When Issues Become Emergencies:When Issues Become Emergencies:Assessment and Treatment of Assessment and Treatment of

Spiritual ProblemsSpiritual Problems

When Issues Become Emergencies:When Issues Become Emergencies:Assessment and Treatment of Assessment and Treatment of

Spiritual ProblemsSpiritual Problems

Nadine DuckworthNadine Duckworth

University of LethbridgeUniversity of Lethbridge

Nadine DuckworthNadine Duckworth

University of LethbridgeUniversity of Lethbridge

IntroductionIntroductionIntroductionIntroduction

Spiritual practices have beneficial effects on Spiritual practices have beneficial effects on healthhealth For healing of illnessesFor healing of illnesses Psychological growthPsychological growth Self-actualizationSelf-actualization

Spiritual problems Spiritual problems Can emerge spontaneously or during intense Can emerge spontaneously or during intense

spiritual practicespiritual practice Can resemble a variety of mental disordersCan resemble a variety of mental disorders Can lead to disruption in social and Can lead to disruption in social and

psychological functioningpsychological functioning

Spiritual practices have beneficial effects on Spiritual practices have beneficial effects on healthhealth For healing of illnessesFor healing of illnesses Psychological growthPsychological growth Self-actualizationSelf-actualization

Spiritual problems Spiritual problems Can emerge spontaneously or during intense Can emerge spontaneously or during intense

spiritual practicespiritual practice Can resemble a variety of mental disordersCan resemble a variety of mental disorders Can lead to disruption in social and Can lead to disruption in social and

psychological functioningpsychological functioning

IntroductionIntroductionIntroductionIntroduction

Misdiagnosis can result in inappropriate treatment Misdiagnosis can result in inappropriate treatment and intensification of distressful symptomsand intensification of distressful symptoms

If properly diagnosed and treated, can result in If properly diagnosed and treated, can result in personal growth and healingpersonal growth and healing

Spiritual practices are gaining popularity worldwideSpiritual practices are gaining popularity worldwide Spiritual problems are likely to increase as wellSpiritual problems are likely to increase as well

Therapists should be Therapists should be ““spiritually-sensitivespiritually-sensitive”” Increased awareness and understandingIncreased awareness and understanding Appropriate treatment approachAppropriate treatment approach

Misdiagnosis can result in inappropriate treatment Misdiagnosis can result in inappropriate treatment and intensification of distressful symptomsand intensification of distressful symptoms

If properly diagnosed and treated, can result in If properly diagnosed and treated, can result in personal growth and healingpersonal growth and healing

Spiritual practices are gaining popularity worldwideSpiritual practices are gaining popularity worldwide Spiritual problems are likely to increase as wellSpiritual problems are likely to increase as well

Therapists should be Therapists should be ““spiritually-sensitivespiritually-sensitive”” Increased awareness and understandingIncreased awareness and understanding Appropriate treatment approachAppropriate treatment approach

DSM DiagnosisDSM DiagnosisDSM DiagnosisDSM Diagnosis

1994 DSM IV - 1994 DSM IV - ““Religious or Spiritual ProblemReligious or Spiritual Problem”” (Code (Code V62.89), is used to diagnose a religious or spiritual crisis that is V62.89), is used to diagnose a religious or spiritual crisis that is usually a brief reactive response to specific religious or usually a brief reactive response to specific religious or spiritual experiencesspiritual experiences

Designated as a Designated as a ““V codeV code””, acknowledging a category of , acknowledging a category of distressing religious and spiritual experiences that are distressing religious and spiritual experiences that are nonpathological in naturenonpathological in nature

A religious or spiritual problem is not a mental disorder, but is A religious or spiritual problem is not a mental disorder, but is a condition that requires clinical attentiona condition that requires clinical attention

Traditional psychiatry has not differentiated mysticism from Traditional psychiatry has not differentiated mysticism from psychosispsychosis often misdiagnosed as psychotic disordersoften misdiagnosed as psychotic disorders typically treated with psychotropic medication and hospitalizationtypically treated with psychotropic medication and hospitalization

1994 DSM IV - 1994 DSM IV - ““Religious or Spiritual ProblemReligious or Spiritual Problem”” (Code (Code V62.89), is used to diagnose a religious or spiritual crisis that is V62.89), is used to diagnose a religious or spiritual crisis that is usually a brief reactive response to specific religious or usually a brief reactive response to specific religious or spiritual experiencesspiritual experiences

Designated as a Designated as a ““V codeV code””, acknowledging a category of , acknowledging a category of distressing religious and spiritual experiences that are distressing religious and spiritual experiences that are nonpathological in naturenonpathological in nature

A religious or spiritual problem is not a mental disorder, but is A religious or spiritual problem is not a mental disorder, but is a condition that requires clinical attentiona condition that requires clinical attention

Traditional psychiatry has not differentiated mysticism from Traditional psychiatry has not differentiated mysticism from psychosispsychosis often misdiagnosed as psychotic disordersoften misdiagnosed as psychotic disorders typically treated with psychotropic medication and hospitalizationtypically treated with psychotropic medication and hospitalization

Spiritual IssuesSpiritual IssuesSpiritual IssuesSpiritual Issues

Spiritual issues or concerns are not as sudden or Spiritual issues or concerns are not as sudden or as intense as spiritual emergenciesas intense as spiritual emergencies

Include things like:Include things like: Loss or questioning of faithLoss or questioning of faith Conversion to new religion or denominationConversion to new religion or denomination Moral or ethical issuesMoral or ethical issues Personal identity issuesPersonal identity issues Existential issuesExistential issues TraumaTrauma Relationship and family problemsRelationship and family problems Grief and lossGrief and loss Physical or terminal illnessPhysical or terminal illness Substance abuseSubstance abuse Extremes of thinking or livingExtremes of thinking or living Psychological disturbancePsychological disturbance Burnout and working with other people in crisisBurnout and working with other people in crisis

Spiritual issues or concerns are not as sudden or Spiritual issues or concerns are not as sudden or as intense as spiritual emergenciesas intense as spiritual emergencies

Include things like:Include things like: Loss or questioning of faithLoss or questioning of faith Conversion to new religion or denominationConversion to new religion or denomination Moral or ethical issuesMoral or ethical issues Personal identity issuesPersonal identity issues Existential issuesExistential issues TraumaTrauma Relationship and family problemsRelationship and family problems Grief and lossGrief and loss Physical or terminal illnessPhysical or terminal illness Substance abuseSubstance abuse Extremes of thinking or livingExtremes of thinking or living Psychological disturbancePsychological disturbance Burnout and working with other people in crisisBurnout and working with other people in crisis

Spiritual EmergencySpiritual Emergency Spiritual EmergencySpiritual Emergency Spiritual emergency/crisis - when oneSpiritual emergency/crisis - when one’’s Self becomes overwhelmed by an s Self becomes overwhelmed by an

infusion of spiritual energies or new realms of experience which it is not infusion of spiritual energies or new realms of experience which it is not yet able to integrate yet able to integrate

The practice of personal or spiritual transformation can become a crisis, The practice of personal or spiritual transformation can become a crisis, resulting from a process of growth or change that has become chaotic or resulting from a process of growth or change that has become chaotic or overwhelmingoverwhelming

It has been described in the sacred literature of all ages, and is recognized It has been described in the sacred literature of all ages, and is recognized as being the result of meditative practices and the mystical pathas being the result of meditative practices and the mystical path

Individuals may experience:Individuals may experience: self identity disintegratingself identity disintegrating old beliefs and values no longer hold trueold beliefs and values no longer hold true reality is radically changingreality is radically changing new realms of spiritual experiences appear suddenly and dramaticallynew realms of spiritual experiences appear suddenly and dramatically immense confusion, anxiety, and sometimes impaired functioningimmense confusion, anxiety, and sometimes impaired functioning worry that they are going crazy, or experiencing psychosisworry that they are going crazy, or experiencing psychosis

Spiritual emergency/crisis - when oneSpiritual emergency/crisis - when one’’s Self becomes overwhelmed by an s Self becomes overwhelmed by an infusion of spiritual energies or new realms of experience which it is not infusion of spiritual energies or new realms of experience which it is not yet able to integrate yet able to integrate

The practice of personal or spiritual transformation can become a crisis, The practice of personal or spiritual transformation can become a crisis, resulting from a process of growth or change that has become chaotic or resulting from a process of growth or change that has become chaotic or overwhelmingoverwhelming

It has been described in the sacred literature of all ages, and is recognized It has been described in the sacred literature of all ages, and is recognized as being the result of meditative practices and the mystical pathas being the result of meditative practices and the mystical path

Individuals may experience:Individuals may experience: self identity disintegratingself identity disintegrating old beliefs and values no longer hold trueold beliefs and values no longer hold true reality is radically changingreality is radically changing new realms of spiritual experiences appear suddenly and dramaticallynew realms of spiritual experiences appear suddenly and dramatically immense confusion, anxiety, and sometimes impaired functioningimmense confusion, anxiety, and sometimes impaired functioning worry that they are going crazy, or experiencing psychosisworry that they are going crazy, or experiencing psychosis

Spiritual EmergenciesSpiritual EmergenciesSpiritual EmergenciesSpiritual Emergencies

Anomalous experiences: Anomalous experiences: deviate from the usually accepted explanations of realitydeviate from the usually accepted explanations of reality can involve intense emotions, visions, perceptual can involve intense emotions, visions, perceptual

disturbances, unusual thought processes, tremors, and disturbances, unusual thought processes, tremors, and sensations of heat and energysensations of heat and energy

Examples include: Examples include: intense kundalini awakeningintense kundalini awakening mystical or mystical or ““peakpeak”” experiences experiences near-death experiencesnear-death experiences psychic openings or psi-related phenomenapsychic openings or psi-related phenomena past-life experiencespast-life experiences shamanic journeysshamanic journeys UFO/alien encounters or abductionsUFO/alien encounters or abductions communicating with spirits or channelingcommunicating with spirits or channeling possession statespossession states

Anomalous experiences: Anomalous experiences: deviate from the usually accepted explanations of realitydeviate from the usually accepted explanations of reality can involve intense emotions, visions, perceptual can involve intense emotions, visions, perceptual

disturbances, unusual thought processes, tremors, and disturbances, unusual thought processes, tremors, and sensations of heat and energysensations of heat and energy

Examples include: Examples include: intense kundalini awakeningintense kundalini awakening mystical or mystical or ““peakpeak”” experiences experiences near-death experiencesnear-death experiences psychic openings or psi-related phenomenapsychic openings or psi-related phenomena past-life experiencespast-life experiences shamanic journeysshamanic journeys UFO/alien encounters or abductionsUFO/alien encounters or abductions communicating with spirits or channelingcommunicating with spirits or channeling possession statespossession states

AssessmentAssessmentAssessmentAssessment

1.1. Brief Mental Status Exam:Brief Mental Status Exam: general description and appearance of clientgeneral description and appearance of client mood and affectmood and affect perceptionperception thought processesthought processes level of consciousnesslevel of consciousness orientation to time, place, and peopleorientation to time, place, and people memorymemory impulse controlimpulse control

Disturbances in perception, consciousness, or orientation Disturbances in perception, consciousness, or orientation may indicate:may indicate:

spiritual emergencyspiritual emergency psychotic symptomspsychotic symptoms organic brain disorderorganic brain disorder

2. Subjective Units of Disturbance Scale (SUDS)2. Subjective Units of Disturbance Scale (SUDS)

1.1. Brief Mental Status Exam:Brief Mental Status Exam: general description and appearance of clientgeneral description and appearance of client mood and affectmood and affect perceptionperception thought processesthought processes level of consciousnesslevel of consciousness orientation to time, place, and peopleorientation to time, place, and people memorymemory impulse controlimpulse control

Disturbances in perception, consciousness, or orientation Disturbances in perception, consciousness, or orientation may indicate:may indicate:

spiritual emergencyspiritual emergency psychotic symptomspsychotic symptoms organic brain disorderorganic brain disorder

2. Subjective Units of Disturbance Scale (SUDS)2. Subjective Units of Disturbance Scale (SUDS)

AssessmentAssessmentAssessmentAssessment

3. Clinical Interview3. Clinical Interview Listening to clientListening to client’’s storys story Building rapportBuilding rapport History-takingHistory-taking Checklist of symptomsChecklist of symptoms

physical, behavioural, cognitive, emotionalphysical, behavioural, cognitive, emotional frequency, intensity, and durationfrequency, intensity, and duration

4. Global Assessment of Functioning Scale (GAF)4. Global Assessment of Functioning Scale (GAF)

5. Psychological Tests5. Psychological Tests SCID-I and SCID-II - for Axis I and IISCID-I and SCID-II - for Axis I and II MMPI-III and MCMI-2 - for Axis I and IIMMPI-III and MCMI-2 - for Axis I and II SIRS - Structured Interview of Reported SymptomsSIRS - Structured Interview of Reported Symptoms

3. Clinical Interview3. Clinical Interview Listening to clientListening to client’’s storys story Building rapportBuilding rapport History-takingHistory-taking Checklist of symptomsChecklist of symptoms

physical, behavioural, cognitive, emotionalphysical, behavioural, cognitive, emotional frequency, intensity, and durationfrequency, intensity, and duration

4. Global Assessment of Functioning Scale (GAF)4. Global Assessment of Functioning Scale (GAF)

5. Psychological Tests5. Psychological Tests SCID-I and SCID-II - for Axis I and IISCID-I and SCID-II - for Axis I and II MMPI-III and MCMI-2 - for Axis I and IIMMPI-III and MCMI-2 - for Axis I and II SIRS - Structured Interview of Reported SymptomsSIRS - Structured Interview of Reported Symptoms

AssessmentAssessmentAssessmentAssessment

6. Religious and Spiritual Assessment6. Religious and Spiritual Assessment gain an understanding of the clientgain an understanding of the client’’s worldviews worldview determine whether the clientdetermine whether the client’’s religious-spiritual s religious-spiritual

orientation is healthy or unhealthy, and what impact it has orientation is healthy or unhealthy, and what impact it has on the presenting problemon the presenting problem

determine whether the clientdetermine whether the client’’s beliefs and community can s beliefs and community can be used as a resourcebe used as a resource

determine whether the client has unresolved spiritual determine whether the client has unresolved spiritual doubts, concerns, or needs that should be addressed in doubts, concerns, or needs that should be addressed in therapytherapy

To aid in assessment and help identify clientTo aid in assessment and help identify client’’s goals:s goals: Spiritual Transcendence ScaleSpiritual Transcendence Scale Spiritual Well-Being ScaleSpiritual Well-Being Scale Theistic Spiritual Outcome ScaleTheistic Spiritual Outcome Scale

6. Religious and Spiritual Assessment6. Religious and Spiritual Assessment gain an understanding of the clientgain an understanding of the client’’s worldviews worldview determine whether the clientdetermine whether the client’’s religious-spiritual s religious-spiritual

orientation is healthy or unhealthy, and what impact it has orientation is healthy or unhealthy, and what impact it has on the presenting problemon the presenting problem

determine whether the clientdetermine whether the client’’s beliefs and community can s beliefs and community can be used as a resourcebe used as a resource

determine whether the client has unresolved spiritual determine whether the client has unresolved spiritual doubts, concerns, or needs that should be addressed in doubts, concerns, or needs that should be addressed in therapytherapy

To aid in assessment and help identify clientTo aid in assessment and help identify client’’s goals:s goals: Spiritual Transcendence ScaleSpiritual Transcendence Scale Spiritual Well-Being ScaleSpiritual Well-Being Scale Theistic Spiritual Outcome ScaleTheistic Spiritual Outcome Scale

Differential DiagnosisDifferential DiagnosisDifferential DiagnosisDifferential Diagnosis

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

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

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

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

Spiritually-Sensitive ApproachSpiritually-Sensitive ApproachSpiritually-Sensitive ApproachSpiritually-Sensitive Approach

Promote a positive context for clientPromote a positive context for client’’s s experienceexperience

Provide them with information about the Provide them with information about the spiritual emergence processspiritual emergence process

Move away from the concept of disease, and Move away from the concept of disease, and focus on the potential healing and focus on the potential healing and transformative nature of the experiencetransformative nature of the experience

Involve clientInvolve client’’s social support network if s social support network if possiblepossible

Promote a positive context for clientPromote a positive context for client’’s s experienceexperience

Provide them with information about the Provide them with information about the spiritual emergence processspiritual emergence process

Move away from the concept of disease, and Move away from the concept of disease, and focus on the potential healing and focus on the potential healing and transformative nature of the experiencetransformative nature of the experience

Involve clientInvolve client’’s social support network if s social support network if possiblepossible

Goals for TreatmentGoals for TreatmentGoals for TreatmentGoals for Treatment

1) Respond to crisis situation1) Respond to crisis situation Aim to reduce frequency, duration, and/or intensity of Aim to reduce frequency, duration, and/or intensity of

distressful symptomsdistressful symptoms

2) Normalize the experience2) Normalize the experience Provide information and resources to the clientProvide information and resources to the client

3) Encourage emotional release/catharsis through creative expression3) Encourage emotional release/catharsis through creative expression art therapyart therapy

4) Psychotherapy to integrate the experience4) Psychotherapy to integrate the experience narrative therapynarrative therapy existential, contemplative/transpersonal, integrative approachexistential, contemplative/transpersonal, integrative approach

5) Enhance positive spiritual outcomes5) Enhance positive spiritual outcomes as identified by assessment and client goalsas identified by assessment and client goals

6) Facilitate the transformational process6) Facilitate the transformational process Promote holistic well-beingPromote holistic well-being Encourage psychological and spiritual healing, learning, and Encourage psychological and spiritual healing, learning, and

growthgrowth

1) Respond to crisis situation1) Respond to crisis situation Aim to reduce frequency, duration, and/or intensity of Aim to reduce frequency, duration, and/or intensity of

distressful symptomsdistressful symptoms

2) Normalize the experience2) Normalize the experience Provide information and resources to the clientProvide information and resources to the client

3) Encourage emotional release/catharsis through creative expression3) Encourage emotional release/catharsis through creative expression art therapyart therapy

4) Psychotherapy to integrate the experience4) Psychotherapy to integrate the experience narrative therapynarrative therapy existential, contemplative/transpersonal, integrative approachexistential, contemplative/transpersonal, integrative approach

5) Enhance positive spiritual outcomes5) Enhance positive spiritual outcomes as identified by assessment and client goalsas identified by assessment and client goals

6) Facilitate the transformational process6) Facilitate the transformational process Promote holistic well-beingPromote holistic well-being Encourage psychological and spiritual healing, learning, and Encourage psychological and spiritual healing, learning, and

growthgrowth

Interventions for Spiritual EmergenciesInterventions for Spiritual EmergenciesInterventions for Spiritual EmergenciesInterventions for Spiritual Emergencies

For clients in a state of crisis:For clients in a state of crisis:

1)1) Use the therapy session to help ground/center the patientUse the therapy session to help ground/center the patient• ““here and nowhere and now””

2)2) Create a therapeutic containerCreate a therapeutic container• therapist presence is key - warmth, compassion, therapist presence is key - warmth, compassion,

non-judgmentnon-judgment3)3) Normalize and educateNormalize and educate4)4) Help patient to reduce environmental and interpersonal Help patient to reduce environmental and interpersonal

stimulationstimulation5)5) Have patient temporarily discontinue spiritual practicesHave patient temporarily discontinue spiritual practices6)6) Suggest the patient eat a diet of "heavy" foods and avoid Suggest the patient eat a diet of "heavy" foods and avoid

vegan diet and fastingvegan diet and fasting7)7) Evaluate for medication - refer to psychiatristEvaluate for medication - refer to psychiatrist

For clients in a state of crisis:For clients in a state of crisis:

1)1) Use the therapy session to help ground/center the patientUse the therapy session to help ground/center the patient• ““here and nowhere and now””

2)2) Create a therapeutic containerCreate a therapeutic container• therapist presence is key - warmth, compassion, therapist presence is key - warmth, compassion,

non-judgmentnon-judgment3)3) Normalize and educateNormalize and educate4)4) Help patient to reduce environmental and interpersonal Help patient to reduce environmental and interpersonal

stimulationstimulation5)5) Have patient temporarily discontinue spiritual practicesHave patient temporarily discontinue spiritual practices6)6) Suggest the patient eat a diet of "heavy" foods and avoid Suggest the patient eat a diet of "heavy" foods and avoid

vegan diet and fastingvegan diet and fasting7)7) Evaluate for medication - refer to psychiatristEvaluate for medication - refer to psychiatrist

Interventions for Spiritual EmergenciesInterventions for Spiritual EmergenciesInterventions for Spiritual EmergenciesInterventions for Spiritual Emergencies

After the immediate crisis has subsided:After the immediate crisis has subsided:

8)8) Encourage the patient to become involved in calming activitiesEncourage the patient to become involved in calming activities• gardening, walking, relaxationgardening, walking, relaxation

9)9) Encourage the patient to express their experience through creative Encourage the patient to express their experience through creative and artistic mediumsand artistic mediums

• art, music, dance, writing, poetry, drama, etc.art, music, dance, writing, poetry, drama, etc.• symbol and metaphor for nonverbal expressions and integrationsymbol and metaphor for nonverbal expressions and integration

After the immediate crisis has subsided:After the immediate crisis has subsided:

8)8) Encourage the patient to become involved in calming activitiesEncourage the patient to become involved in calming activities• gardening, walking, relaxationgardening, walking, relaxation

9)9) Encourage the patient to express their experience through creative Encourage the patient to express their experience through creative and artistic mediumsand artistic mediums

• art, music, dance, writing, poetry, drama, etc.art, music, dance, writing, poetry, drama, etc.• symbol and metaphor for nonverbal expressions and integrationsymbol and metaphor for nonverbal expressions and integration

PsychotherapyPsychotherapyPsychotherapyPsychotherapy

Along with these immediate responses, a Along with these immediate responses, a more generalized psychotherapeutic more generalized psychotherapeutic intervention should be used to help the intervention should be used to help the client integrate the experienceclient integrate the experience

This involves a narrative approach, This involves a narrative approach, including 3 phases:including 3 phases:

1)1) telling the story of the experiencetelling the story of the experience

2)2) tracing its symbolic/spiritual heritagetracing its symbolic/spiritual heritage

3)3) creating a new personal mythologycreating a new personal mythology

Along with these immediate responses, a Along with these immediate responses, a more generalized psychotherapeutic more generalized psychotherapeutic intervention should be used to help the intervention should be used to help the client integrate the experienceclient integrate the experience

This involves a narrative approach, This involves a narrative approach, including 3 phases:including 3 phases:

1)1) telling the story of the experiencetelling the story of the experience

2)2) tracing its symbolic/spiritual heritagetracing its symbolic/spiritual heritage

3)3) creating a new personal mythologycreating a new personal mythology

Prevention StrategyPrevention StrategyPrevention StrategyPrevention Strategy

Learning stress management skills Learning stress management skills might also be useful for the client to might also be useful for the client to help prevent a re-occurrence of the help prevent a re-occurrence of the spiritual crisis:spiritual crisis: Self-monitoring of anxietySelf-monitoring of anxiety De-escalation of symptoms through De-escalation of symptoms through

relaxation therapiesrelaxation therapies Knowledge gained from the therapeutic Knowledge gained from the therapeutic

interventions previously listedinterventions previously listed

Learning stress management skills Learning stress management skills might also be useful for the client to might also be useful for the client to help prevent a re-occurrence of the help prevent a re-occurrence of the spiritual crisis:spiritual crisis: Self-monitoring of anxietySelf-monitoring of anxiety De-escalation of symptoms through De-escalation of symptoms through

relaxation therapiesrelaxation therapies Knowledge gained from the therapeutic Knowledge gained from the therapeutic

interventions previously listedinterventions previously listed

Spiritual InterventionsSpiritual Interventions Spiritual InterventionsSpiritual Interventions

For other less severe spiritual issues and concerns, For other less severe spiritual issues and concerns, examples of major therapeutic techniques include:examples of major therapeutic techniques include:

spiritual relaxation or guided imageryspiritual relaxation or guided imagery meditation and/or prayermeditation and/or prayer journaling about spiritual feelingsjournaling about spiritual feelings study of scripture or spiritual textsstudy of scripture or spiritual texts using the clientusing the client’’s support systems support system participating in religious services or spiritual gatheringsparticipating in religious services or spiritual gatherings encouraging the client to seek guidance from a encouraging the client to seek guidance from a

compassionate religious or spiritual leadercompassionate religious or spiritual leader giving/receiving blessingsgiving/receiving blessings encouraging forgiveness and/or repentanceencouraging forgiveness and/or repentance cognitive restructuring of irrational religious or spiritual cognitive restructuring of irrational religious or spiritual

beliefs (discernment required)beliefs (discernment required)

For other less severe spiritual issues and concerns, For other less severe spiritual issues and concerns, examples of major therapeutic techniques include:examples of major therapeutic techniques include:

spiritual relaxation or guided imageryspiritual relaxation or guided imagery meditation and/or prayermeditation and/or prayer journaling about spiritual feelingsjournaling about spiritual feelings study of scripture or spiritual textsstudy of scripture or spiritual texts using the clientusing the client’’s support systems support system participating in religious services or spiritual gatheringsparticipating in religious services or spiritual gatherings encouraging the client to seek guidance from a encouraging the client to seek guidance from a

compassionate religious or spiritual leadercompassionate religious or spiritual leader giving/receiving blessingsgiving/receiving blessings encouraging forgiveness and/or repentanceencouraging forgiveness and/or repentance cognitive restructuring of irrational religious or spiritual cognitive restructuring of irrational religious or spiritual

beliefs (discernment required)beliefs (discernment required)

http://www.youtube.com/watch?v=z9nOD6foI64&feature=related

http://www.youtube.com/watch?v=z9nOD6foI64&feature=related

Mystical Experiencehttp://www.youtube.com/watch?v=UQ44lJ-eItw