Comments On the Practical Use of Spiritual Care
Disclaimer: nothing in this post should be taken or held as clinical instruction, clinical supervision, or advisory concerning patient care.
Spiritual care is a clinical discipline.
- Spiritual care can be a clinical team member in the separate settings for physical health problems, psychiatric problems, or substance use disorders.
- And spiritual care can be a member of an interdisciplinary team treating co-occurring conditions.
The simple proof of the reality of this is seen daily in the routine work of systems that include spiritual care in their interdisciplinary process. But there is one example I would like to show you, and this example might reveal a way to better utilize spiritual care even where it already exists and is integrated.
Imagine a treatment team in a residential addiction treatment program serving those with co-occurring psychiatric conditions. And imagine that the treatment team consists of primary health clinicians, nurses, addiction counselors, clinical psychology, spiritual care, and a physician specializing in psychiatry. And the team is reviewing how each patient is doing.
The team leader asks, “How is (name of patient) doing?”
The assigned counselor says, “Good.”
After a moment, a nurse calmly states, “Not good.”
The team leader says, “Oh?”, as if to ask for more information.
The nurse says, “They’re not taking their medication for their bipolar disorder.”
To which the team leader then asks aloud to the team, “How do we understand this?”
The nurse adds, “They don’t believe in it. Neither do their parents.”
After waiting and hearing no other input, the team leader then asks, “What’s our plan?”
And at that point a pause in the team process ensues and an extended silence is held. The silence is finally broken by the Spiritual Care team member who speaks directly to the prescribing psychiatrist, saying “Here’s the open door…”
And spiritual care then provides person-specific coaching to the prescriber in understanding the basic cosmology of the patient in real-world matters. And quickly coaches the team and its members in identification and use of an open door in the patient’s world view.
And we now return to our scenario.
Prescribing psychiatrist: “Great. Thanks. I’ll be speaking with the patient and the family.”
Team leader: “Any other inputs to our plan?”
And hearing no other needed inputs to the plan, the meeting moves on.
In this way, spiritual care contributed to patient adherence to the plan.
Some systems limit spiritual care to the support of patients and family members in times of crisis and end-of-life matters.
In doing so the system seems to function as if the basic bio-psycho-social-spiritual nature of all people is not understood. And that the simple value of spiritual care in all care is not understood.
Rather, it’s almost as if the “inter-disciplinary treatment team” is not about the person as a person, but is rather:
- built by clinicians centered in their clinical identities
- all about the mix of clinical disciplines that are present
- centered in the disorder.
It’s almost as if “inter-disciplinary” does not start with what a human being is in the first place (a bio-psycho-social-spiritual being). And thus, the team is not formed in a way to include those 4 components of a person.
If any of this is accurate, does it matter, and is it practical?
In the industrialized medicine environment of today:
- there is so much attention paid to the “work relative value unit” of each clinician’s every working minute
- there is great attention paid to squeezing out maximal precision and accuracy
- there is great strain to find what is “effective, efficient, necessary, and sufficient.”
And that environment of today leaves me amazed that:
- patient adherence to any plan for any condition is not improved by applying spiritual care from the bottom up in routine care
- spiritual care is not applied to understanding every patient with every kind of condition (especially chronic conditions)
- systems often believe that the way to improve patient adherence is by adding a top-down organization-wide mandate that everyone in every discipline across the system must learn and implement some aspects of motivational interviewing and doing that will “work”.
Suggested Reading
Goodheart, C. D. & Lansing, M. H. (1997). Treating People with Chronic Disease: A Psychological Guide. American Psychological Association.