For most of the history of psychology and psychiatry, there has been a focus on the negative aspects of mental health, involving the diagnosing and treating of diseases and disorders. In recent years, however, there has been a move toward “Positive Psychology,” in which (as the name implies) the focus is on the positive aspects of mental health. Psychological changes and symptoms throughout the life span are seen as having the potential for positive growth that can be incorporated into the treatment process rather than a pathologic process that needs to be eliminated or suppressed. Additionally, over the past few decades, practitioners are seeing more and more people who may not have a clinical diagnosis yet feel there is something “missing” in their lives.
For too long, mind and body were considered separate entities, but great strides have been made in the past few decades with regard to recognizing the interconnections between the mind and body in disease and health. However, many practitioners are still neglecting a third entity—the role of spirituality in health and healing. Recent research is indicating that spirituality plays a significant role in health and longevity. (Granted, more research needs to be done, and many studies are in process, as described in the book's Introduction.) Yet, spirituality is rarely present in the therapy session.
Spirituality should not be confused with religiosity, as the 2 vary in distinct ways (and this distinction is discussed throughout the book). When utilizing spirituality in therapy, the practitioner must take into consideration the individual's personal belief systems and help him or her derive a concept of spirituality that is a unique fit. The client's religious views (or lack thereof) may or may not be related to his or her spiritual philosophies. As John E. Mack, M.D., points out in the first chapter, “Clinicians must be able to approach individuals who present with unfamiliar or extraordinary experiences from a perspective that is unbiased and open-minded” (p. 18). Chapter 1 proceeds to describe the elements of such a perspective and the implications for diagnosis, clinical work, and research.
Chapter 2 describes how to take the psychospiritual approach and apply it to adjustment disorders, which the author suggests might be a “summons to new life adventure” rather than a poor response to a life situation (p. 33). Chapter 3, by Selene Vega, M.A., M.F.T., takes the psychospiritual approach and applies it to anxiety disorders. The author succinctly describes how our post-9/11 world is one that holds more fears, worries, and uncertainties than previously—essentially more anxiety in general. Although much of the chapter focuses on generalized anxiety disorder, the approaches Vega covers apply to other anxiety disorders, as well. She also does a thorough job of laying out how to incorporate a spiritual approach into treatment in general, again focusing on the need for individualistic approaches. She writes, “Our clients are unique, and paying attention to the spiritual paths and beliefs that are part of their history and current worldview will help us determine the approach to take and how overt our psychospiritual perspective should be” (pp. 59–60).
Chapter 4 describes how to use a psychospiritual approach in those who have experienced trauma. The author (also an editor), Sharon G. Mijares, Ph.D., presents the idea that, when viewed through a spiritual approach, trauma can be viewed as “an opportunity for a quantum leap in consciousness” (p. 76). How many practitioners have worked with a client who has experienced severe trauma and who, months or years later, asserts that he or she wouldn't go back and “undo” the trauma if such a thing were possible? The client has learned something so profound, or become someone so different, that he or she is sometimes actually thankful that the trauma occurred. Some rare individuals are able to do this on their own, but many may need psychospiritual guidance to achieve this state of acceptance and contentment. Mijares provides specific treatment approaches and case examples to clearly define the psychospiritual approach as it relates to trauma.
Chapter 5 focuses on eating disorders and how many treatment approaches focus on the obvious (e.g., the food, weight, fat, and body image) but fail to recognize that the physical eating disorder may represent a spiritual need to be fed and nurtured. According to the authors, “Therapy then becomes a process of revealing the unseen, unknown, and as yet unstoried, mystery” (p. 99). Again, the emphasis is that the treatment approach has to be individualized to each client's history—his or her story—and the etiology of the development of the eating disorder used in developing a treatment plan. The approach is unique, and hopefully we will see more research that supports the treatment, as eating disorders are known to be difficult to treat, with a high recidivism rate.
Chapter 6 is dedicated to the use of spirituality as an approach to attention-deficit disorders. In today's increasingly mobile, high-tech, and almost forced-intomultitasking world, these disorders are being diagnosed at higher and higher rates, both among younger and younger children and adults. This chapter discusses not only etiology but also treatment approaches and case examples. Especially helpful are photos of various poses used for meditations to help increase focus and clarity of thought.
Chapters 7 and 8 deal with the difficult-to-treat dissociative identity disorder (DID), borderline personality disorder (BPD), and narcissistic personality disorder (NPD). As with the other chapters, the psychospiritual etiology of these disorders is discussed, followed by treatment approaches and case examples. The authors acknowledge that research on the success of using a psychospiritual treatment approach is limited in these areas, but research on other successful treatment approaches is also limited. In the discussion of BPD and NPD, the author outlines current treatment approaches (such as the work of Marsha Linehan, Ph.D., in BPD) and how to integrate these techniques with a psychospiritual approach. Again, photographs and detailed meditation instructions are included so that even those unfamiliar with meditation have sufficient information to try the recommended poses.
Chapter 9 uses the same format with conduct disorders, beginning with recommendations for a multifaceted assessment (e.g., physiologic, environmental, academic, behavioral, social, and spiritual). Comorbidity with low self esteem and overall psychological functioning in the child are discussed, as well as the need for positive role models and the willing participation of the family of the client. The rationale and treatment protocol for using a spiritual approach in conduct disorders as well is provided in detail.
Chapters 10 and 11 focus on the psychospiritual approach to bipolar disorder and psychotic disorders. The chapter on bipolar disorder, by Jeffrey Rediger, M.D., M.Div., focuses primarily on integrating a spiritual approach with conventional treatment methods and includes a discussion of what the author describes as a “narrow Western ontology” that leaves many patients “feeling lost or unfairly pathologized” (p. 206). Rediger's integrative approach is designed to avoid this outcome, although again, research into the treatment is needed.
The chapter on psychotic disorders discusses the relationship between psychotic processes and spiritual experiences and how modern Western society tends to pathologize certain experiences, whereas other cultures view such experiences as opportunities for spiritual insights and growth. The author writes of psychotic episodes as “spiritual emergencies” and provides case examples of how a client can be further traumatized by a typical intervention for a psychotic “break.” The author goes into detail regarding an alternative treatment approach. Again, further research into the success of such an approach would be welcome.
Chapter 12 focuses on the Sufi technique for “healing” depression. Sufism is described as “an ancient wisdom tradition that has existed for over 1400 years. Sufism contributes a theoretical foundation from which we can understand the etiology, symptoms, and treatment of depression” (p. 265). The Sufibased psychospiritual approach is one that requires additional training and experience, and the chapter provides primarily an overview for the theory and use of Sufism. This was one of the few chapters that left me feeling woefully inadequate in attempting to utilize the technique with my clients.
Chapter 13 is an interesting discussion of the neuroplasticity of the brain and using “mindful awareness” to integrate psychospiritual and biological approaches to mental health. Although there is some focus in the chapter on the use of these concepts in the treatment of obsessive-compulsive disorder, the chapter is a good outline on using cognitive treatments in conjunction with the practice of mindfulness in daily life.
Chapter 14 explores the combination of spirituality and sexuality to achieve healthy sexual relationships. Although a clear distinction is made between spirituality and religion, the role of religion in the development of sexual difficulties is discussed. The need to discuss the origins of the role of religion (if present) and incorporate the client's current religious views into the therapy is explained, as is the ability to use one's spirituality to enhance the sexual experience beyond what has been known previously.
Chapter 15 discusses an integrative medical and spiritual approach to the treatment of Alzheimer's disease. The author discusses the role of physical exercise, cognitive exercise, and good nutrition and supplementation (e.g., Omega-3 essential fatty acids) in keeping the brain healthy and well functioning. The author also reviews the benefits of meditation, mind/body exercises (which are detailed in the chapter), and medications and hormones, with specific suggestions for what the research has found to be helpful in avoiding, delaying, or slowing the symptoms of dementia.
The final chapter focuses on the increasing number of centers dedicated to supporting spiritual approaches to psychotherapy that have sprouted up in the last few years. Information on current centers and programs is provided, as is a vision for the future of psychotherapy in spirituality.
As noted above, most chapter authors incorporated other therapeutic techniques into the use of their particular psychospiritual approach to a given problem. Some discussed how to incorporate methods such as cognitive therapy, dialecticalbehavioral therapy, and self-psychology into a spiritual approach in great detail, whereas others only lightly touched on other interventions or did not discuss them at all. I found the chapters that discussed integrative therapies in depth to be most helpful, as they provided a foundation on which to base use of a new approach to an “old” problem. There was very little discussion of the use of pharmacotherapy in conjunction with the psychospiritual approach, and I was left with the impression that the 2 approaches were not necessarily compatible—or that the use of a certain psychospiritual technique could circumvent or eliminate the need to utilize pharmacotherapy altogether. I will leave to the reader's personal beliefs the decision as to whether this is a good approach to the treatment of various disorders. However, a discussion of how to work with someone who is taking psychotropic medications would have been helpful. (This topic was discussed briefly in some chapters, but never in great depth.)
When I agreed to write this book review, I underestimated the time that it would involve. Writing the actual review was hardly time-consuming, but what took a great deal of time was reading the book. I frequently found myself stopping for several minutes at a time, thinking about the implications of what I was reading and how I might apply the concepts to specific clients and to my own personal growth. Some of the concepts I was familiar with; some were new and required closer reading to understand how to incorporate them into a particular therapeutic context. With few exceptions, I think readers will find The Psychospiritual Clinician's Handbook a fascinating read. Even if they choose not to personally adopt all of the approaches into their work with clients, the book will educate them about the spiritual approaches out there and, along with the multiple resources provided, allow them to make a referral to a provider who is more skilled in the psychospiritual approach.