Building the Foundation of Hope: Spirituality Group Among Long Time Psychiatric Patients Using Techniques from Cognitive

Behavioral Therapy and Dialectical Behavioral Therapy

Presented by Dorothy Symonds, M.Div., C.T.

Problem
I am poured out like water, and all my bones are out of joint; my heart is like wax; it is melted within my breast. Psalm 22:14 A person in despair wants despairingly to be himself. But surely if he wants despairingly to be himself, he cannot want to be rid of himself. Yes, or so it seems. But closer observation reveals the contradiction to be still the same. The self which, in his despair, he wants to be is a self he is not (indeed, to want to be the self he truly is, is the very opposite of despair). Sren Kierkegaard, Sickness Unto Death When asked in Spirituality Group, What can we work on this time thats different? Patients with good familiarity of inpatient psychiatric treatment respond with great consistency, Take the pain away. Despair, sometimes called Spiritual Distress or Negative Religious Coping, is most simply defined as an absence of hope. It is the problem at the core of the human existential dilemma, a problem as old as humankind. It is a problem long exclusive to the domain of theologians and philosophers and to the rights and dogmas of religion. In recent years, research in psychology and mental health nursing, and an increased focus on developing a practice based on evidence-based outcomes in Clinical Pastoral Care, has turned to look more closely into the age old existential dilemma of despair, into its negative impact on patient well being and how developing hopefulness and positive religious coping behaviors increasing a patients willingness to engage in activities and behaviors supportive of well being and improved healthcare outcomes. While the majority of current research currently explores the impact of despair among cancer patients, an emerging body of research is beginning to understand the impact of despair as an important contributor to a diminished sense of well being and hopefulness in patients who must manage life with chronic mental illness.

Goal
Weekly, patients attend a spirituality group and grief-loss group (Mourning Our Losses) on a variety of topics including, but not limited to: Forgiveness Compassion Gratitude Myths of Grief Grieving Towards New Meaning and Process

Plan
Communicate the all accepting and forgiving love of God and develop a therapeutic alliance through: empathetic attunement | compassionate concern | mirroring normalizing | acceptance Psycho-Spiritual, Psycho-Grief Education. Related to the focus topic of the group integrating the education on the human capacity and need for meaning making and the neuroplasticity of the brain. Cognitive Behavioral Therapy (CBT). As appropriate, patients are encouraged to explore their own patterns of spiritual meaning making, how those beliefs effect how they think about themselves and their world and their assumptions about their lives, life in general and God, their Higher Power or their concept of spiritual Other and his, her, its relationship with them. Patients are encouraged, as appropriate, to begin to explore any habits of thought that are not supportive of spiritual well being: all or nothing thinking over generalizations filtering magnification/minimization discounting the positive mind reading discounting the positive fortune telling emotional reasoning perfectionism unfair judgments name calling

Outcomes
Corrective emotional experiences of being accepted not only by the group, but by the Chaplain facilitator representative of God and or Church. As able, new insight into life experiences and potential for new meaning making. As able, deepening awareness of existing and newly discovered and practiced resources for grieving to new meaning. New tools for managing distressing emotions associated with working through the healthy tasks of mourning. Deepening awareness of their ability regularly engage healthy religious and spiritual coping strategies are supportive of increased hopefulness and well being.

The sessions are focused on developing and practicing positive religious coping behaviors well integrated into group-based psychiatric treatment as part of holistic interdisciplinary care in both inpatient and outpatient behavioral health treatment settings. Techniques of Cognitive Behavioral Therapy and Dialectical Behavioral Therapy are integrated into a treatment framework informed by psycho-spiritual dynamic therapy. Group is facilitated by a professional Chaplain.

Patients are encouraged to make regular use, as they are able, of CBT skills taught by other members of the interdisciplinary team. As indicated, patients are encouraged to make use of CBT techniques: reframing, hindsight biases analysis, ABC belief monitoring; special emphasis in group is place on positive belief exploration and reinforcementcompassionately comparing old self-critical beliefs about self in relation to God as they understand God to existing and/or new self-compassionate beliefs about self in relationship with the Divine. Dialectical Behavioral Therapy (DBT). Patients strengths explored and encouragedincluding DBT distress tolerance skills explored in other groups. Patients are encouraged to explore and claim own reasons for wanting to understand the meaning of what has happened in their lives in new ways and develop, as tolerated, an understanding of how current understandings are no longer offering benefit to their sense of well being and relationships. Mindfulness Meditation and Meditation for Compassion. Mindfulness meditation and meditation for compassion for self and others taught and practiced patients are encouraged to practice mindfulness meditation for self-regulation and increasing tolerance of distressing feelings when group process stimulates anxiety and/or disassociation. Radical Acceptance Techniques. Psycho-spiritual education on benefits of radical acceptance of self and past painful situations, in the moment. Developing capacity to tolerate associated distressing feelings in the presence of a compassionate other practiced and encouraged through the modeling and practicing radical acceptance techniques integrated with healthy strategies for grieving towards new meaning.

Hope
Hope is the thing with feathers that perches in the soul, And sings the tune - without the words, And never stops at all, And sweetest in the gale is heard; And sore must be the storm That could abash the little bird that kept so many warm. Ive heard it in the chillest land, and on the strangest sea; Yet, never, in extremity, it asked a crumb of me.

Emily Dickinson