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When Issues Become Emergencies: Assessment and Treatment of Spiritual Problems. Nadine Duckworth University of Lethbridge. Introduction. Spiritual practices have beneficial effects on health For healing of illnesses Psychological growth Self-actualization Spiritual problems

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When issues become emergencies assessment and treatment of spiritual problems

When Issues Become Emergencies:Assessment and Treatment of Spiritual Problems

Nadine Duckworth

University of Lethbridge


  • Spiritual practices have beneficial effects on health

    • For healing of illnesses

    • Psychological growth

    • Self-actualization

  • Spiritual problems

    • Can emerge spontaneously or during intense spiritual practice

    • Can resemble a variety of mental disorders

    • Can lead to disruption in social and psychological functioning


  • 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
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

  • 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

  • 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
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


  • 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)


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


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
    Differential Diagnosis

    • Important to distinguish spiritual emergencies from psychotic-like symptoms/disorders

    • http://www.spiritualcompetency.com/dsm4/lesson5_1.asp

    Spiritually sensitive approach
    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
    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
    Interventions for Spiritual Emergencies

    For clients in a state of crisis:

    • Use the therapy session to help ground/center the patient

      • “here and now”

    • Create a therapeutic container

      • therapist presence is key - warmth, compassion, non-judgment

    • Normalize and educate

    • Help patient to reduce environmental and interpersonal stimulation

    • Have patient temporarily discontinue spiritual practices

    • Suggest the patient eat a diet of "heavy" foods and avoid vegan diet and fasting

    • Evaluate for medication - refer to psychiatrist

    Interventions for spiritual emergencies1
    Interventions for Spiritual Emergencies

    After the immediate crisis has subsided:

    • Encourage the patient to become involved in calming activities

      • 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


    • 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:

      • telling the story of the experience

      • tracing its symbolic/spiritual heritage

      • creating a new personal mythology

    Prevention strategy
    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
    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)

    When issues become emergencies assessment and treatment of spiritual problems

    Mystical Experience