Nancy Kehoe: A Pioneer

Faith and Mental Illness: An Interview with Nancy Kehoe, Ph.D. author of "Wrestling with Our Inner Angels," conducted by Therese J. Borchard on Beyond Blue, (Please click on "A Pioneer" above to go to the original.)

Nancy is a Society of the Sacred Heart sister and a psychologist in Cambridge, Massachusetts.

1. Why are so many mental health professionals so opposed, reluctant, or uncomfortable talking about religion and faith with their clients?

Nancy: "Because of Freud's unparalleled influence on the way psychodynamic training and mental health treatment has been practiced in this country since the early 20th c. his views on religion have been profoundly influential. Essentially he viewed religion as a symptom of immaturity or pathological disorder. Until the most recent edition of the DSM ( Diagnostic and Statistical Manual) all the references to religion were negative, symptoms of illness. In addition to the historical roots, the omission of the discussion of religion in treatment is also related to the fact that mental health professionals have higher rates of atheism and agnosticism than the general population." (Wrestling with Our Inner Angels" p. xxi.)

What this brief paragraph does not address is the discomfort that clinicians feel in talking about religion and faith with their clients because of their own unresolved issues around their religious backgrounds. For many clinicians, psychiatry, psychology, psychoanalysis has become their religion. These disciplines have many of the characteristics associated with religion - a system of beliefs, an oral and written tradition, authority figures, rules, rituals and a community of fellow believers.

Other factors exist that make it difficult to talk about religion and faith with clients.

• Clinicians often feel uncertain as to what to ask, what questions may be perceived as intrusive or judgmental. For this reason I developed a religious history questionnaire to offer mental health providers ways of exploring a person's religious/spiritual background. (A copy of this may be obtained from the author at www.expandingconnections.com)
• Clinicians are anxious that a client may ask them about their beliefs.
• Judgment, proselytizing, dogmatism, an inability to have an open, respectful conversation about beliefs make it difficult to have a discussion in society at large and these same elements make it difficult to have a conversation in a therapeutic environment.

2. How would you advise a person seeking treatment from depression and anxiety to broach the topic of religion?

Nancy: When a person of faith, or a person with a strong spiritual practice, one for whom participation in a religious tradition is an important part of who they are, then he/she should ask the therapist if he/she is open to talking about this aspect of the client's life. That does not mean that the therapist be a believer himself or herself, but that he or she can attend to this aspect of a client's life respectfully and non-judgmentally. Asking questions that lead to a deeper understanding of the role a person's faith or practice plays in his or her life are a vital part of therapy and do not suggest a negative attitude toward a person's beliefs.

Therapists do not need to know about every religion but they do need to have an attitude or respectful curiosity and the ability to withhold judgment. It is important to trust one's own sense of whether the therapist seems open and willing to talk about a person's religious beliefs.

3. How can you find a mental-health professional open to faith discussions?

Nancy: Finding the right therapist is often a challenge. Factors that affect the options are:

• the area in which one lives,
• the resources that are available,
• the insurance one carries,
• the networks one has

In some states a person can call the parent organization such as the American Psychiatric Association, the American Psychological Association, and the Association of Licensed Social Workers and ask if they have therapists on their lists that are open to the discussion of religion/faith/spirituality in the process of treatment. Word of mouth is always a useful resource - knowing someone who has had a successful therapy and who was able to talk about their beliefs or knowing religious professionals in the area who may know therapists who have or are respectful of a faith dimension.

If a person's religious/spiritual beliefs are to be an integrated aspect of the therapy, the client must take responsibility for that and seek out a therapist that will honor that.