This case study describes the treatment of "Olav," a divorced lawyer in his mid-30's, who, at the time of treatment, had been continuously hospitalized in closed, short-term psychiatric wards for more than seven years with severe treatment-resistant depression, transient psychotic episodes, self-destructive behavior, suicide attempts, and Axis II diagnoses of Borderline and Paranoid Personality Disorders, with narcissistic traits. He was about to be admitted to a long-term ward for chronic schizophrenics. A great deal of his psychopathology revolved around his feeling tortured from condemning inner voices of what he called "The Committee," which he believed were the sacred voices of God. Olav's treatment took place in our institution's "VITA" unit, a 12-week, group-based, residential day-treatment program that explicitly concentrates on existential and religious issues, and is based on principles drawn from existential, narrative, object relations, and affect theories. The VITA program includes diary-writing, affect consciousness exploration, individual therapy, and regular group sessions with such activities as mindfulness training; art therapy focusing on drawing or painting internal representations of self, father, mother, and God; reflection on existential issues; "here-and-now-oriented" psychodynamic group therapy; and physical exercise. An assessment battery of standardized, quantitative, clinical questionnaires documents Olav's dramatic improvement over the course of treatment and at one-year follow-up.
CASE CONTEXT AND METHODHistorically, religious belief as a part of a patient's mental health treatment has not been given the attention it deserves, and the patient's relationship to God is often a neglected issue in psychotherapy (e.g., Rizzuto, 1979;Shafranske, 1992). Rizzuto's (1979) research 30 years ago demonstrated the psychological significance of the individual's representations of God for psychic health and sickness. Many patients state that religious belief is an important part of their life (Bergin, 1991). Recently a journal, Psychology of Religion and Spirituality, has been established by the American Psychological Association, and other developments in the field have shown a gradually increasing focus on religious issues in psychotherapy (e.g., Rizzuto, 1979;Meissner, 1984;Shafranske, 1992; Sperry & Shafranske, 2005;Silverstein, 2008). Nevertheless, there is a long way to go in learning how to address systematically religious belief and related affects in psychiatric treatment. The present case is intended as a contribution to this ongoing development.
A. The Rationale for Selecting This Particular Patient for StudyA patient we will call "Olav" had a severe, long-standing, treatment-resistant depression linked to religious pathology, with psychotic episodes and suicidal behavior. This case was chosen to demonstrate how our institution's "VITA" model (Austad & Folleso, 2003; see below) could impact on severe pathology as well as personality structure, affect organization, and inner r...