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by Dr. Nathaniel R. Strenger

Clinicians Need Clergy

Americans seeking mental health care often turn to faith leaders first

By some counts, a quarter or more of Americans seeking mental health care turn to faith leaders first. This is according to a 2020 study out of Brigham Young University. Some 90% of Americans still believe in a Higher Power, yet only a sliver of mental health professionals reports thorough training in religious and/or spiritual issues as part of their graduate studies. The trends are what push The Center to take so seriously its efforts to equip clinicians with religious and spiritual competence.

It is also why The Center collaborates with faith groups for the sake of our communities. Pastors, church elders, organizers, and para-church operations serve crucial social functions. So, all in a day’s work, we engage faith leaders near and far. I must say, when chatting about mental health, the ministry folks I speak with mostly chime this refrain: "Refer, refer, refer..." As seminarians, it seems, faith leaders with a few exceptions learn to defer to the professionals when it comes to matters of mental health. Of course, there is little question that clinicians and clergy alike must respect one another’s professional expertise. But the difficulties distinguishing matters of faith and matters of psychology aside, I do think that we mental health professionals owe faith communities a nod too. Referral habits need not be unidirectional. They should go both ways.

So, when should mental health care providers consider referring a patient to a faith leader? I spoke with a few folks in local ministry, representing a variety of faith traditions. Across the board they echoed some iteration of this. Emotionally or existentially loaded problems of living are often intimately associated with a person’s faith. In fact, we clinicians are probably talking about matters of faith more than we are aware.

When someone is wrestling with his or her religious identity as a member of a faith community, a referral to a leader is worth considering. Pastors, rabbis, priests, imams, and so on are deeply aware (far more than we are, to be sure) of the languages, cultural experiences, and "ologies" familiar to a certain faith system.

In reference to that enormous chunk of Americans believing in some ultimate power or deity, mental health providers do well to attend to the ways a patient’s vision of, or relationship to, that deity might accommodate personal suffering. Matters of theodicy—that is efforts to reconcile images of a powerful and good God with the obvious presence of suffering or evil in the world—frequently bubble to the surface in therapeutic conversations. It does not take much to think of the ways a faith leader or designated spiritual guide might better address such questions than a licensed clinician.

And then, of course, there is the clinician’s simple need for knowledge. I, for one, know my own background and expertise. And I need not hesitate to reach out to a respected member of some faith community about which I have little knowledge. By doing so, I learn some of the ins and outs of different rites, cultural pillars, and systems of thought common to a religious or spiritual tradition.

Of course, a referral requires a delicate trust. Unfortunate abuses do occur in both ministry and mental health care, as they do in other helping professions. Professional relations and vetting are crucial components to be sure. With that in mind, I recommend any clinician include a diverse group of faith leaders in a well-rounded referral network. Need some help breaking the ice? Here's an idea: Join an OLOGY event!

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Lisa Miller, Ph.D., is the New York Times bestselling author of The Spiritual Child and a professor in the Clinical Psychology Program at Teachers College, Columbia University. She is the Founder and Director of the Spirituality Mind Body Institute, the first Ivy League graduate program and research institute in spirituality and psychology, and has held over a decade of joint appointments in the Department of Psychiatry at Columbia University Medical School.

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