Psychotherapy and religion: Do they mix and blend?

By John Thoms
January 1, 1999



A Tibetan Buddhist monk, who is a practicing psychologist in Los Angeles, travels this month to New York City’s Beth Israel Hospital to train nurses in meditation and other Eastern spiritual techniques to help ease their patients’ mental pain of suffering and death.

The monk, Losang Rabgyay, Ph.D., said he has developed a 15-hour training program for Beth Israel nurses using similar Buddhist meditation practices to the ones he uses at the Neuropsychiatric Institute of the University of California at Los Angeles.

The experiment in finding some common ground between modern Western technology and ancient Buddhist practices is the brainchild of Fred Epstein, M.D., director of the Institute of Neurology and Neurosurgery at Beth Israel.

Epstein said he came up with the idea after the Dalai Lama visited his facility in May 1998. The head of the Tibetan Buddhists was looking for ways to incorporate meditation and other relaxation techniques into modern medicine.

Epstein’s idea to use Buddhist techniques is one of the bolder plans to emerge very recently in what is a trend in breaking down the wall that separates modern medicine and the spiritual well-being of patients in pain.
It may also have implications for psychology.

More and more, medical schools are offering courses in how prospective doctors can add spirituality to their usual treatment regimen. At Albert Einstein College of Medicine in New York City, members of the clergy teach a course on the religious issues in life-and-death matters, such as organ transplants.

Around 40 other medical schools are offering similar courses. Four years ago, only four of the nation’s 125 medical school offered such courses, according to the National Institute for Healthcare Research.

But, while medical schools have embraced the idea that spirituality can be integrated into medical practices, psychology graduate schools have not been so quick to adopt that philosophy. However, that situation appears to be changing slowly, whether in response to market pressure or a post-modern view that science has failed to answer many of the more vexing problems.

One psychologist suggests that lack of materials and graduate-level resources have kept the subject of spirituality and religion out of graduate school classrooms. Another thinks the trend toward integrating spirituality into therapy may have resulted from patient dissatisfaction with managed care.

As an example of growing interest in this field, the American Psychological Association (APA) has published three books in the last three years dealing with how religion and spirituality can be integrated into therapy.

A task force of Division 36 (Psychology of Religion) plans to issue a proposed handbook and model curriculum guide before the end of the year.

It appears many psychologists today are in agreement about the value of spirituality and religion in therapy, and predict that such course work in graduate schools may not be that far off.

It’s difficult to determine which graduate schools–if any other than the traditional Christian institutions–offer any courses related to spirituality and religion.

The APA’s Education Directorate reported that it pays attention only to psychology courses being offered in graduate schools.

Several accredited schools already offer religion courses to psychology students, usually Christian-based counseling courses.

Edward P. Shafranske, Ph.D., of Pepperdine University, editor of the first APA-published book on the subject, Religion and the Clinical Practice of Psychology, heads the Division 36 task force charged with submitting a model free-standing graduate school curriculum dealing with issues of spirituality, religion, morality and other subjects once dealt with by members of the cloth, not psychologists.

Shafranske said he was at first surprised by how well his book has sold (it remains in the top 25 books published by APA), but on reflection, “I should not have been surprised. I knew there was a demand out there for this kind of text. But, I am pleased the book has been so well received.”

Although Pepperdine is a Christian school affiliated with the Churches of Christ, Shafranske said there is no requirement that graduate students take courses dealing with spirituality.

“I’m not saying these things don’t get discussed in classes, but we do not offer courses dealing with the spirituality aspects of psychotherapy,” he said.

He noted that since Pepperdine has a diverse faculty and student body it would be difficult to examine in any depth the various aspects of spirituality and religion and therapy.

Shafranske said he believes the creation of diversity and multiculturalism in graduate schools has led to the growing interest on the part of those practitioners who are learning that the many forms of spirituality and religion form core belief systems that cannot be separated from individual therapy.

The belief that one’s spirituality, regardless of religion, plays key roles in individuals’ lives has created an atmosphere in which these aspects of life can be discussed, he said.

“But, that’s a fairly new development. I think the main reason that spirituality in therapy has not been discussed and presented more in the graduate courses is that there have not been the materials and resources available to do the kind of presentations needed,” Shafranske added.

He said that void could be filled later this year when the Division 36 task force presents its report and draft of a model curriculum dealing with these issues.

The key to presenting spirituality and religious issues is to learn how to respect all religions and being able to place the patients in the appropriate social, political, economic and religious context, Shafranske said.

Those graduate schools that do offer and require religious courses see the demand for spirituality in therapy a reaction to science’s failure to provide answers to life’s perplexing and puzzling question, many of which lead them to psychologists’ offices.

Four Christian-based graduate schools–Wheaton, George Fox, Fuller and Rosemead–are accredited by APA. An additional three– Asuza Pacific, Seattle Pacific and Regents University–are being considered for accreditation.

Mark McMinn, Ph.D., of Wheaton in Illinois, said the common belief by the Christian-based graduate schools is that science does not always have the answers to the questions people ask in therapy. Those individuals learn how to deal with life’s problems by applying their spirituality and religious beliefs to help come up with answers.

“Some people prefer therapy that is grounded in a faith common to the therapist and the patient. They may not be totally against the science of psychology, but think that one’s spirituality is too important to be ignored in therapy,” McMinn said.

“Many others,” he noted, “have a deep suspicion of psychology. Particularly, if they are told that their religious beliefs are a big part of their problem.”

Has managed care played a role in the growing interest of recognizing the importance of religion and spirituality in therapy?
Ken Pargament, Ph.D., a psychology professor at Bowling Green State University in Ohio, thinks the backlash to changes in how mental health services are delivered under managed care has played a part.

“Managed care is not the whole reason, of course, but I think it has pushed these issues to the forefront,” Pargament said. “Many problems can’t be taken care of in 10 sessions. That’s where clinical practitioners begin to look for other resources. The ability to include spirituality and religion becomes very important at that point.”

Pargament, author of Psychology of Religion and Coping (Guilford Publications, 1997) teaches undergraduate and graduate school psychology students the importance of recognizing spirituality and religion as resources that can be used in therapy. He said the courses, which are optional, have been well received.”

Pargament, who serves on the Division 36 task force developing a model curriculum for graduate school students, said he was “cautiously optimistic” that courses in spirituality and religion would soon become part of a clinician’s training.
“I just hope this trend is not a fad. This is too profound to be faddish,” Pargament said.

Meanwhile, UCLA’s Rabgyay, a native of Tibet and a graduate of the Pacifica Graduate Institution in California, said he will be interested in the results of his work with Epstein at Beth Israel.

“A lot of the issues deal with pain and death, which many medical professionals have little training and knowledge about,” he said.
“It’s time we looked at more activities like this.”

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