Spiritually Focused Counseling and Individual Counseling for Patients with Schizophrenia
When treating schizophrenia, the concept of hope can be considered foremost in the content of
spiritual counseling practices. Hope is an essential component in healing and providing positive
coping skills for mental illnesses such as schizophrenia. Hope can be said to be at the center of
the concept of recovery from mental disorders because it is both a trigger in the healing process
as well as a sustaining factor (Schrank, Stanghellini, & Slade, 2008). Lyu and Zhang (2014)
reported in their study that schizophrenic patients with low levels of hope attempt suicide more
often.
Vrbova et al. (2017), in a crosssectional study of schizophrenic patients, showed hope to be one
of the determinants of patients’ quality of life. Olçun and Şahin Altun’s (2017) study found high
hope in schizophrenic patients to decrease the level of internalized stigma and increase resistance
to stigmatization. Hope is seen in the Jewish-Christian tradition as a virtue of God and a spiritual
gift (Schrank, Hayward, Stanghellini, & Davidson, 2011). From the Islamic point of view, God,
who creates disease, also creates healing. One must trust Allah and be free from the feelings of
vulnerability and despair; after doing everything necessary for the treatment of a disease, one
must believe that the high power is on their side. This is called tawakkul in the Islamic literature,
which means to rely on and trust in God.
This is clearly stated in the Qur’an (65:3), “And will provide for him from where he does not
expect. And whoever relies upon Allah – then He is sufficient for him. Indeed, Allah will
accomplish His purpose. Allah has already set for everything a [decreed] extent.” Hopefulness
and reliance in schizophrenic patients is considered to increase their coping skills and accelerate
treatment and the healing process. For this reason, having the whole team of health specialists
take steps to increase hope is of great importance. The results from the review study conducted
by Olçun and Şahin Altun (2017) recommend that people, especially nurses, should pay attention
to certain behaviors while working with patients with schizophrenia.
The relationship between health professionals and patients has a significant impact on increasing
hope. When developing a therapeutic relationship with patients, accepting them and
understanding their points of view are necessary. The responsibility of nurses and health workers
is to provide structured trainings to improve society’s level of knowledge regarding mental
illnesses and reduce society’s negative attitudes towards patients (Kirkpatrick, 1995). All in all,
these presented behavioral recommendations are considered important for psychologists and
psychological counselors working in the field. Mizock, Millner, and Russinova’s (2012) study,
which examined the cultural/ religious psychotherapy practices and cultural differences of
schizophrenic patients, reviewed one example of this spiritually-oriented psychological
counseling framework.
The steps in this consultation process include training, disquisition, evaluation, and practice.
While working with a spiritual focus, therapists cannot follow this process linearly due to the
nature of spiritual methods and are able to be flexible. The training phase includes the religious
and spiritual development of the therapist who will provide counseling. A lack of adequate
knowledge and skills in the therapist who is to provide spiritual counseling is very significant as
it may result in the client being misled. In the disquisition stage, the therapist can actively
question the role of spirituality in the client’s life. In the evaluation stage, therapists can use
measurement tools to determine the patient’s level of hope to assist in this process. During the
practice phase and in accordance with the spiritual history of the counselee and the goals
determined in the therapy session, activities can be done such as praying; meditating; holy book
or devotional readings; performing religious services in a house of worship; singing in religious
groups; or talking with religious leaders, peers or providers, depending on the specific religious
doctrine adhered to (Fallot, 2008). Although fundamentally a coping mechanism, religion and
spirituality can help to deal not only with illnesses (symptoms) but also with challenges in social
and daily life (Huguelet, Mohr, & Borras, 2009).
When reviewing published studies documenting the relationship between religion and spirituality
in mental illnesses, especially in schizophrenia, depression, and substance dependence, some
interventions are noticed to have been considered within the scope of spiritual counseling
practices. With regard to these interventions in general, cognitive behavioral therapy, which is
used to describe and alter patients’ religious beliefs and unnecessary thoughts and behaviors, has
been integrated into spiritual counseling to reduce symptoms of depression. Other psychological
approaches to intervention are inspirational stories and citations from Jewish religious literature
and spiritual assessments from a psychiatrist followed by psychologically-integrated treatment,
including guidance and counseling from a religious psychologist (for schizophrenic patients).
Some studies have used spiritually-oriented interventions based on the Buddhist framework,
while others have found spiritual counseling practices through intervention groups composed of
interactions between the church community and local activists (Zagozd & Wrotkowska, 2017). A
study conducted by Rashid, Copello, and Birchwood (2012) examined which kinds of assistance
the Muslim population living in the UK have sought from religious officials for psychiatric and
related problems. The aim was to examine what patients told Muslim religious officials and what
suggestions these officials made to the patients. For this, interviews occurred with the Muslim
religious officials. As a result of the interviews, religious officials were seen to make certain
suggestions to the patients and believed that these would protect the patient. When we look at the
recommendations religious officials made to the patients; they concern when voices come, and
the recommendations are to always to chant the name of Allah, to read the verses from Allah that
will give them the confidence and power to resist the voices.
To chant (preform dhikr) is a state of remembering Allah and is believed to give power in
reducing and coping with the individual’s psychotic symptoms. In addition to praying and
reading the Qur’an, they stated giving various prayers to the patients who had for their help and
showed that these patients had made progress by using them as coping methods. When
examining studies in general, although having religious-oriented skills is not necessary, having
the necessary religious tools is considered to be more ethical in order to prevent the clinicians
who work with schizophrenic patients from misinforming them while using spiritual methods as
a means of coping. Spiritually-Focused Psychological Group Counseling in Treating
Schizophrenia Schizophrenic patients inevitably to have great problems in human relations due
to the nature of the disease.
These patients are afraid of communicating with people and are also uncomfortable with their
loneliness and isolation. Continuous individual therapy provides great support for establishing
and maintaining a healthy relationship with patients. One of the most important problems
experienced by patients is accepting the disease and not getting over the idea of why they have it.
Participating in group counseling is very important for schizophrenic patients to overcome
loneliness, to see that they are not the only ones that have this disease, and to learn other
patients’ coping strategies. The Spirituality Matters Group (SMG) was founded in 2001 in the
Clinical Research Evaluation Facility (CREF) of the Nathan Kline Institute for Psychiatric
Research (NKI), which works with the Rockland Psychiatric Center (RPC). When examining
SMG, it is seen to contain cognitive elements. Reading texts that are written for use in
counseling sessions, presentations, and banners to create an environment of discussion can be
prepared every week. Overall, each session has three stages. The first session establishes the
necessary therapeutic relationship. The second session continues with a previously-planned
group activity.
This could be an activity that includes personal sharing (e.g., talking about loneliness, hope,
forgiveness, patience, etc.) or reading religious stories, interpreting verses and hadiths in the
therapeutic environment, creating prayers, and writing. In the final session, group members are
asked to summarize the day. Then a closure is made with a formal prayer created by the group
members. When examining the results obtained from the group participants, the patients who
participated in the spiritually-focused counseling sessions are seen to have higher levels of hope.
Spiritually-oriented group counseling practices are appropriate for cooperation.
If necessary, support and guidance from religious occupational groups can be received for
guiding and informing the patients. One longitudinal analysis of such interventions may be
consulted to determine how mental coping and hope affect recovery in schizophrenic patients
(Reyheim, Greenberg, & Citrome, 2010). Based on this information, clinicians who use
spiritually-oriented coping methods can be said to be able to work with patients in accordance
with their own competencies; by integrating spiritual counseling practices into psychological
group counseling programs, they can ensure that patients positively benefit from the group
consultation process while at the same time not ignoring spiritual coping methods.
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