Thus, insofar as it is possible--and all of us fail now and then when one of our private interests is touched upon--the psychiatrist remembers that his role is that of an expert.
--Harry Stack Sullivan, The Psychiatric Interview (1954, p36)
On Oct. 20, 2000, the New York Academy of Medicine, the New York Medical College and the World Psychiatric Association jointly sponsored a conference titled "Psychiatry and Religion: Friends or Foes?" The conference was oversubscribed, with standing room only for some of the more than 150 people present. Three previous presidents of the American Psychiatric Association were in attendance; two were presenters. In the course of the daylong meeting, each speaker agreed that we have to carefully proscribe our interventions in areas outside our expertise and called on clergy to do the same. The details of where to place the boundaries were left open for discussion and are still ripe for research.
Little did any of us realize that less than a year later, expert dialogue between clinicians and clergy would be crucial in the aftermath of Sept. 11, 2001 (American Red Cross, 2002).
The need for research to determine the best mode of reciprocal collaboration between clergy and mental health care professionals was made dramatically apparent after the attack on the World Trade Center. Civic leaders called upon citizens to go to their houses of worship and to seek psychological counseling. In St. Paul's Chapel--an Episcopal church that was a main place of refuge for relief workers at Ground Zero--a handwritten sign near the entrance said, "Counselor available. Please ask" (Wakin, 2001).
For the past 10 years, I have studied the process of reciprocal collaboration between clergy and clinicians. In the last five years, I have implemented pilot projects designed to examine the complementarity of religion and mental health care within the contexts of professional and vocational specialization (Milstein et al., 1999).
Clergy or Clinician
Research has consistently shown that people with emotional problems most frequently turn to clergy for help (Chalfant et al., 1990; Gurin et al., 1960; Veroff et al., 1981) and that even people with serious mental illness are as likely to contact clergy as they are to contact mental health care professionals (Larson et al., 1988). In a survey conducted less than one month after Sept. 11, approximately 60% of all the respondents said they would likely seek help from a spiritual counselor, compared to 45% of all the respondents who would likely seek help from their physician and 40% who would seek help from a mental health care professional (American Red Cross, 2002).
People do not choose these patterns of help-seeking because they are unaware of mental health care resources. Rather, they do so because they are more familiar with clergy, clergy do not charge fees and there is less stigma involved in discussing one's personal problems with clergy (Chalfant et al., 1990; Schindler et al., 1987). It is estimated that 10% of people who go to clergy with psychological problems are then referred to mental health care professionals (Mollica et al., 1986). Few studies have examined circumstances wherein mental health care professionals have made referrals to or consulted with clergy (Weaver et al., 1998, 1997).
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