Keynotes

Helena Larsson, RN, PhD

Senior lecturer in care science

Kristianstad University, Sweden

Person-centered Care as a Remedy for Existential Loneliness

Background: Older adults are provided with care from many different professionals and care contexts. Globally care is structured in several different ways. As many older adults become frail and in need of care it is likely that their relatives and health care professionals become increasingly important for the older adult not only to satisfy physical needs but also in moments when existential concerns come to mind. One existential concern is existential loneliness often described as a deep form of loneliness that emerges in vulnerable situations in life. In order to better encounter persons who experience existential loneliness and to ease, it is important to build knowledge about experiences, expressions, situations and circumstances that can lead to existential loneliness. The project is part of the LONE study.

Objective: To explore existential loneliness from different perspectives; older adults, relatives, family care advisors and in relation to where the care is provided.

Methods: Qualitative studies based on in-depth interviews with older adults, relatives and a quantitative study with a questionnaire have been performed.

Results: Existential loneliness is often experienced in so-called limit situations in life. Existential loneliness arises in difficult choices related to close relationships, in connection with experiences of meaninglessness and in the absence of connection to something or someone. In addition, a recent study indicates that there are situations and circumstances that trigger existential loneliness in different care contexts. For example, unnecessary waiting, not feeling at home and not being treated as an adult can trigger existential loneliness.

Conclusion: The findings can be used to develop person-centred care as a remedy for existential loneliness, i.e., a care where the needs of the older adults and relatives, including the existential ones, are noticed and encountered. Since professionals in different care contexts have different conditions, there is not just one way to achieve this. The findings can be used as a basis for reflective discussions in working groups on how older adults who experience existential loneliness can be noticed and met and on how person-centred care in one’s own workplace can be anchored and developed. In order to have such discussions, it is important that the necessary prerequisites, such as time and knowledge exists within the organisation.

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Samuel Pfeifer

M.D., Specialist in Psychiatry and Psychotherapy, Prof. em.

Marburg Institute of Religion and Psychotherapy (MiRP)

Religion and Spirituality as Relevant Dimensions in Psychiatry - from Research to Practice

Approaching the relationship between psychiatric syndromes and religion/spirituality (R/S) requires the consideration of several preliminary aspects: the question of causality, the interpretation of statistical correlations, and the role of coping resources. Moreover, the formulation “relevant dimensions in psychiatric patients” points to the subjective, existential aspects of the experience in the individual. The presentation focusses on three major syndromes in psychiatric patients: a) delusions with religious content, b) depressive conditions, c) anxiety disorders. Delusional experiences are basically caused by neurobiological mechanisms; however, the content of delusions is marked by cultural factors, including religious concepts. There is empirical evidence that R/S may have a significant supportive role in patients with schizophrenia. The second group, affective disorders, shows a more varied pattern of causality, as some research has found a higher incidence in patients with a conservative, guilt oriented religious background. The correlation is complex, as there might be personality factors which attract individuals to religious traditions. A broad meta-analysis however indicates, that “religious beliefs and practices may help people to cope better with stressful life circumstances, give meaning and hope, and surround depressed persons with a supportive community.” The third group, anxiety disorders, show a marked difference between clinical anxiety disorders and complex personality constellations with a high degree of neuroticism (as a major indicator of anxiety). In the clinical group a meta-analysis could not find a correlation between R/S and the expression of the syndrome. Research into the emerging field of “Spiritual struggles” has shown a multifactorial interaction between subjective anxieties and religious conflicts, strongly influenced by the level of neuroticism, having its roots in a complex temperamental basis beyond religious factors. In conclusion the correlation of R/S and dysfunctional psychological experience may be summarized in three concepts: culture, conflict, and coping, modulated by the neuro-biological basis of psychiatric disorders.

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PDF Slides

David H. Rosmarin

Director, Spirituality & Mental Health Program, McLean Hospital; Associate Professor, Department of Psychiatry, Harvard Medical School

McLean Hospital/Harvard Medical School

Spiritual Psychotherapy for Inpatient Residential & Intensive Treatment (SPIRIT)

The statistical majority of individuals presenting to psychiatric hospitals report a desire to integrate spirituality into treatment when asked. However, due to a lack of training/clinician competency, spiritually-integrated psychotherapy is virtually non-existent within acute psychiatry. To address this disparity, we previously developed Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT), a flexible group psychotherapy protocol for clinically and religiously diverse patients presenting for acute psychiatric care. Grounded in the principles of cognitive behavioral therapy, SPIRIT delivers elements of spiritual assessment, psychoeducation, and skill building, within a non-denominational framework. In a project funded by the Bridges Consortium (a project of the John Templeton Foundation), SPIRIT was successfully piloted with 1,443 self-referred patients, by a cadre of 22 multidisciplinary clinicians (e.g., psychology, counseling, social work, psychiatry, and chaplaincy) throughout the divisional structure of McLean Hospital. Results demonstrated that SPIRIT can be feasibly provided to a large number of demographically, religiously, and clinically diverse acute patients presenting with mood, anxiety, psychotic, traumatic, alcohol/substance use, eating-feeding, and/or personality disorders. Implications for clinical practice of spiritual psychotherapy in psychiatric hospital settings will be discussed.

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Suvi-Maria Saarelainen

University Lecturer, Deputy Head (Education)

University of Eastern Finland

Religious Capital as a Central Factor in Coping with the recent Covid-19 Pandemic

When Bourdieu thinking from ‘capitals’ are transferred into everyday life, it comes visible that besides economics ‘capital’ has significance in the lives of individuals. Cultural capital provides roots for formation of knowledge. Surrounding culture provides context where important values in life are built, negotiated, tested and found. Family, relationships, and networks form the social capital in which an individual interacts. Symbolic capital forms from experiences where an individual experience being honored and recognized. Further, research has identified ‘religious’ and ‘spiritual capitals.’ In this presentation I will seek an answer to a question: what is the role of religion as a capital during the Covid-19 pandemic?

I will present results and preliminary from three different datasets to discuss how religion and religiosity has played a role in different phases of the pandemic. First dataset provides a European perspective from an explorative study and shows the importance of religious capital during the spring 2020. As according to Finnish legislation, it is the job of the Evangelical-Lutheran Church to provide psycho-social support to all Finns during the societal changes, I will shortly explain how wellbeing of Finnish church employees were found in mixed-method study in early Summer 2020. Preliminary results from the appearance of Covid-stress among Finns are presented with the third dataset.

Results show that religion provides strong anchor for meaning for those who identified themselves as believers. Both datasets (1 and 3) seem to suggest that religion supported finding experience of meaningfulness during the pandemic. From the perspective of Covid-stress, it is notable that the amount of stress is high among young participants (under 30 years) and another peak of stress seem to link to high age. Even though the church employees were doing reasonably well during the first wave of pandemic, mixed-method findings suggest from the Finnish perspective, it is crucial to make sure that the wellbeing of the employees are take care off as the legislation positions them with a pressure to support others in a need of psycho-social care.

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Hanneke Schaap-Jonker

psychologist and theologian

Vrije Universiteit Amsterdam

Shame, Society & Spirituality: How Clinical Psychology of Religion can support Mental Health

Starting point of this lecture is a socio-ecological perspective on mental health, in which mental health problems are not regarded as individual problems, but as interpersonal interaction problems within a cultural context. In this view, mental well-being also results from interactional processes on multiple levels. In line with this, recovery processes are understood in a multidimensional way.

Clinical psychology of religion is faced with the challenge to take into account this socio-ecological network perspective in its theorizing on, modeling of, and investigation of the dynamic interactions between religion/ spirituality (R/S) and mental health. At the same time, clinical psychology of religion already has a lot of expertise in the broader perspective on mental health and factors that stimulate recovery processes. In this way, clinical psychology of religion can not only enrich thinking about mental health, but also improve mental health care, responding to people’s existential care needs and their wish to integrate R/S in mental health care. It can address the role of meaning making and existential recovery in resilience and wellbeing, and give insight into existential factors which have implications for interventions on different levels of the network.

To illustrate this capacity of clinical psychology of religion, a socio-ecological approach to the emotion of shame will be discussed in relation to society and spirituality – an emotion that plays a part in various mental health problems. We will discover how shame is not only a personal and social emotion, with cultural factors leading to the hiding of shame, but also has existential aspects, being experienced on the most fundamental level of existence. Implications for research and clinical practice will be outlined.

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Prof. Dr. Siebrecht Vanhooren

KU Leuven

Save our souls: The challenge of being in therapy and counseling

The existential dimension of therapy is often explained through a set of general themes which would describe our human condition – and it’s accompanied pains and pleasures. Tillich (1952) coined the concept of the ultimate concern; the fact that we are and that we fear to be transformed into non-being. We sense this ultimate concern when we are confronted the finiteness, the fragility of life, when meaning gets lost, and which Yalom (1980) further elaborated in four specific existential anxieties: death anxiety, the fear of meaninglessness, of existential isolation, and when we are overwhelmed with emptiness, guilt, and despair. Yalom (1980) and Greening (1992) would distill four existential givens or existential challenges from Tillich’s work. The problem is not that there are existential challenges, argues Greening, but that we get stuck in the way we relate to these fundamental questions of humankind. During the last decades, research indeed shows how these existential challenges can be understood as trans-diagnostic factors that cause or enable human suffering. Death anxiety, lower levels of meaning in life, existential loneliness, and freedom-related problems (such as locus of control, hopelessness, powerlessness, helplessness) are robustly associated with the entire horizon of psychiatric disorders. When we suffer mentally, we suffer from life. Consequently, as our clients suffer from their way of existing, existence should be at the core of the psychotherapy process – and willing or not, so it does.

From an existential and humanistic psychological point of view, therapy can be understood as a crystalized life process, which can help the client’s existence to unfold. However, psychotherapy cannot escape from the human condition itself. In line with Heidegger, Merleau-Ponty, and Gendlin, human beings are basically interaction and primarily embodied. Who and how we are in therapy – as clients and therapists – depends on our interaction, is a shared timely co-existence, and is bodily felt. The experienced concerns are no longer only the client’s; the discovery of new meaning is bodily sensed by both.

In this lecture we will explore how the existential dimension runs like a backbone through the process of therapy itself, how it is a fundamentally shared experience, and how therapy is not only about meaning in life, but about life as such.

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Dr. Rania Awaad

Clinical Associate Professor & Director, Muslim Mental Health and Islamic Psychology Lab

Stanford University; Maristan

Religion and Suicide Prevention in Muslim Mental Health - A Clinical Approach

Abstract:
Suicide is one of the leading causes of death and has steadily increased throughout the past 2 decades. Religious affiliation may be associated with a lower risk for both suicide attempt and death through multiple mechanisms, including the promotion of social support, personal empowerment, healthy lifestyle, and commitment to religious life-preserving morals. In the US, Muslim individuals represent a religious minority group who are vulnerable to religious discrimination but may access mental health services more infrequently than other groups. We compare the prevalence of suicide attempts among Muslim adults compared with adults of other faith communities in the US.

Learning Objectives:
By the end of this session attendees will be able to:

Identify and discuss the impact of increased suicide attempts on American Muslims.

Reflect upon the association between the higher rates of suicide attempts in Muslim populations ascompared to other faith groups.

Visualize how the learned concepts are translated into direct community programming including Suicide Response Trainings for Religious and Community Leaders.

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Professor Christopher C.H. Cook

Emeritus Professor

Durham University

Spiritually Significant Voices: Theological and Phenomenological Perspectives

Auditory verbal hallucinations (AVHs), although traditionally associated with mental illness, are actually common in non-clinical populations, and not infrequently have spiritual/religious significance. Theological and scientific perspectives upon these phenomena have differently emphasised form and content, diagnosis and meaning. A mixed methods study of spiritually significant voices, in a largely Christian sample, was undertaken as a part of the Hearing the Voice project at Durham University, UK. 90% of participants identified the voice(s) that they had heard as being divine. The phenomenological characteristics of the voice(s) were unlike those of other groups of voice hearers, and were experienced as positive and meaningful, but do show some overlap with psychopathology that could lead to misdiagnosis. A taxonomy of spiritually significant voices is proposed.

Here you can watch the recording of the session