Praying with a patient constitutes a breach of professional boundaries in psychiatric practice

Poole, Rob; Cook, Christopher C. H.

doi:10.1192/bjp.bp.111.096529

Cited by 40 publications

(32 citation statements)

References 12 publications

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“…49 Although some argue for proactively including service users' religious and spiritual perspectives and experiences in the initial assessment and therapy, 95 other caution against it. Crossley and Salter's 96 study of clinical psychologists' experience of addressing spiritual beliefs in therapy found that, although some practitioners reported a proactive approach, others waited for users to raise spiritual issues on the assumption that if these were significant users would mention them without prompting.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, belief in demon possession as an explanation for mental illness has been noted in many Christian, Muslim and other communities in the UK. 49 In the study by Leavey et al 50 on clergy contact with people with mental illness, both imams and Pentecostal pastors stated that they were often contacted by individuals or families who feared that ill health or misfortune had been provoked by a curse or witchcraft, or was the result of spirit possession. In such cases, prayer and religious rituals such as deliverance (exorcism) were considered to be the LITERATURE REVIEW appropriate response.…”

Section: Spiritual and Religious Beliefsmentioning

confidence: 99%

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Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 99%

Section: Spiritual and Religious Beliefsmentioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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“…(For a sample of the extensive writing on boundaries controversies across several professions, see Chu, 2011;Doel et al, 2010;Gabbard & Nadelson, 1995;Galton, 2006;Guthheil & Gabbard, 1998;Poole & Cook, 2011;Pope & Keith-Spiegle, 2008).…”

Section: The Central Principlementioning

confidence: 99%

Boundary Modifications in the Treatment of People with Dissociative Disorders: A Pilot Study

Sachs¹

2013

Journal of Trauma & Dissociation

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This article examines the prevalence and types of modifications to professional boundaries that occur in the treatment of people with dissociative disorders (DDs) and considers some of the implications of the findings. The study is based on the replies of 163 professionals to a 20-question survey. The survey compared the boundaries that each practitioner kept with patients/clients (P/Cs) who suffered DDs to their boundary practice with all of their other P/Cs (non-DDs). Boundaries were deemed modified when professionals treated their DDs P/Cs differently than their other P/Cs. Professionals' general boundaries were not examined. The results showed a marked tendency for the modification of professional boundaries when treating people with DDs. These results appeared to be independent of country or profession but were more pronounced among the more experienced professionals. Areas of greatest modifications were identified. The prevalence of these modifications points to their potential importance in understanding some features of DDs.

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“…Disclosure to the patient by the psychiatrist of their own religious beliefs in the context of treatment is seen by some as potentially harmful. [6] The search for meaning in life is a universal phenomenon selective to human beings. Over the last few decades, there has been an ever increasing body of evidence in the arenas of spirituality, mental health, and psychotherapy.…”

Section: Introductionmentioning

confidence: 99%

Spirituality and Religion in Modern Medicine

Singh¹,

Ajinkya²

2012

Indian Journal of Psychological Medicine

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Man has always yearned for a higher sense of belonging in life. Since ancient ages, human beings have tried to examine and evaluate the relationship between spirituality, religion and medicine. The interface of spirituality, quality of life and mental health is fascinating and sublime. Religion and spirituality play an essential role in the care giving of patients with terminal illnesses and chronic medical conditions. Patient's needs, desires and perspectives on religion and spirituality should be addressed in standard clinical care. Ongoing research in medical education and curriculum design points towards the inclusion of competence, communication and training in spirituality. There are structured and reliable instruments available for assessing the relationship between spirituality, religion and health in research settings. Intervention based scientific studies in the arena of spirituality and modern medicine are needed. Further research should be directed towards making modern medicine more holistic.

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Praying with a patient constitutes a breach of professional boundaries in psychiatric practice

Cited by 40 publications

References 12 publications

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Boundary Modifications in the Treatment of People with Dissociative Disorders: A Pilot Study

Spirituality and Religion in Modern Medicine

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