From personal experience to clinical practice to research: A career path leading to public policy changes in integrating spirituality into mental health.

By David Lukoff

images.jpegMy initiation into spirituality both personally and professionally began with some lived experience in my early 20s that provided me with both a mental health challenge (during which I benefitted greatly from a 5-year course of psychotherapy with a psychologist figuring out what led me to believe for 2 months that I was a reincarnation of Buddha and Christ writing a new holy book) and a spiritual awakening that led me from being an atheist to becoming a spiritual seeker. As Beebe (1981) pointed out, “Psychosis introduces the individual to themes, conflicts, and resolutions that may be pursued through the entire religious, spiritual, philosophical and artistic history of humanity” (p. 252). I read Jung and Joseph Campbell to understand the larger cultural and psychological context of my non-ordinary experiences (Grof, 1993). I started a meditation practice and attended retreats with Lamas and Zen Masters, took qigong courses, and studied Medicine Wheel teachings and ceremonies with Wallace Black Elk, a Lakota Medicine Man. Ultimately, this spiritual quest led me to fulfill the archetype of a wounded healer by becoming a clinical psychologist (for a fuller account see Lukoff, 1991, 2013).

In my American Psychological Association approved graduate psychology program in the mid 1970s, I was told that if clients wanted to talk about religious issues (the term spirituality was not in common use back then), we should refer them to a pastoral counselor or religious professional. This was an appropriate approach for meeting APA ethical standards pertaining to competence since at my school, as is still true of most schools, students were not prepared to work with religious and spiritual issues (Vieten et al., 2013). However, I had already begun a meditation practice and taken courses in Qigong before starting graduate school. When it was time to choose a dissertation topic, I designed a study of a holistic health program for patients with schizophrenia that included meditation and yoga as well as sessions that focused on comparing the experiences of group members with those of shamans, mystics, and artists (Lukoff et al., 1986). Early in my career I identified as a transpersonal psychologist because of my interest in spirituality and mindfulness practices that were absent in mainstream psychology at the time. Currently I am the co- president of the Association for Transpersonal Psychology.

My introduction to formally assessing spirituality came 10 years later when, as a psychologist at the San Francisco VA Medical Center, I began leading a dual diagnosis group. The patients were required to be in a community 12-step group, but in the group therapy sessions, it became clear that many of the patients had not made any connection to a higher power or other key elements of the 12-step program. They attended only to comply with the mandate of the program.

I initiated a group called Finding Your Higher Power co-led with the VA chaplain, a Lutheran minister, and offered individual sessions to patients who wanted to look at prior religious wounds or explore options for new spiritual paths. To conduct the individual psychotherapy, I felt the need to make a more thorough spiritual assessment. In 1988, psychology did not have much to offer in this area. I was able to obtain a copy of the pastoral counseling Spiritual Needs Assessment from St. Elizabeth’s Hospital (Washington, DC). There were also some models from the nursing literature (Stoll, 1979) and pastoral counseling literature (Hay, 1989) that were useful in creating a spiritual assessment that included family of origin religious history, current beliefs and practices, and important spiritual experiences. Because it was only a composite of other interviews, I have not included it here.

In 1994, I was one of the coauthors of the Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM–IV) category Religious or Spiritual Problem (American Psychiatric Association, 1994; Lukoff, Lu, & Turner, 1992, 1998) that served as one of the openings in the field for integrating spirituality in mental health. I began receiving requests to conduct training related to spirituality. My workshops have always incorporated training in spiritual assessment as the first step to including, or even knowing whether to include, a spiritual component in a client’s psychotherapy, wellness, or recovery plans. I initially used the spiritual assessment interview from my dual diagnosis work, but clinicians often expressed concern that they did not have time to do such a comprehensive spiritual assessment during intake sessions. Although there are a number of well-validated instruments for measuring specific dimensions of religious and spiritual coping, well-being, and qualities such as intrinsic versus extrinsic, none are designed for routine clinical use (Hill & Edwards, 2013).


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