Psychotherapy with African American Women with Depression: Is it okay to Talk about Their Religious/Spiritual Beliefs?

Abstract

A growing body of research focusing on African Americans' mental health is showing that this group relies heavily on their religious/spiritual beliefs and practices to cope with mental health issues including depression. Unfortunately, the psychotherapy literature provides little guidance on how to incorporate religion/spirituality into psychotherapy with African American women. With the growing cultural diversity of the U.S. population, there has been more emphasis on providing patient-centered culturally sensitive care, which involves providing care that is respectful of, and responsive to, individual patient preferences, needs, and values. This paper provides a synthesis of literature that psychotherapists could use to become more culturally sensitive and patientcentered in their clinical practices; that is, to recognize and integrate religion/spirituality into their work with African American women experiencing depression, and possibly other groups with similar needs.

A Scoping Review of Ethical Considerations in Spiritual/Religious Counseling and Psychotherapy

“…Several of these conceptual papers and literature reviews actually dealt with spiritual/religious interventions in special groups. These groups with their distinctive set of cultural values and beliefs are: (a) Christians (Sanders, 2016;Tjeltveit, 2016); (b) Muslims (Henry, 2015;Ibrahim & Dykeman, 2011); (c) African American women with depression (Mengesha & Ward, 2012); (d) religiously affiliated men (Robertson, 2013); and (e) individuals with schizophrenia (Mizock, Millner, & Russinova, 2012).…”

“…Understanding how the clients' attribute personal meanings to religion and spirituality is important for establishing therapeutic alliance and rapport (Mizock et al, 2012; Worthington as cited by Parker, 2011). Such an approach provides a patient-centered and culturally-sensitive care which reflects a respect for the patients' preferences, needs, and values (Mengesha & Ward, 2012). This sense of respect can be articulated in different ways.…”

Older, Church-Going African Americans’ Attitudes and Expectations About Formal Depression Care

“…Once disregarded by medical professionals, spirituality and religion have recently been incorporated into treatment considerations for individual wellbeing (Mengesha & Ward 2012). Current conceptualizations of health and treatment have begun to recognize the role of spirituality in an individual’s life, as well as aspects of belonging and social network support found in religious or faith-based groups, particularly for African American adults (Chatters, Taylor, Woodward, & Nicklett, 2015; Mengesha & Ward, 2012; Watkins et al, 2015). This tension between the medicalized view of depression and the perceived spiritual and social underpinnings of mental health issues is evident in the literature (Pearce et al, 2015; Rojas-Fernandez, Miller, & Sadowski, 2010), and provides the context for understanding how participants in this study conceptualize depression and the need for care.…”

“…There is evidence that the stigma of mental illness and treatment, coupled with mistrust of care providers for both mental and physical health, makes identifying and implementing needed interventions particularly complex (Payne, 2012; Sanders-Thompson, Bazile, & Akbar, 2004). Cultural perceptions of mental health conditions may be deeply tied to community engagement and spirituality, and the effects of these beliefs have a strong impact on patterns of help seeking and expectations of formal providers, when care is sought (Mengesha & Ward, 2012; Payne, 2012; Watkins, 2012a ; Watkins, Walker, & Griffith, 2010). Additionally, misdiagnosis of depression in African Americans is high, and language used to describe symptoms is often different than might be seen in their White counterparts; for example, descriptive (“downhearted,” “blue”) rather than clinical (“depressed”; Givens, Houston, Van Voorhees, Ford, & Cooper, 2007; Matthews & Hughes, 2001; Mitchell et al, 2015).…”

“…Over the last decade, the acknowledgment of depression as a medical illness has expanded, and orientations toward evidence-based interventions have accordingly shifted, leading to a more medicalized view of treatment. Once disregarded by medical professionals, spirituality and religion have recently been incorporated into treatment considerations for individual well-being (Mengesha & Ward, 2012). Current conceptualizations of health and treatment have begun to recognize the role of spirituality in an individual’s life, as well as aspects of belonging and social network support found in religious or faith-based groups, particularly for African American adults (Chatters, Taylor, Woodward, & Nicklett, 2015; Mengesha & Ward, 2012; Watkins, Wharton, Mitchell, Matusko, & Kales, 2015).…”