When Issues Become Emergencies:
Assessment and Treatment of
Spiritual Problems
Nadine Duckworth
University of Lethbridge
Introduction
F Spiritual practices have beneficial effects on health
F For healing of illnesses
F Psychological growth
F Self-actualization
F Spiritual problems
F Can emerge spontaneously or during intense
spiritual practice
F Can resemble a variety of mental disorders
F Can lead to disruption in social and
psychological functioning
Introduction
Misdiagnosis can result in inappropriate treatment
and intensification of distressful symptoms
If properly diagnosed and treated, can result in
personal growth and healing
Spiritual practices are gaining popularity worldwide
Spiritual problems are likely to increase as well
Therapists should be “spiritually-sensitive”
Increased awareness and understanding
Appropriate treatment approach
DSM Diagnosis
1994 DSM IV - “Religious or Spiritual Problem” (Code
V62.89), is used to diagnose a religious or spiritual crisis that is
usually a brief reactive response to specific religious or spiritual
experiences
Designated as a “V code”, acknowledging a category of
distressing religious and spiritual experiences that are
nonpathological in nature
A religious or spiritual problem is not a mental disorder, but is a
condition that requires clinical attention
Traditional psychiatry has not differentiated mysticism from
psychosis
often misdiagnosed as psychotic disorders
typically treated with psychotropic medication and hospitalization
Spiritual Issues
Spiritual issues or concerns are not as sudden or
as intense as spiritual emergencies
Include things like:
Loss or questioning of faith
Conversion to new religion or denomination
Moral or ethical issues
Personal identity issues
Existential issues
Trauma
Relationship and family problems
Grief and loss
Physical or terminal illness
Substance abuse
Extremes of thinking or living
Psychological disturbance
Burnout and working with other people in crisis
Spiritual Emergency
Spiritual emergency/crisis - when one’s Self becomes overwhelmed by an
infusion of spiritual energies or new realms of experience which it is not
yet able to integrate
The practice of personal or spiritual transformation can become a crisis,
resulting from a process of growth or change that has become chaotic or
overwhelming
It has been described in the sacred literature of all ages, and is recognized
as being the result of meditative practices and the mystical path
Individuals may experience:
self identity disintegrating
old beliefs and values no longer hold true
reality is radically changing
new realms of spiritual experiences appear suddenly and dramatically
immense confusion, anxiety, and sometimes impaired functioning
worry that they are going crazy, or experiencing psychosis
Spiritual Emergencies
Anomalous experiences:
deviate from the usually accepted explanations of reality
can involve intense emotions, visions, perceptual
disturbances, unusual thought processes, tremors, and
sensations of heat and energy
Examples include:
intense kundalini awakening
mystical or “peak” experiences
near-death experiences
psychic openings or psi-related phenomena
past-life experiences
shamanic journeys
UFO/alien encounters or abductions
communicating with spirits or channeling
possession states
Assessment
1.
Brief Mental Status Exam:
general description and appearance of client
mood and affect
perception
thought processes
level of consciousness
orientation to time, place, and people
memory
impulse control
Disturbances in perception, consciousness, or
orientation may indicate:
spiritual emergency
psychotic symptoms
organic brain disorder
2. Subjective Units of Disturbance Scale (SUDS)
Assessment
3. Clinical Interview




Listening to client’s story
Building rapport
History-taking
Checklist of symptoms


physical, behavioural, cognitive, emotional
frequency, intensity, and duration
4. Global Assessment of Functioning Scale (GAF)
5. Psychological Tests



SCID-I and SCID-II - for Axis I and II
MMPI-III and MCMI-2 - for Axis I and II
SIRS - Structured Interview of Reported Symptoms
Assessment
6. Religious and Spiritual Assessment
 gain an understanding of the client’s worldview
 determine whether the client’s religious-spiritual
orientation is healthy or unhealthy, and what impact it has
on the presenting problem
 determine whether the client’s beliefs and community can
be used as a resource
 determine whether the client has unresolved spiritual
doubts, concerns, or needs that should be addressed in
therapy
 To aid in assessment and help identify client’s goals:
 Spiritual Transcendence Scale
 Spiritual Well-Being Scale
 Theistic Spiritual Outcome Scale
Differential Diagnosis
 Important to distinguish spiritual
emergencies from psychotic-like
symptoms/disorders
 http://www.spiritualcompetency.co
m/dsm4/lesson5_1.asp
Spiritually-Sensitive Approach
 Promote a positive context for client’s
experience
 Provide them with information about the
spiritual emergence process
 Move away from the concept of disease, and
focus on the potential healing and
transformative nature of the experience
 Involve client’s social support network if
possible
Goals for Treatment
1) Respond to crisis situation

Aim to reduce frequency, duration, and/or intensity of
distressful symptoms
2) Normalize the experience

Provide information and resources to the client
3) Encourage emotional release/catharsis through creative expression

art therapy
4) Psychotherapy to integrate the experience

narrative therapy

existential, contemplative/transpersonal, integrative approach
5) Enhance positive spiritual outcomes

as identified by assessment and client goals
6) Facilitate the transformational process

Promote holistic well-being

Encourage psychological and spiritual healing, learning, and
growth
Interventions for Spiritual Emergencies
For clients in a state of crisis:
1) Use the therapy session to help ground/center the patient
• “here and now”
2) Create a therapeutic container
• therapist presence is key - warmth, compassion,
non-judgment
3) Normalize and educate
4) Help patient to reduce environmental and interpersonal
stimulation
5) Have patient temporarily discontinue spiritual practices
6) Suggest the patient eat a diet of "heavy" foods and avoid
vegan diet and fasting
7) Evaluate for medication - refer to psychiatrist
Interventions for Spiritual Emergencies
After the immediate crisis has subsided:
8)
Encourage the patient to become involved in calming activities
•
9)
gardening, walking, relaxation
Encourage the patient to express their experience through creative
and artistic mediums
•
•
art, music, dance, writing, poetry, drama, etc.
symbol and metaphor for nonverbal expressions and integration
Psychotherapy
 Along with these immediate responses, a
more generalized psychotherapeutic
intervention should be used to help the
client integrate the experience
 This involves a narrative approach,
including 3 phases:
1) telling the story of the experience
2) tracing its symbolic/spiritual heritage
3) creating a new personal mythology
Prevention Strategy
Learning stress management skills
might also be useful for the client to
help prevent a re-occurrence of the
spiritual crisis:
Self-monitoring of anxiety
De-escalation of symptoms through
relaxation therapies
Knowledge gained from the therapeutic
interventions previously listed
Spiritual Interventions
 For other less severe spiritual issues and concerns,
examples of major therapeutic techniques include:







spiritual relaxation or guided imagery
meditation and/or prayer
journaling about spiritual feelings
study of scripture or spiritual texts
using the client’s support system
participating in religious services or spiritual gatherings
encouraging the client to seek guidance from a
compassionate religious or spiritual leader
 giving/receiving blessings
 encouraging forgiveness and/or repentance
 cognitive restructuring of irrational religious or spiritual
beliefs (discernment required)
http://www.youtube.com
/watch?v=z9nOD6foI64&
feature=related
Mystical Experience
http://www.youtube.com/watch?v=UQ44lJ-eItw