Including the Ultimate: A Spiritual Focus Treatment Program in an Inpatient Psychiatric Area of a Hospital in Partnership with a Pastoral Counseling Center

Abstract

Describes how an American Association of Pastoral Counselor (AAPC) accredited pastoral counseling center and a community medical center developed in inpatient psychiatric treatment program which integrated the spiritual/religious resources of patients. Outlines the process of collaboration, some basic principles of the integration of faith resources, the ways that staff resistance surfaced and substantially was overcome, and the positive responses of patients. Notes the decision to base treatment on the religious/spiritual position of patients (rather than of therapists), the role of the therapist in this model, and some relevant isomorphic replications.

Risks, Benefits, and Recommendations for Pastoral Care on Inpatient Psychiatric Units: A Systematic Review

“…With regard to patients with acute religious delusions, although some of the literature cautions against PaC providers interacting directly with patients with acute religious delusions, finding it ineffective 17 or excluding this population from studies, 34,35 other publications suggested potential benefits of having PaC providers involved with this population, such as providing context as to whether or not a belief is appropriate or delusional. 2,41 Although articles on spiritual healing did not deal with PaC providers and were therefore not included in our review, 1 article describing a study of elderly Egyptian patients with schizophrenia suggested that spiritual healing could be associated with an increased risk of relapse.…”

“…15,17,22,33 Second, the authors reported feeling most effective as PaC providers when they are integrated into the care team 13,26 and given definitive roles that are made clear to other team members. 13,18 Six nonevaluative reports described PaC integration models and detailed how a PaC provider functions when integrated into inpatient psychiatric care team and discussed the attitudes of 24 Rattray 29 Stephens 31 Jensen et al 35 patients and staff members toward the PaC provider in this role. These articles fall into 2 categories: (1) descriptions of specific spirituality groups/ worship services run by a PaC provider and (2) descriptions of patient and staff perceptions of the PaC provider.…”

“…36 Although no formal patient outcome data were included in these reports, the authors considered the groups beneficial, and 1 article reported that patients rated the spirituality group the highest of all groups attended. 35 Overall, the articles viewed spiritual groups as favorable and stressed the importance of discretion and positivity in running spiritual groups. The remaining 3 nonevaluative reports reviewed specific subtopics, such as specific religious traditions, geriatrics, and chaplains performing psychotherapy, related to PaC providers on inpatient psychiatric units.…”

“…The author also speculated that, if a worship service is construed as magic or a means of escape, it may foster maladaptive patterns of behavior. In another nonevaluative report, Meyer et al 37 suggested that, when a PaC provider is integrated into the care team, some patients may use religion "defensively," such as requesting a prayer to not have any further 49,52,58 This need has been identified even in nonreligious patients 48,51,52 Spirituality groups run by PaC providers, which often include sacred stories as a theme, have been reported to be beneficial, even by nonreligious patients 34,35,37,53,55,67 Qualitative studies PaC providers are trained to address patients' spiritual needs and provide comfort and counseling, 52 while addressing feelings of loss, abandonment, and guilt 14,[18][19][20]22,23,38,39,44 Nonevaluative reports (and opinions voiced in evaluative studies)…”

“…Many authors expressed the opinion that this may give the patient a more supportive community upon discharge 2,20,25,26,29,35,37,42,46 PaC providers may provide a useful perspective about a patient and help in determining whether a specific belief or practice is pathologic 22,24,29,31,40,41,42 Summary points Although PaC is almost unanimously reported to have positive outcomes in the literature, controlled outcomes studies are needed to verify this assumption There is no evidence base to suggest that the generalized fears of having PaC providers interact with psychiatric inpatients are valid electroconvulsive therapy. Some authors 39,45 have speculated that, if an inadequately trained PaC provider focuses on guilt and judgment, this could lead to a worsening of a patient's mood.…”