Introduction
Religion and spirituality are essential parts of the human experience and, for many, they play a central role in both health and suffering. In psychotherapy, however, there is uncertainty about whether and how the spiritual domain should be addressed professionally. Increasing diversity and secularisation in Western societies such as Norway add to the dilemma. This study explores the place of religion and spirituality in Norwegian psychotherapy, in both the clinical and university contexts. The aim is to provide a more differentiated overview of the status quo and possibly make some recommendations for the future training of psychotherapists in Norway.
Methods
In a mixed-methods design, the study used statistical data collected from 260 mental health care professionals (one-third of this number are psychologists) in three Norwegian clinics, 650 psychology students from all four Norwegian universities that offer clinical training, and qualitative data was gathered from interviews with eight Norwegian psychologists who attempt to integrate the spiritual domain in their therapeutic work in different settings and specialities. One of the studies replicates a survey from 2005 and uses national norm data and current data for comparisons. Statistical and thematic analyses were used to extract results, and a literature review positions them in general international research.
Results
In contrast to the keen interest among students and the verified clinical relevance of spiritual and religious struggles as well as coping strategies related to spirituality and religiosity, this study’s data show low inclusion of relevant topics in university training and an ambivalent clinical picture; while many mental health care professionals seem to be open to the topic, only few psychologists address it actively in therapy. However, those who do, experience an enhanced therapy process with gains for both their patients and themselves. Therapist self-disclosure is identified as a barrier, but adequate training seems to be lacking.
Discussion
Discussing the results in the context of an increasingly secular and diverse society, several connections became evident. While the need for culturally sensitive psychotherapy is growing in Norway, traditional religious terminology appears to be an inhibiting factor, as it seems inappropriate in a secular health system. Existential terminology, however, could be more accessible to patients and professionals, as it addresses experiences of limitation and freedom, belonging and loneliness, guilt and responsibility, and body and mind as elements of psychological struggles. It therefore includes and exceeds pure religious or spiritual terminology. Appropriate training for psychologists should include not only knowledge, attitudes, and skills in the existential domain, but also self-reflection as a prerequisite for professional self-disclosure that does not violate ethical borders but crosses boundaries in the process of healing.
Articles belonging to this thesis:
Paper 1
Mandelkow, L., Frick, E., Büssing, A., & Reme, S. E. (2021). Norwegian psychotherapy: religiosity gap and spiritual care competence. Journal of Spirituality in Mental Health, 1-22.
Paper 2
Mandelkow, L., Austad, A., & Freund, H. (2021). Stepping carefully on sacred ground: religion and spirituality in psychotherapy. Journal of Spirituality in Mental Health, 1-21.
Paper 3
Mandelkow, L., Reme, S. E. (2022). Religious sensitivity at secular universities – a cross-sectional replication study among Norwegian psychology students. Nordic Journal of Religion and Society, 4-19