design. A review of the literature is summarized. Researchers interviewed 75 participants in four cultures: (1) chaplains and (2) pastoral counselors in the Canadian Association of Pastoral Practice and Education (CAPPE), (3) community clergy and persons in lay ministry, and (4) students after internship in a theological reflection course. Interviews were audiotaped, transcribed and then coded for themes. Findings include seeing more similarities than differences between prayer and theological reflection. One of the differences is that prayer is more affective and theological reflection is more cognitive. There are also some areas of ambiguity. Discussion includes what ought to be normative or the orthopraxis for prayer and theological reflection in pastoral care and counseling. Limitations and areas for future research are outlined.     

Pain Control and Chaplaincy in Aotearoa New Zealand

This paper summarizes the results of 100 New Zealand health care chaplains with regard to their involvement in issues concerning pain control within the New Zealand health care context. Both quantitative (via survey) and qualitative methods (in-depth interviewing) were utilized. The findings of this study indicated that approximately 52 % of surveyed hospital chaplains had provided some form of pastoral intervention directly to patients and/or their families dealing with issues concerning pain and that approximately 30 % of hospital chaplains had assisted clinical staff with issues concerning pain. NZ chaplaincy personnel involved in pain-related issues utilized a number of pastoral interventions to assist patients, their families and clinical staff. Differences of involvement between professionally stipended hospital chaplains and their volunteer chaplaincy assistants are noted, as are the perspectives of interviewed chaplains about their pastoral interventions with issues relating to pain. Some implications of this study with respect to chaplaincy utility, training and collaboration with clinical staff are noted, as are comparisons with international findings.     

Abortion and Health Care Chaplaincy in Australia

This paper summarizes the results gained from quantitative and qualitative research involving 327 Australian health care chaplains with regard to their involvement in abortion issues within the health care context. The findings indicate that approximately 20% of surveyed chaplains had provided some form of pastoral intervention to patients and/or their families dealing with issues of abortion and that approximately 10% of chaplains had assisted clinical staff with issues concerning abortion. There was found to be no-statistically significant difference with regard to the number of catholic chaplains compared with protestant chaplains or staff chaplains compared with volunteer chaplains involved in abortion issues. Analysis using the WHO Pastoral Intervention codings highlighted a variety of issues encountered by chaplains and the non-judgmental pastoral care used by chaplains when assisting those dealing with abortion. Some implications of this study with respect to patient and clinical staff support are suggested. Dr. Lindsay Carey, M.App.Sc., Ph.D.: National Research Fellow, Australian Health & Welfare Chaplains Association & Faculty Associate, Palliative Care, School of Public Health, La Trobe University, Melbourne, Australia. Dr. Christopher Newell, AM, Ph.D.: Associate Professor, School of Medicine, University of Tasmania, Hobart, Australia.     

Confidentiality and Mental Health/Chaplaincy Collaboration

Confidentiality can both facilitate and inhibit working relationships of chaplains and mental health professionals addressing the needs of service members and veterans in the United States. Researchers conducted this study to examine opportunities for improving integration of care within the Department of Defense (DoD) and Department of Veterans Affairs (VA). Interviews were conducted with 198 chaplains and 201 mental health professionals in 33 DoD and VA facilities. Using a blended qualitative research approach, researchers identified several themes from the interviews, including recognition that integration can improve services; chaplaincy confidentiality can facilitate help seeking behavior; and mental health and chaplain confidentiality can inhibit information sharing and active participation on interdisciplinary teams. Cross-disciplinary training on confidentiality requirements and developing policies for sharing information across disciplines is recommended to address barriers to integrated service delivery.     

Chaplains' Engagement with Suicidality among Their Service Users: Findings from the VA/DoD Integrated Mental Health Strategy

Chaplains play an important role in supporting the mental health of current and former military personnel; in this study, the engagement of Department of Veterans Affairs (VA), Army, Navy, and Air Force chaplains with suicidality among their service users were examined. An online survey was used to collect data from 440 VA and 1,723 Department of Defense (DoD) chaplains as part of the VA/DoD Integrated Mental Health Strategy. Differences were noted for demographics, work setting characteristics, encountering suicidality, and self‐perceived preparation for dealing with suicidality. Compared to DoD chaplains, VA chaplains encounter more at‐risk service users, yet feel less prepared for dealing with suicidality.     

Provision of spiritual and pastoral care facilities in a high-security hospital and their increased use by those of Muslim compared to Christian faith

The relationship between religion and psychiatry remains controversial amongst British psychiatrists. We looked at the provision of spiritual and pastoral care facilities in a high-security hospital and the role of faith chaplains with particular reference to the Muslim minority group. There was a significantly higher uptake of pastoral care services amongst those of Muslim faith compared to Church of England and Roman Catholic Christians. Possible reasons for this are discussed. Resources allocated for the Muslim faith group were limited and heavily dependent on the availability of the Muslim faith chaplain. Our study highlighted the need for clearly defined standards for the provision of spiritual and pastoral care within high-secure psychiatric hospitals, and by implication other NHS psychiatric settings, a re-examination of the role of the faith chaplain in relation to the clinical team, and raised questions about the equitable allocation of resources between various faith groups within the hospital.     

Spiritual advisors and old age psychiatry in the United Kingdom

This survey investigates the role and views of NHS spiritual advisors across the United Kingdom on the provision of pastoral care for elderly people with mental health needs. The College of Health Care Chaplains provided a database, and questionnaires were sent to 405 registered NHS chaplains/spiritual advisors. The response rate was 59%. Quantitative and qualitative analyses were carried out. Spiritual advisors describe their working patterns and understanding of their roles within the modern NHS, and their observations of the level of NHS staff awareness of the importance of spiritual issues in the mental health care of older adults. They provide insights into possible negative and positive perceptions of their roles at a service level, and contribute suggestions of topics relevant to shared education between pastoral care and clinical services. This survey further highlights ethical and operational dimensions at the point of integration of the work of spiritual advisors and multidisciplinary teams.     

The church and its pastor: Community agents

Summary The clergymen can contribute to community mental health,first of all, by enabling the church to fulfill its mission;second, by carrying out pastoral duties sensitively and competently;third, by developing and using counseling skills at various levels;fourth, by supporting and using community mental health and other human services; andfifth, by giving leadership in making the community a place which is consistent with the teachings of his faith.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Spirituality and Religion: Implications for Counselors

In recent years, the topics of spirituality and religion have become more evident in the counseling literature. It seems logical that these areas could be of great interest to those in the counseling profession. This article summarizes W. R. Miller and C. E. Thoresen's (2003) overview of the field of research dealing with spirituality, religion, and health. Possible roles for spirituality and religion in counselor education and school counseling are highlighted.     

Negotiating Religious Differences: The Strategies of Interfaith Chaplains in Healthcare

Chaplains in healthcare increasingly work in interfaith roles with patients and families from a range of religious and spiritual backgrounds. Some move with ease between their own religious backgrounds and those of the individuals with whom they work. Others encounter tensions as their status as a person of faith comes into conflict with their status as an interfaith chaplain. We explore the two main strategies—neutralizing and code‐switching—chaplains at one large academic medical center use when working with patients and families whose religious and spiritual backgrounds are different from their own. Through training in clinical pastoral education and experiences on the job, chaplains learn to neutralize (use a broad language of spirituality that emphasizes commonalities rather than differences) and to code‐switch (use the languages, rituals, and practices of the people with whom they work). To the extent that the strategies evident here are present among chaplains in a broader range of institutional settings, they suggest a kind of spiritual secularism or broad approach to meaning makings that may be facilitated by interfaith chaplains in a range of settings.     

The church's response to the severely emotionally distressed

The clergy and church are deeply involved in aiding persons who have emotional problems. Many of those seeking help manifest psychotic symptoms. This paper addresses the issue of how organized religion can better understand and minister to the needs of those suffering severe emotional distress. Programs and models at national and local levels are discussed, with an emphasis upon the latter. Local level models include mental health promoting aspects of local church functions, pastoral counseling programs of the local church, the Wholistic Health Center (WHC), Community Organization for Personal Enrichment (COPE), Christian Action Ministry (CAM), and Mennonite Mental Health Services. Clinical vignettes illustrate the functioning of these models.This work was, in part, done at and supported by the Harvard University School of Public Health, Boston, Massachusetts.     

Therapists' judgments of mentally healthy beliefs for women and men

Clinical and counseling literature indicates that practicing psychologists often observe different mental health standards for women and men. Most of this research has examined mental health in terms of personality attributes, and as such there is a noticeable lack of research concerned with mentally healthybeliefs. The present research was concerned with the investigation of a possible gender bias in therapists' mental health standards, defined in terms of personal beliefs. For this purpose, the Irrational Beliefs Test (IBT; Jones, 1969) was completed three different times by a group of licensed psychologists in private practice, measuring their beliefs of how (1) a mentally healthy sex-unspecified adult, (2) a mentally healthy male adult, and (3) a mentally healthy female adult would respond to the IBT. The results indicated that both women and men therapists associated unique beliefs with women's and men's mental health.The late Dr. Frank B. Lambert studied the philosophical foundations of psychotherapy theory and was concerned about value issues in the practice of psychotherapy. He was pursuing his Ph.D. in counseling psychology at the time of his untimely death.Portions of these data were presented at the 1985 annual meeting of the American Psychological Association, Los Angeles, California. Graditude is extended to Lucia Gilbert and Mark R. Leary for their helpful comments on an earlier version of this article.