Gods Lost, Found, and Reconsidered:

Discovering and Managing Spiritual and

Religious Coping in Clinical Care

James W. Lomax, M.D.Karl Menninger Chair for Psychiatric Educationand Brown Foundation Chair in Psychoanalysis

Presentation Objectives

• Why learn about religion and spiritual matters?

• Illustrative clinical stories, interpretation and

framework

• Discussion of your experiences

Disclosure of Interests

• Personal developments

• Institute for Spirituality and Health (ISH)

Disclosure of Interests (Cont.)

• Center for Psychoanalytic Studies

• Center for Professionalism

Spiritual Coping

• Frequent response to stress

• Positive and negative implications

• Relationship to “anomalous” experiences

• Religious Ordering, Spiritual Seeking,

Behavioral Activity

Spiritual Struggles

• Dark side to “Seeking the Sacred”

• Intrapsychic, Interpersonal, Supernatural

• Insecurity, Ambivalence, Conflictual

• Predisposing to Mood, Anxiety, Substance

Abuse Disorders

First Clinical Situation: Fred, Spiritual

Coping After Sacred Losses

• Traumatic End of Career and calling

• Compensation in Professional and Personal

Relationships

• Ongoing tensions

Treatment of a Very Complicated Grief

• Things mostly improved

• A major gap

• Building an alliance allows revelation

Psychotherapy as “Practice Field”

• Translating therapy into life

• Mutual relief

• “Displaced” recovery of shared love

Sylvia, Spiritual Struggle

• Surprising irritability and unprofessionalism

• Angrily anticipating my intervention

• Major Depression and Pharmacotherapy

• Getting and using a developmental history

• Spiritual struggles and her psychopathology

Seeking Spiritual Community

• Something missing

• Seeking community

Seeking Spiritual Community (Cont.)

• My boundary crossing

• Utility of community partnership

• Finding new community

Connecting Stories to Framework

• Two “Sacred Moments”

• Fred: Using an anomalous/sacred coping

• Sylvia: Struggles coping with “betrayals”

• Therapeutic “practice field”

• Translating therapeutic learning into repaired

(Fred) or new “community” (Sylvia)

Your Experiences Using Patient

Religious, Spiritual Resources

• What is helpful?

• What is “challenging?”

• Use of community partners

Thank you