Symposium S1

God's Image, Attachement's Figures and Psychosis

Philippe Huguelet

In Bowlby’s normative attachment conceptualization, the term “attachment relationship” does not refer to any type of close relationship but exclusively to those that meet four criteria: proximity maintenance, safe haven, secure base, and separation distress. The present study is based on the assumption that these four criteria are reasonably met as concerns the relationship of the believer with a spiritual object/figure. Two different modes of psychological coherence related to spiritual/religious coping have been described. The correspondence hypothesis suggests that there is a correspondence between early child-parents interactions on the one hand and a person’s ability to cope in relation to a spiritual object/figure on the other. According to this hypothesis, a secure attachment history would enable a person to use a spiritual/religious object/figure as an attachment figure, which proximity would help regulate affects. The compensation hypothesis suggests that an insecure attachment history would lead to a strong religiousness/spirituality as a compensation of the lack of felt security.

Thirty patients with schizophrenia or schizo-affective disorder and 20 healthy controls were interviewed in order to measure their attachment style (AAI interview and coding method), and to explore their relation to a spiritual figure as a form of spiritual coping (semi-directive interview). Qualitative and quantitative results of this study will be presented in this conference.

Adressing the Spiritual Needs of Patients with chronic psychiatric Disorders

Sylvia Mohr

The relevance of spirituality and religious coping practices (S/R) to people with severe mental disorders is even greater than the general population. S/R may be adaptive (a resource for recovery), or not (a source of despair and suffering). In a previous study, psychiatrists assessed S/R to their own patients. It elicits major spiritual themes which could be integrated into care. However, we didn’t assess patients’ wishes. This is the aim of the present study.

Method: The five psychiatrists of an outpatient psychiatric clinic in Geneva asked consecutively their patients about their wish to integrate S/R into their care; with who they share their spiritual concerns; and if they wish to discuss this issue with a psychologist leading the psycho-therapeutic group” spirituality and recovery” of the clinic.

Results: Among the 147 outpatients with severe mental disorders included in the study, less than half of them share their spiritual concerns with other people: chaplain (7%), a religious professional of their community faith (9%), psychiatrist (3%), or only relatives (24%). A quarter of patients wish the psychiatrist to address spiritual issues in their care, a third of them both with a religious professional, and 8% do not wish to address spiritual issues in their care, currently sharing this issue with a religious professional. 16% wish to meet the psychologist. The “spirituality and recovery” group was a psychotherapeutic indication for 11% of patients, other therapeutic objectives were more appropriate for 5%.

Discussion: The main result is that for one patient out of ten, S/R issues were of clinical significance to be integrated into treatment, such as supporting adaptive S/R, working on identity and value, disentangling psychotic symptoms from faith, linking the patient with a religious professional, addressing negative S/R.

Integration of S/R into psychiatric care ranges from referral to chaplain, exploration of spirituality in individual and group psychotherapies, bringing in spiritual concepts and practices into psychotherapies, to holistic care programs. When the patient express spiritual needs and wants them to be addressed by a religious professional, the integration of spirituality requires collaboration with the chaplaincy service or other relevant religious professional. Some patients wish to address spiritual issues with mental health professional only. Psychotherapies may be tailored to meet the special needs of patients.

Discussion