Religion and psychology: Why mental health professionals must not ignore religiosity for effective practice

Introduction

Therapy is simply defined as a treatment that helps restore a state of well-being and improves functioning of an individual. Traditional approach to healing involves employing non-empirical and or anecdotal means which are based on customs and rites passed down to our generation from our ancestors. The healing technique could be derived from religion, culture, ethnicity etc. Spiritual intervention is a form of traditional therapy in that it is based on the belief that illnesses and/or mental disorders result from losing connection with the Supreme Being: Divine Force which is a Source of Creation otherwise known as God. It is impossible or difficult to describe the identity of a person without considering the cultural values especially the religious belief of such person. Human beings form their behaviors and lifestyle based on values and beliefs that are shared among a group of people. Therefore, religion influences clients’ motivations, attitudes and perceptions about whatever therapeutic intervention being received. The implication of this is that clients or patients who seek for therapy wants to feel connected to the therapy in many if not all dimensions of life especially in a dimension such as spirituality.

It is not strange that despite the modern health interventions and awareness of using such services, there are still a large number of people who patronize spiritual healers. This is common in some places such as many countries in Africa, India, etc. Spiritual and religious will be used interchangeably in this article. Although, spirituality is not necessarily tied to any particular religious belief or tradition. It is exclusive. Spirituality simply refers to the quality that involves deep feelings and connections to a Divine Force or Supreme Being through our mindfulness, meditation and calmness. Religion refers to particular system of faith and worship of a Supreme Being by seeking to please him. Religion could guide a person to experience spirituality.

There are different kinds of religious groups with different special rites, however this article identifies those basic dynamics that are peculiar to their spiritual practices and how these dynamic have been justified scientifically to really being about positive  behavioral change and overall wellbeing within a person and the society at large. Like I mentioned earlier on, this is not favouring science over spirituality nor favouring spirituality over science. It’s only an insightful analysis with back up references to expand our knowledge which will benefit both religious and psychological services in promoting wellbeing of the people.

Spiritual or religious healers basically are labelled as pastors, Alfas, herbalists, etc. They consult divine or supernatural being on behalf of the people they prescribe or give naturally made concoctions. They organize specific activity to help the people connect to the Supreme being, atone for sins etc. Fasting, sacrifices, dancing, praying are the special activities engaged in by the believers including the religious head or leader For every religious group, there is a leader who is considered by the followers or believers to be more righteous and closer to the Supreme Being.

Psychological approach and religiosity

The need to respect and understand religious diversity was also emphasized by the American Counseling Association’s code of ethics in 1995. This concept remains an important aspect in the association’s most recent ethical guidelines (ACA, 2005).

Psychologists and counselors have a responsibility to understand, respect, and competently address religious diversity. This concept is emphasized in the ethics of mental health professionals such as psychologists, counselors, and social workers. Such inclusion of religion as an aspect of diversity that mental health professionals need to respect and be competent in can be considered a major development in the field. The relevance of this was especially emphasised in the American Psychological  (Association’s ethical guidelines in 1992.)

Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin,  religion,  sexual orientation, disability, language, and socioeconomic status, and they consider these factors when working with members of such groups, where scientific  or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin,  religion,  sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals. (Thor, 2010).

Understanding that our life is determined by our thoughts, perceptions and beliefs is fundamental to psychological treatment. In fact, human beliefs play significant role in our actions, lifestyle, choices, preferences etc. It is therefore important to identify and restructure dysfunctional beliefs and replace with more constructive ones. Integrating both psychological therapy and spiritual intervention can help to achieve this. Many individuals tend to deeply respect and adore their religious leaders. This may be exploited to amplify psychological services. These deeds are not easily achieved until there is deep value orientation by encouraging reflections, mindfulness and social interests through training, enlightenment, modelling etc.

According to individual psychology by Alfred Adler, human wellbeing involves sense of significance, setting and achieving goals, striving for superiority, personal accountability, social interests and experiencing quality relationships. Religious principles tend to offer opportunities to experience all of these through their practices and ethics. This explains that religion should be considered as a system that guides individuals toward self-realization, self-development and thus facilitate community development. A lot of people have attached different meaning to religion, a reason religion has become an excuse to demonstrate our infirmities and weaknesses such as discrimination, aggression, fallacies etc. Religion in its real sense is a vital institution that elevates societies through empowering the people with knowledge and skills to live peacefully, happily, purposefully, meaningfully, morally, selflessly, and intentionally. Some basic concepts identified in this theory are Soft Determinism: Personal accountability and our perceived control over our life; Teleology: Our determination to achieve particular goals fuel our passion and serve as motivational forces, attaining salvation, escaping damnation; Striving for Superiority: We seek to attain superiority similar to our need to survive and progress; Social Interest: Life tasks that help us achieve unity of purpose, mutual helpfulness and communal life promotes wellbeing. All of these will be related to each identified religious practice.

Some concepts such as devil, salvation, sin, angels all have empirical implications Devil can simply indicate those reflexive processes that make us act in ways we later regret or that are not healthy to personal or social well-being. Devilish acts will then be those actions triggered by the reflexive reactions. Salvation simply means restoring one’s mental well-being by being more mindful, staying conscious and responding in ways that reflect personal integrity and that respect others’ differences that is, we do nothing to intentionally cause pains to others. Sin can mean those past actions that go against our resolution, our sense of morality or social norms. Sometimes religious people suffer more psychological pains because they are fixated on the beliefs that they do not consider the reality or the presence to guide their responses or behaviours. These people feel restrained and inhibited because they continue to adopt unhealthy defense mechanisms to deal with their desires or behaviors they consider socially, culturally or religiously inappropriate. Meanwhile, needs differe across people and across time. Here is a reason it is vital to ensure one is well informed and practise mindfulness exercise to stay conscious and engage in acts that respect humanity and reflect constructive values.  Once the act is aimed at solving a particular problem or it is to meet a need (such act  does not at the same time aim at causing harm to anyone, then you are still morally conscious and the conscience should be satisfied). Angels simply refer to entities that come to a person’s aid during a specific circumstance. Looking critically at this, a lot of people, things, animals etc serve this purpose in our life, coming to our rescue at appropriate time. E.g, a cab driver suddenly arrives when you have been standing under sum for a while, getting a phone call that announces you have been offered that job you are about to lose hope on etc.

Good deeds emphasized in religions simply refer to healthy habits that enable us to realize our visions, achieve our goals, relate properly with others and engage in productive activities that serve humanity in some way that adds value to the society. Such deeds include patience, perseverance, kindness, selfless acts, respect, modesty etc are all to facilitate the fulfilment of our potentials.

DSM and Spirituality

When the DSM-IV was published in 1994, it included a new V-code designed to specifically address religious and spiritual problems. The introduction of this new code represented a major shift in the field, signifying the importance of recognizing and developing competence in issues of faith, religion, and spirituality. The justification for including this category in the new diagnostic manual was that the frequency of religious and spiritual problems was much higher than once thought. There was also a need to train psychologists in the areas of religion and spirituality, and there were concerns about how to address the ethics of cultural sensitivity related to religion and spirituality (Lukoff, 1998).

The proposal for the Psycho-religious or Psychospiritual Problem code was formally submitted to the Task Force on DSM-IV in 1991 (Lukoff, Lu, & Turner, 1992). It stressed the need to improve the cultural sensitivity of the DSM-IV and argued that the adoption of the new category would increase the accuracy of diagnostic assessments when spiritual and religious issues are implicated. Second, it would reduce the occurrence of iatrogenic harm from misdiagnosis of religious and spiritual concerns. Third, it would improve treatment of such problems by stimulating research. And finally, it would improve treatment of religious and spiritual problems by encouraging training in this area. In fact, this might also identify areas where collaboration may be necessary between spiritual healers and mental health professionals.

It is important to reiterate that conducting analysis of spiritual practices and their constructive influence on well-being will add value to both spirituality and scientific interventions for psychological and or behavioral problems. Also, spiritual based healing center may as well receive formal training and support to amplify their service and effects on sound wellbeing of the people.

Spirituality has received much interest in health care services; (heart and blood vessels), hormonal,  and  nervous  systems.  For this reason,  it  may  be  implicated  in a  wide  range  of  physical  and  mental  health  conditions. Recent definition of health by WHO is…health is  a state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity ( Francesco, 2016)

Reported cases of psychosocial problems

Here are the common psychosocial problems that are often reported to religious leaders or therapists. Sometimes people do no directly report the issues to their spiritual leaders but they speak of it amongst their friends or co-believers in church. Sometimes they pray so loud about it. Information about this was randomly gathered through observations and survey of some individuals that visit places of worship. We look at these issues/cases that people seek spiritual intervention for and examine the psychological elements that could be responsible for such issue experienced by the people.

• Marital problems: A large number of people will often pray out so loud about their partners. Some people will go to spiritual leaders for consultation on which partner is right for them. This could be through some forms of prayer, meditation, astrology etc. Some people would boldly speak about their marriage problems during fellowships or in the spiritual clinic within churches to have some counselling sessions. Marital problem are universal, a high percentage of the global population suffers from this in some way. Some people complain about impotency of their partners, addictions, misunderstanding with in-law, lack of job, adultery, unruly partner, aggressive partner, peer pressure, depressed partner, violence, emotional abuse, physical abuse, extravagant partner, cold partner, over ambitious partner, lack of trust, outrageous partner, negligence (of the partner or children), narcissistic partner, possessive partner, frustration, anxiety, moody partner, illiteracy,   One or more of these components are present when a person is reporting marital problem. Usually, people may not be totally specific or explicit about describing the marital problems in terms of the highlighted components. Many of the people will for example simply say, “I don’t understand my husband/wife, he/she gets angry easily. I am tired of my marriage, I no longer feel connected to my partner,” The components are psychological concepts which have been researched on to truly affect psychological and social functioning.

The causal-factors have been established and some effective interventions have been developed to deal with them. Some of these components are only indicators of some other bigger issues such as personal disorder, childhood experiences, frustration, mood disorders, depression, work stress, learning disorder, neurological impairments, or other psychological distress that both parties do not understand. For these problems, psychologists would often recommend family therapy, interpersonal therapy, client centered therapy, Cognitive Behavioral Therapy, Chemotherapy (in case of addictions or other associated neural dysfunctions) or maybe stress inoculation therapy. It is key to mention that many people sometimes believe that their problems are as a result of some supernatural forces , they therefore express external locus of control, believing they are not in control of their situation, only Supreme Being can intervene. It is important for therapists to be aware of every client’s belief system and motivations. In this case, clients might be psychoeducated and taught some skills whilst also including or acknowledging what they believe and find a way to integrate it to amplify their motivations, hope and cooperation. Such integration is expected to bring about wonderful results and promote wellbeing of the clients and affected individuals.

• Financial problems: Some people would pray about or report lack of sales, low income, interpersonal deficiency, unemployment, poverty, etc. This is quite common amongst large number of people who are tagged believers. There is prayer about increase in money, employment, possession of luxurious things etc. Financial problems are caused by so many factors such as personal convictions, hopelessness, depression, addictions, impulsivity, attitudes, corruption, lack of skills, ignorance, negligence, etc. All of these are psychological constructs that majorly influence our way of life and definitely consequences of those ways of life. When we observe people’s actions, we simply see actions of people, meanwhile these atomic actions form the life of the people, what they experience and how they continue to react to life situations. In fact, poverty has been reported to be consequence of mindset and habits. According to Gandhi, “change your habits, change your life. Your actions form your habits, your habits form your character, and your character form your destiny.”
• Behavioral Problems: Some people will seek spiritual help for people (such as children, relatives, friends, colleagues etc) who reflect stubbornness, apathy, irritability, deviance (healthy or unhealthy), excessive anger, truancy, running away from home, addiction, low energy, lack of concentration, coldness, poor academic performance, impulsivity etc. Some of these are indicators of depression, mood disorders, stress, frustration, unhealthy socialization, modelling, peer pressures, PTSD, etc.
• Social issues or problems: These include: Crimes, persistent conflicts, corruption, perceived disgust, elections, unemployment, leadership appointment, rivalry, job interview, barreness  isolation, discrimination etc. People seek for spiritual intervention over these issues they encounter or observe their loved ones encountering
• Medical Issues: Some of which include: infertility, migraines, cancer, blindness, lameness, deafness, schizophrenia, surgery, abdominal pains, stroke, numbness, itchy body, swollen body, pregnancy, childbirth, etc.
• Psychoreligious problems: These are experiences that a person finds troubling or distressing and which iinvolve the beliefs and practices of an organized religious institution. Such as loss or questioning of a firmly  held faith, change in denominational membership, conversion to a new faith, and intensification of adherence to religious practices and orthodoxy. Similar to this are psychospiritual problems, which are experiences that a person finds troubling or distressing and that involve that person’s relationship with a transcendent being or force. These problems are not necessarily related to the beliefs and practices of an organized religious institution. Examples include near-death experiences and mystical experience. This category can be used when the focus of treatment or diagnosis is a psychoreligious or psychospiritual problem that is not attributable to a mental disorder or specific severe behavioral problems  (Lukoff, Lu, & Turner, 1992, p 680)
• Other problems include: insomnia, suicidal attempts, loss of faith, rejection, etc.

Like I have tried to justify, many of these problems have specific psychological components showing how those problems are reflections of dysfunctional cognitions, emotional distress and inappropriate responses. Spiritual practices have their roles to play in inciting hope, motivation and insight which are key to healing. Psychological approach will facilitate this process by providing more rational explanations and how the affected persons will become proactive in resolving their own personal problems while experiencing self-renewal, competence, and improved state of wellbeing. That is, they become psychologically, emotionally, spiritually, financially and socially functional and healthy.

References

American Psychological Association (1992). Ethical principles of psychologists and code of conduct.  American Psychologist, 47, 1597–1611.

Francesco C., (2016). Spiritual well-being in the 21st century: It is time to review the current WHO’s health definition. Journal of Health and Social Sciences 8, 11-16

Lukoff, D. (1998). From spiritual emergency to spiritual problem: The transpersonal roots of the new DSM-IV category.  Journal of Humanistic Psychology, 38, 21–50.

Lukoff, D., Lu, R., & Turner, R. (1992). Toward a more culturally sensitive DSM-IV: Psychoreligious and Psychospiritual Problems.  Journal of Nervous and Mental Disease, 180, 11, 673–682.

Thor J., (2010) Religion and Spirituality in Psychotherapy An Individual Psychology Perspective. New York