As either doctor or patient, the way we approach the religious beliefs of another person or culture can either help or hinder m sitostuations.

Psychology interns often seek guidance in dealing with spiritual or religious matters which arise during the course of psychotherapy. My internship supervisor once provided me with sage advice which I continue to rely upon almost thirty years later. He advised that if something religious or spiritual comes up during treatment ask the client if he or she is affiliated with a particular religion, then help them to explore how their life may or may not be congruent with that choice. (I’ve modified that initial question about religious affiliation by asking if the client was raised in a particular religious tradition.) That nugget of guidance has evolved in the professional literature into a wide array of tools for effective spiritually-sensitive psychotherapy.
Both the structure and function of the human brain are profoundly impacted by the spiritual concepts we hold according to Newberg and Waldman (2009). Thus both physiological as well as psychological data support the need for spiritual sensitivity in psychotherapy. Additionally, psychological research indicates that the religious orientation of a person, i.e., our stance on the continuum of internal (spirit of the law) to external (letter of the law) is far more important than the particular denomination one was raised in or presently practices (Seif, 1987a & 1981b). Spiritual sensitivity in therapy, then, is much more than simply knowing the name of the faith tradition of a client.
Having a toolbox of techniques to assist us in therapy can be invaluable in becoming a spiritually-sensitive therapist. Athiest, agnostic, lukewarm religious person, or a more committed religious person can all be taught effective strategies to help with their symptoms related to anxiety, depression, trauma, abuse, and just about anything else that we encounter in our clinical work. Let us now look at some specific tools which psychologists can use in day to day practice.
The backdrop for spiritually-sensitive psychotherapy, very much related to transpersonal psychology and mind-body medicine, was largely woven by someone who was not a mental health professional, but rather a cardiologist. Herbert Benson (1996; Benson & Klipper, 2000) expunged any reference to spirituality as he researched what was essentially Transcendental Meditation. This Eastern form of meditation was very popular in the 1960s and 1970s. Benson’s research supported the effectiveness of the repetition of a simple word or “mantra” during meditation for twenty minutes twice daily. His focus was on lowering blood pressure and improving cardiac health and his hypotheses were supported. (Benson & Klipper, 2000).
Benson’s subsequent work allowed for the use of any word which represented the spirituality of the meditator. Words such as “shalom,” “Allah,” “Jesus,” could be used as a mantra or mental anchor for meditation. He found an even greater evocation of the relaxation response, i.e., lowering of blood pressure, respiration, anxiety, etc. (Benson & Proctor, 1984). His work basically dealt with the lowering of the flight/fight response (sympathetic nervous system) and the raising of what he termed the “relaxation response” (parasympathetic nervous system).
Centering Prayer (Keating, 2009) is a form of mantra meditation that might easily be viewed as a Christian form of Transcendental Meditation. The technique is much the same and is being practiced by people all over the globe today. Jewish, Moslem, and people of just about any spiritual tradition can use these practices fruitfully, choosing a mantra that is comfortable and appropriate for them.
Are these terms taking you back in time to graduate, or even undergraduate, studies? Some form of this process is taught in general psychology courses all over the world. Today, with the advent of additional research, we call the fight/flight response the “fight/flight/freeze” response. Another well used term from psychology training is “neurotransmitter.” Neurotransmitters are an integral part of the fight/flight/freeze response. Biochemist Gottfried Kellermann has created an entire laboratory dedicated to the analysis of neurotransmitters (through urine samples) and a product line of targeted amino acids used to bring the body back into balance when needed. One category of neurotransmitters is excitatory in its effect and the other is inhibitory in nature. If this beginning to sound like fight/flight/freeze response vs. the relaxation response you are following very well. Another cultural rendition of the above, this time from Asia, leads us to think about terms like “yin” and “yang,” i.e., gentle, cooler, strongly feminine, symbolized by the moon vs. more assertive, hot, masculine, symbolized by the sun.
Now that we have noted the basic bio-psychological-cultural mechanism of action underlying many behavioral and spiritual tools used in self-care and human development, let us focus more upon the spiritual tools themselves. Though many such tools are presented as Western creations, they often have an Eastern root if one looks closely. Such is the case with the Chinese practice of qigong (pronounced like “chee gung”). This 5,000 year old practice of moving, breathing and meditating for health and wellness is actually the parent of its better know offspring, tai chi. (Medical qigong is actually a specialty in Chinese medicine whereby patients are treated but we will keep our focus on self-cultivation qigong, simply referred to as “qigong.”)
“Qi” is the Chinese word for the life force and “gong” means a skill developed over time, in this case the development, movement of, and sensitivity to qi. Such ordinary activities as eating, moving, breathing, thinking, all create and move qi, especially when the food is nutritious, the air is clean, and the self-talk is healthy. Qigong looks like tai chi in that it is often practiced as a series of flowing movements.
Unlike tai chi, which requires a very specific set of movements, there are literally thousands of forms of qigong, some as simple as one movement. Kenneth Cohen’s The Way of Qigong: The Art and Science of Chinese Energy Healing (1997) provides a fine history of qigong, a number of simple to moderately simple forms, and a scientific foundation for the practice of qigong.
Suggesting that a patient attend a qigong or tai chi class is the simplest clinical use for this modality. I have personally encountered several people who have made dramatic improvements in their lives by purchasing a qigong book or DVD and practicing with that. One woman, for example, was “on her couch” for two years after a traffic accident. Qigong helped her to get up and moving and today she is a world traveler who also teaches qigong. Another case concerns a man who had difficulty walking due to arthritis. He improved dramatically and became a disciple of qigong. Having an instructor is preferred, but educational materials alone can do the job. In addition or as an alternative to the Cohen book (1997) mentioned above, one might consider using a qigong DVD. There are a multitude of them available. One that is clear and simple would obviously be the most helpful. The author has created one (Seif, 1999) called “Qigong for the Spirit” and it is being used by individuals and groups throughout the country.
Let us now travel to India. There we find the roots of a form of “meditation in motion” called Yoga. Yogic postures are essentially body positions we stay in for a matter of seconds or minutes, thus they are stretches--spiritual stretches. In the West we often expunge the spiritual aspect out of yoga so as to be politically correct in health clubs. At root, yoga is a spiritual practice and meditation and breath work are essential aspects of this ancient practice. Thomas Ryan (1995), a Paulist Catholic priest, has written a wonderful book called Prayer of Heart and Body: Meditation and Yoga as Christian Spiritual Practice. The author retains the spiritual aspects of yoga in this well-written volume.
Yoga, like qigong and other self-regulatory practices, comes in many forms. Encourage your patients to seek out a style with which they are most comfortable. Let them know that every type of practice can be adapted to individual needs. This is especially true of qigong. This author has found Kripalu Yoga (www.kripalu.org) to be especially sensitive to spirituality and adaptable to individual conditions.
A very easy tool to teach comes in the form of breathing exercises. A common technique is something called “Hara breathing” (yogic), “tan tian” breathing (Chinese medicine), or simply “belly breathing.” It comes down to using the entire trunk to breathe by expanding the lower abdomen on the inhalation and letting it relax upon exhalation. Caveat: Please underscore the fact that one is not supposed to exert oneself excessively during this practice but rather do it in a relaxed fashion. One excellent reference book is called The Complete Book of Chinese Health and Healing (Reid, 1995).
These tools for spiritual self-care can be effective for both psychologist and patient. This leads us to the topic of self-care for psychologists. It is my observation that clinicians can be a bookish bunch, more comfortable reading a study about the tools we have discussed than actually practicing them. It is for this reason that I include a caveat which can be helpful to both psychologist and patient. Avoid the trap of spending more time reading about spiritual self-help techniques than doing them.
When guiding others to the utilization of the tools under discussion, please remember to include oneself in the audience. This is most practically expressed by one twenty minute session of meditation of some sort followed by brief and frequent practices throughout the day. Sixty seconds of a breathing exercise, a brief yoga stretch, or a qigong move between sessions can refresh and re-focus the practitioner as he or she shifts from one patient to the next.
Stress, be it psychological or physical, is cumulative. Psychological and / or chemical toxins in the body build up to a critical point and then manifest in symptoms. Such symptoms can include headache, muscle spasms, depression, anxiety, and any of the litanies of symptoms we deal with in day to day practice. Brief and frequent self-regulatory procedures such as prayer, meditation, self-hypnosis, etc. help to drain accumulating stress.
Insight, be it spiritual or psychological, comes from, in my opinion, the same place where dreams reside. Many people today can relate to the idea of keeping a “gratitude journal” (Lambert, Fincham, Braithwaite & Graham, 2009) which might be shared with a good friend, spouse, therapist, or spiritual director. Do you remember having a dream and, when you try to share it later in the day with someone, it has disappeared? Such can be the case with spiritual and psychological healing and progress. Brief thoughts jotted down can help us to cultivate the progress we make rather than letting it die off as seedlings. Additionally, the work of Lambert and his colleagues provides empirical support for the hypothesis that prayer can increase gratitude--a precious asset to any therapeutic outcome.
One might ask if these tools are spiritual or psychological. Our Western culture often equates spirituality with going to church or temple, or with the recitation of rote prayer formulas. The spiritual/psychological practices detailed above can be carried out as a way of opening the heart and mind to God in what the mystics might call “non-discursive prayer,” i.e., a simple non-verbal attitude of being with God or the Sacred. This contemplative form of prayer is more subtle and unstructured than external observances but can be radically life-changing. Consider, for example, how many of the prophetic people of our age included mind or body meditative practices in their spiritual regimes, e.g., Gandhi, George Fox, Thomas Merton, and Mother Theresa.
Director of the Spirituality and Health Institute at Santa Clara University Thomas Plante (2009) provides both religiously and non-religiously oriented therapists with a contemporary list of spiritual tools and case examples in Spiritual Practices in Psychotherapy: Thirteen Tools for Enhancing Psychological Health. A printed spiritual toolbox such as this one can be helpful, especially in the beginning, as we work at developing spiritually-sensitive psychotherapy skills.
The tools for spiritual sensitivity in psychotherapy are plentiful and support materials in the form of books, DVDs, and the like are also abundant. The spiritually-sensitive psychologist will be at his or her best by practicing what is preached, perhaps the golden rule for all whose lives are focused on service to others and gratitude for that call.



REFERENCES
Benson, H. & Klipper, M. (2000). The relaxation response. New York: HarperCollins.
Benson, H. (1996). Timeless healing. New York: Schribners.
Benson, H. & Proctor, W. (1984). Beyond the relaxation response. New York: Berkley Books. Cohen, K. (1997). The way of qigong: The art and science of Chinese energy healing. New
York: Ballantine Books.
Keating, T. (2009). Intimacy with God: An introduction to centering prayer. New York:
Crossroads Publishing.
Lambert, N., Fincham, F., Braithwait, S. & Graham, S. (2009). Can prayer increase gratitude?
Psychology of Religion and Spirituality, 1, 3, 139-149.
Newberg, A., & Waldman, M. (2009). How God changes your brain. New York: Ballantine
Books.
Plante, T. (2009). Spiritual practices in psychotherapy: Thirteen tools for enhancing
psychological health. Washington DC: American Psychological Association.
Reid, D. (1995). The complete book of Chinese health and healing. Boston: Shambhala.
Ryan, T. (1995). Prayer of heart and body: Meditation and yoga as Christian spiritual practice.
Mahwah, NJ: Paulist Press.
Seif, B. (1999). Qigong for the spirit DVD. Brodheadsville PA: Salesian Monastic Community.
Seif, B. (1981b). The effect of counselor religious orientation upon student perception of
counselors. Dissertation Abstracts International, 42. 1015A. (University Microfilms No.
81-18850).
Seif, B. (1981a). Counselor religious orientation and student discrimination of counselor-offered
therapeutic level. Counseling and Values, 26, 2-12.

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