Norman A. Clemens

The parish clergy as a mental health resource.

SummaryThis paper presents observations on the assets and liabilities of the parish clergy as a mental health resource within the community. These observations are drawn from a ten-year program of continuing education for cleargy in mental health, which focuses on daily pastoral experience. The parish setting is similar in many respects to the service area of a community mental health center. The clergys assets often include availability, experience, tradition, and the special significance of the religious leader. Inadequate training in mental health skills and the complex demands of parish life are among the problems confronting the clergy in this area. On the whole, the pastoral role offers a unique and highly useful opportunity for positive psychological intervention.

Obstacles to Early Career Psychiatrists Practicing Psychotherapy

Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader. Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction. High educational debts, practice structures, intrusive management, and reimbursement policies that devalue psychotherapy discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of being unable to develop a critical mass of experience or a secure identity as a psychiatric psychotherapist. Implementation of parity laws and the Affordable Care Act (ACA) will affect the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care. The authors recommend 1) vigorous advocacy for better payment levels for psychotherapy and freedom from disruptive management; 2) aggressive action against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the environment for providing psychotherapy in their practice, and 4) post-graduate training in psychotherapy through supervision/consultation, continuing education courses, computer instruction, and distance learning.

In-depth continuing education for clergy in mental health: Ten years of a large scale program

This paper describes an interdenominational continuing education program for parish clergy in the mental health dimension of pastoral work. The program is in its eleventh year and has reached a significant proportion of the clergy, representing a wide range of religious, ethnic, and socio-economic groups, within a large urban community. The format utilizes case-oriented, small group discussion focused on the clergys own pastoral work. It emphasizes preventive educational activities along with the development of basic counseling and mental health skills. Ongoing evaluation indicates that the program constitutes an effective, economical, and flexible tool for continuing education with clergy.

Psychotherapy for suicidal patients with borderline personality disorder: an expert consensus review of common factors across five therapies

The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research.The publications from the proponents of five therapies for the treatment of suicidal behavior in individuals with borderline personality disorder (BPD), were reviewed and discussed by the members of the Group for the Advanced of Psychiatry, Psychotherapy Committee (GAPPC). Twenty nine published research and summary reports were reviewed of the specific treatments noted above along with two other reviews of common factors for this group of treatments. We used expert consensus as to the salient articles for review and the appropriate level of abstraction for the common factor definition. We formulated a definition of effectiveness and identified six common factors: 1) negotiation of a specific frame for treatment, 2) recognition and insistence on the patient’s responsibilities within the therapy, 3) provision to the therapist of a conceptual framework for understanding and intervening, 4) use of the therapeutic relationship to engage and address suicide, 5) prioritization of suicide as a topic to be actively addressed whenever it emerges, and 6) provision of support for the therapist in the form of supervision, consultation or peer support. We discuss common factors, their formulation, and implications for development and teaching of psychotherapeutic approaches specific to suicide in patients with borderline personality disorder and note that there should be greater attention in practice and education to these issues.

An intensive course for clergy on death, dying, and loss

In the current popular focus on death and dying, the clergy have naturally been recognized as having a central role in helping people deal with this major life crisis. Although their traditional functions in regard to death are well demar cated, thoughtful clergymen are aware that the emotional impact of ones anticipated death and the bereavement of the survivors are complex psychologi cal events to which they would like to respond with greater understanding and effectiveness. They also perceive that there are many similarities between the process of bereavement after a death and the emotional reaction to a wide variety of losses (such as divorce, rejection, illness, job loss) in everyday life. With these concerns in mind, I have described an intensive course of continuing education in which I, a psychiatrist, joined with a group of 10 clergymen in studying the human experiences of terminal illness, the loss of loved ones, and other kinds of losses.