Spirituality in Practice With Marginalized Patients

What are your reactions when you meet someone who has a set of spiritual or religious belief systems that are different from your own?

Jesús Malverde is a spiritual icon that originated in Sinaloa, Mexico, over one hundred years ago. Known as “The Generous Bandit” and “The Angel of the Poor,” Malverde represents different ideas and beliefs to the people who pray to him. He is not an official Catholic saint, but people have built shrines for him, especially in Culiacán, Sinaloa, the location of a Jesús Malverde chapel. Sinaloa is also where several Mexican drug traffickers are from. They, too, have embraced Malverde, believing he will protect them from harm and arrest.

Growing up with minorities who practiced multiple faiths spanning from Islam, Christianity, Sikhism, Hinduism, Judaism, Santeria, Mormonism, and more, my eyes were opened to a wide body of belief systems from a young age. Interestingly enough, A drug and weapons trafficking ring involving members of a U.S. Iraqi community and a major Mexican drug cartel was caught selling large amounts of drugs, guns, and grenades in the 2000-2010 decades. Police in El Cajon said they've arrested more than 60 people in the takedown of the ring, whose members are suspected of being affiliated with the Chaldean organized crime syndicate based in Detroit.

In order to provide culturally sensitive services to the racially and ethnically diverse population of the United States, it is necessary for practitioners to consider the impact of spirituality and religion on health and mental health care. The relationships between spirituality/religiosity and health and mental health outcomes, although by no means definitive or clear, indicate that practitioners should be educated and sensitive to the subject. It is not possible to be completely spiritually or religiously blind when practicing in such a diverse society. Therefore, practitioners should be prepared to conduct assessments of spirituality and religiosity and to incorporate issues of spirituality into practice in an ethical and culturally competent manner.

Many believe that spirituality is a crucial dimension of life and ignoring it can be a detriment. However, having patients discuss spirituality and religiosity either as part of the assessment process or during an intervention may exacerbate their already vulnerable state and cause additional distress. For example, if a patient employs religious coping without being willing to consider other options, it can be detrimental to the process of moving forward to therapeutic change.

Lawrence and Smith introduced the EBQT paradigm, a framework that includes four principles to help practitioners determine whether they should address and incorporate spirituality in the treatment or care of a patient. These four principles are:

• Evidence: What evidence dictates the use of a spiritual adjunct to therapy with this particular patient?
• Beliefs: Does sufficient congruence exist between the patient's belief, the practitioner's belief, and the relevance of therapy?
• Quality of Care: Will the spiritual adjunct to treatment improve the quality of care for the patient? Maximum quality of care is achieved when the desired outcomes are accomplished and the patient's values are preserved.
• Time: Can this intervention be implemented within the time constraints of the clinical encounter, respecting the time committed to other patients?

In general, incorporating religion and spirituality into practice should not be spontaneous. It should be thoughtful and systematic. In some cases, such as when a patient feels rejected by God/higher power or has been abused by a spiritual/religious leader, attempts to include spirituality/religion can trigger trauma and anxiety.