Multidisciplinary perceptions and considerations for spiritual care and biblical framework counseling in mental health

Disciplines identified as involved with R/S Care and/or Healthcare support for R/S Clients
Mental health clinicians (may vary based on health professional boards and state-authorized scope of practice (e.g., clinical social workers, licensed professional counselors, psychiatrists, psychiatric nurse practitioners, psychiatric pharmacists, psychologists, etc.) Clinicians and Health Practitioners (non-mental health specific, e.g., primary care physicians, nurses, pharmacists, occupational therapists, physician assistants, nurse practitioners, etc.) Religious Providers (e.g., chaplains, ministers, pastors, etc.) Therapists (non-specific, e.g., psychological counselors, etc.) Mental health caregivers (caregiving organizations and designated family caregivers)
Examples of Care Support Categories
R/S care support or interventions - monotherapy (e.g., BFC, nouthetic counseling) Psychological care support or interventions - monotherapy (e.g., psychotherapy) Medical care or interventions - monotherapy (e.g., psychopharmacotherapy) Concurrent Psychological and R/S care provided independently Concurrent Medical and R/S care provided independently Combined Psychological, R/S care (e.g., Christian counseling, integration counseling) Combined Medical, R/S care that excludes psychotherapy (e.g., Pharmacotherapy, procedures, etc. and BFC, nouthetic counseling)
Examples of identified Care Support Tasks and Interventions for R/S Clients
CBT, CT (religiously modified, e.g. Christian accommodative cognitive therapy -CT, 12-step facilitation, Christian lay coaching/counseling for psychological problems) R/S assessment (e.g., rating scale measures) R/S therapies (e.g., devotional meditation for anxiety, specific group treatments for forgiveness, marital discord, etc.) Challenging beliefs running contrary to therapeutic goals Client engagement and treatment plan adherence Consultations with Clergy Mental health symptom assessment and management Medication education Motivational interviewing Prayer with and for patients Psychoeducation Quality of life (QOL) evaluations Respecting and supporting beliefs Spiritual history-taking

[i] Notes. (R/S Clients) -Individuals who indicate R/S as significant with preference or receive R/S care from the Christian faith tradition. Literature summary references ^5,22,33-54

Table 2

Preliminary Coding Summary for the Multidisciplinary Survey

Research Question Themes, Codes, and Subcodes	Sample Quotes
HCP/Interdisciplinary willingness to coordinate care for individuals receiving BFC.
Yes-varied explanations	“I always offer to maintain communication if the patient wants it.”“Yes, but it would be hard to initiate that without it being clear that that was at the heart of the issue.”“Collaborate or keep lines of communication open to minimize MRPs or other issues and optimize outcomes.”“Yes, to ensure social resources, also congregational supports.”
No-varied explanations	“No, probably not.”“No—no at this time. My approach deals with the individual.”“No. Would refer patient to another health provider.”“No… However, if the client agreed to a multi-phasic team approach to his care, I would participate on such a team.”
HCP/Interdisciplinary support for individuals receiving BFC entails info gathering,direct care within scope of practice, communication with BFC provider, or provider referral.
Gather info-what’s most significant
All (and any) information providedChildhood information (early-life issues)Diagnosis and symptoms Faith information Medication compliance	“Psych history, spiritual history, medication history, psychotropic deprescribing history.”“…Helping clients identify and acknowledge early-life root experiences and how those experiences-often unbeknownst to them-impact their physical, emotional, and spiritual health is key to what I do.”“MM was diagnosed with Schizophrenia without any positive symptoms.”“What’s the PT’s belief system? Spiritual Assess: PT’s beliefs about their illness, the body as God’s temple, spiritual walk, belief in gifts of the Spirit, Fruit of the Spirit.”“I wouldn’t want to treat a patient for whom spirituality was very significant.”“Medication compliance.”
Kinds of interdisciplinary support
Multiple group sessions to manage emotional statesMultiple individual sessions Patient educationPrescribe or recommend medicationReferral, because BFC is out of scope of practice	“Although clients often find relief with only a few sessions, multiple individual and group sessions would help MM stabilize manage his emotional states.”“Talk therapy would be encouraged in patients like MM before the use of anti-psychotic medication.”“PT Ed on the role of meds to resolve misinfo-enhance health literacy.”“Recommendations on appropriate med therapy.”“Referral-outside of scope of practice for physical therapy.”
Follow-up or maintain BFC communication
No-no explanation
Yes, no explanationYes, if symptoms resume Yes, multiple follow-ups	“Sure.”“Yes, faith can be associated with trauma.”“I would follow up… at predetermined intervals.”“Yes, for purposes of identifying faith-centered supports.”
Interdisciplinary perceptions of BFC efficacy
DependsMore information needed, but more supports should be implementedDepends on definition of cured because relapse is possible	“….since spirituality was exercised, the mighty healer, King Jesus has cured him because he dared to believe.”“I would question if he ever had schizophrenia to begin with and if schizotypal personality disorder or a mixed form of depression would have been more fitting diagnosis.”
NoSchizophrenia is incurableTherapy is still needed	“No. This condition has no cure.”
YesBut more info is needed	“Overall, yes, I would still recommend follow ups due to the length of time MM was dealing with their condition.”

[i] *BFC-Biblical Framework, HCP-Health Care Provider/Professional, MRPs-Medication Related Problems, PT-Patient

Table 3

Theme Development Summary

Key Points
Several disciplines provide or support R/S care in mental health with different types of sole or combined interventions Individuals with severe mental illness (i.e. schizophrenia) can use religion to cope with symptoms R/S Care can be a protective factor against recidivism and suicides for schizophrenia R/S-adapted CBT found to be equivalent to regular CBT for mental health treatment	Conflicting data on worsening of already present religious delusions in those utilizing religion-based therapies, with majority reporting no worsening of symptoms; results have study limitations and more definitive research is needed Clinicians are encouraged to assess R/S relevance and incorporate into patient care Professionals have different opinions for/against R/S adaptation, integration, referral Graduate medical education advocates offering individualized religious treatment as a means of coping
Disciplines
Multiple disciplines – psychiatric, nonpsychiatric, religious, nonreligious Physicians hesitant due to time constraints and risk of offending patients	Spiritual leaders’ divergent opinions, support versus rejection of patients
Treatment (Approaches/Encounters/Outcomes)
Adjunctive, adapted, integrated Complementary/Alternative Delusions, Hallucinations – religious content Frameworks, protocols Health beliefs and behaviors Holistic Hospitalizations Measures – Assessment, rating scales, self-report Monotherapy Nonpharmacological management – patient preferences Patient need, patient-centered/individualized care Pharmacological treatment and adherence	Private religious activity (e.g. prayer) Psychotherapy -nonspecific R/S-based CBT Religious coping Religious Community/congregational support Religiously modified care as culturally adapted healthcare Schizophrenia, severe mental illness – adherence, cognition, coping, functioning, guilt, sin, stress, protective effects, suffering, recovery, relapse, risk reduction, symptoms, suicides Social support Therapeutic alliance
Values
Communication, Consultation, Collaboration Congruency (e.g., patient and provider beliefs) Culture, Cultural respect Empathy Hope Proselytize	Quality of life Religious beliefs, convictions, practices, rituals -meaning, hope, self-control, strength Rejection Stigma
Themes by Category
Multiple disciplines can be enlisted to provide and support spiritual care for mental health patients seeking biblically based treatment. Professionals’ attitudes vary about implementing R/S interventions. Religious communities may embrace or reject individuals with severe mental health conditions. Selection of R/S treatment approach, goals, and targeted outcomes for biblical clients involve ethical decision-making surrounding provider attitudes, patient health beliefs and behaviors and R/S beliefs. Interprofessional education and research for R/S care in mental health should be guided by professional values that bridge seamless, respectful communication, patient-centered religious coping, and build awareness with evidence-based efficacy.

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DOI: https://doi.org/10.15566/cjgh.v11i1.845 | Journal eISSN: 2167-2415

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Language: English

Page range: 64 - 83

Submitted on: Aug 10, 2023

Accepted on: Jan 31, 2024

Published on: Feb 25, 2024

Published by: Global Health Institute at William Carey International University

In partnership with: Paradigm Publishing Services

Keywords:

Biblical Framework Counseling (BFC),

ethics,

medical education,

mental health,

multidisciplinary,

religious/spiritual care,

schizophrenia

© 2024 Valerie U Oji, Bailey Powell, published by Global Health Institute at William Carey International University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 11 (2024): Issue 1

Multidisciplinary perceptions and considerations for spiritual care and biblical framework counseling in mental health

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