INSTRUCTIONS
The following questions address how you handle issues related to religion, spirituality, and anomalous experiences in your clinical practice.
Below are some concepts presented in the literature:
AGNOSTICISM: Opposes the gnostic (one who believes in the existence of God or gods), that is, the agnostic does not consider there to be evidence for the existence of a God, and does not know whether a God exists (Mawson, 2013).
ATHEISM: Absence of belief in the existence of a God or gods (Bullivant, 2013).
SPIRITUALITY: The search for the sacred or transcendent. It is characterized by a belief in something existing both within and beyond oneself. It is expressed through connection with others, with nature, through moral values, purpose, and meaning (Peteet, Al Zaben, & Koenig, 2018).
RELIGION: A set of practices, beliefs, and rituals connected to the sacred or transcendent. It may relate to God, the supernatural, or an absolute truth, involving sacred rituals and practices. It can be practiced both in communities that share the same ideology or privately (Peteet, Al Zaben, & Koenig, 2018).
RELIGIOSITY: Expresses the unique way in which each person experiences and expresses religion (Zangari & Machado, 2018).
SECULARIZATION: Characterized by the decline of the influence and authority of religion over individuals’ private lives and the consequent increase in autonomy in various spheres of social life. For example, law, culture, philosophy, and education are based on secular, that is, non-religious, values (Pierucci, 1998; Ranquetat Jr., 2008).
ANOMALOUS EXPERIENCES (AEs): Irregular or unusual experiences that are not necessarily pathological and are understood as expressions of subjectivity and/or culture (Cardeña, Lynn, & Krippner, 2013). Other terms used in academic literature include: “non-usual experiences”, “psychotic-like experiences” (Gin, Banerjea, Abbott, Browning, Bracegirdle, Corrigall & Jolley, 2018). Some types of AEs are:
HALLUCINATORY EXPERIENCES: Visual, auditory, olfactory, gustatory, and tactile (Guandolini, 2017).
SYNESTHESIA: A condition where one sensory stimulus triggers other sensory perceptions unrelated to the experience (e.g., perceiving colors in musical notes) (Tomasi, Brandes, Lopes, Klostermann, & Cyrino, 2018).
OUT-OF-BODY EXPERIENCES: A sensation of leaving the body, floating, and seeing oneself from a distance (De Sá & Mota-Rolim, 2015).
NEAR-DEATH EXPERIENCES (NDEs): Occur in individuals declared clinically dead who describe their final moments or were exposed to severe life-threatening situations (Moody, 1977).
LUCID DREAMS: Awareness of dreaming, where the subject may influence dream elements (Rodrigues, 2016).
ANOMALOUS HEALING EXPERIENCES: Reports of unexpected healings without medical intervention or medication (Cardeña, Lynn, & Krippner, 2013).
PAST LIFE EXPERIENCES: The individual believes they have lived a past life, where they were someone different from their current self (Stevenson, 2010; Tucker, 2007).
MYSTICAL EXPERIENCES: Contact with the sacred and/or divine, difficult to describe objectively (Bingemer, 2015; Stace, 1960).
PSI-RELATED EXPERIENCES: Anomalous transfer of information or energy without motor processes (e.g., telepathy, precognition) (Cardeña, 2018).
ALIEN ABDUCTION EXPERIENCES: Experience of being taken by a UFO (Apelle, Lynn & Newman, 2013; Bullard, 1987; Martins, 2016).
Reminder: Answer the questions according to how your clinical practice actually occurs, not how you would like it to be or consider ideal!
FACTOR 1
- Religion and spirituality are important aspects of human cultural diversity and should be addressed in psychotherapy just like any other aspect that is important to the patient.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Consider the following clinical case: Patient X was born into a Spiritist family and raised in that religious tradition, actively attending the Spiritist Center and working as a medium. Recently, he had a disagreement with his colleagues at the Center and started attending a nearby Neopentecostal church. The patient appears very satisfied with his choice, stating that he found himself in this new religion much more than in the previous one. As a psychotherapist, I acknowledge that religious/spiritual (R/S) beliefs, practices, and experiences evolve and change over the course of life.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Imagine the following situation: Your atheist patient informs you that he has been diagnosed with terminal cancer, that this causes him a great deal of anguish, and that he is struggling to cope. In this situation, I demonstrate openness and receptivity, working on this theme in psychotherapy, never disrespecting his position but remaining attentive to possible changes or questioning in his belief or non-belief that the situation may generate.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Consider a case in which the patient states they belong to a certain religion, with beliefs and practices very different from your own. In this regard, you conduct the psychotherapeutic process in an empathetic and effective manner, regardless of your own background, affiliations, and levels of religious/spiritual involvement.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Suppose the following situation: You have been seeing an evangelical patient for some time who used to regularly participate in the activities of their congregation. In the last session, they report that after entering university, they began to deny the existence of God or gods and have now become a convinced atheist. The patient reports that after adopting this position, they felt much lighter and only now realize the burden religion placed on their life, making them feel “wrong and watched” all the time. Faced with this account, as a therapist, I demonstrate openness and receptivity to better understand this issue, working on this theme in psychotherapy, considering the possible benefits and/or harms of the experience.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree
FACTOR 2
- I believe that understanding the cultural diversity of beliefs, communities, and religious and spiritual practices is essential to facilitate clinical management and to always seek a positive meaning regarding these issues.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - I keep myself updated on advances and research related to religion and spirituality specifically concerning clinical practice, mainly through books and websites on spirituality, not necessarily academic sources, but which greatly contribute to my work as a psychotherapist and help me reflect on my beliefs and competencies to deal with the patient.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - I have a long personal history regarding religion and/or spirituality, and this strengthens me and makes me feel that I have enough knowledge to deal with the topic in psychotherapy.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - When my patient reports anomalous experiences, I consider that my own experiences and beliefs in this regard are fundamental to my clinical practice. In fact, I often share my own experiences to help the patient understand theirs.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - I believe that understanding the diversity of anomalous experiences is essential to clarify the nature of the patient’s experiences and to guide them on how to develop spiritually.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - I keep myself updated on advances and research about anomalous experiences mainly through books and websites that address this topic, not necessarily academic, but that greatly contribute to my practice. These readings also help me assess my own competencies to deal with the subject.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - When my patient brings problems related to their religiosity and/or spirituality to therapy, I identify and address the issue. Depending on the situation, the problem can be resolved either in the context of psychotherapy or in a religious, spiritual, or secular setting. Thus, I make referrals to such places when necessary.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree
FACTOR 3
- When my patient reports their religious/spiritual beliefs, I consider that my own experiences and beliefs do NOT influence my clinical practice in any way.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - In my clinical practice, when a patient speaks about issues related to anomalous experiences, I usually listen attentively because I consider these experiences to be an important clinical symptom.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Consider the following clinical case: Patient Z has always reported seeing and hearing a being he refers to as a “spiritual mentor.” Two months ago, the patient reported a dream in which the “mentor” said goodbye, and since then, the patient no longer sees or hears him. As a psychotherapist, I recognize an evolution in this symptom.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Consider the following clinical case: Patient Y suffered cardiac arrest and had a Near-Death Experience (NDE). Since then, he reports no longer being afraid of death, which previously caused him great suffering and anxiety. In this case, I understand that this is a psychotic-like experience, probably related to the biological effects of cardiac arrest, but I should monitor the evolution of the condition to rule out a possible psychopathological diagnosis.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Consider the following clinical case: Patient W reports having dreamed that her partner had a car accident and died. A few days later, her partner actually suffers a fatal accident. The patient feels very guilty and presents a depressive condition because she believes the dream was a message for her to save him, but she did not take it seriously. In this case, I consider the experience a coincidence and would aim to treat the patient’s depression.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Consider the clinical situation: Patient C claims to have memories of past lives and refers to them during the psychotherapy session. You listen to the experience empathetically, seeking to identify associated symptoms, since science has not proven the existence of past lives.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - Consider the following clinical situation: A patient reports in psychotherapy having had an anomalous experience called a mystical experience, and that it made them feel good. In this case, I listen attentively and assess whether the experience was indeed beneficial. I do not consider it something to be explored in psychotherapy.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree
FACTOR 4
- In the clinical intake interview, I ask about patients’ religious and spiritual background, experiences, practices, attitudes, and beliefs as a standard procedure for understanding their history.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - I am aware of research on religion and spirituality that indicates that religious/spiritual beliefs and practices can contribute to well-being and mental health.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - In the clinical intake interview, I usually do NOT ask about patients’ religious/spiritual background, experiences, practices, attitudes, and beliefs.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree
FACTOR 5
- When my patient reports their religious/spiritual beliefs, I consider that my own experiences and beliefs may influence my clinical practice. Therefore, I must be careful not to impose my background on the patient.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - When I realize that I do not have sufficient knowledge about religion and spirituality to handle a situation presented by a patient, I acknowledge the limits of my qualifications and competencies and seek to consult other professionals more qualified in the subject—people who have deep knowledge of the topic (such as priests, rabbis, pastors, etc.)—or I refer the patient to other professionals.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree - When I realize that I do not have sufficient knowledge about anomalous experiences to handle a situation presented by a patient, I acknowledge the limits of my qualifications and competencies and seek to consult and/or collaborate, or even refer them to other professionals more qualified on the subject.
( ) Strongly disagree
( ) Disagree
( ) Neither agree nor disagree
( ) Agree
( ) Strongly agree
Qualitative Questions (for reflection):
- Would you like to comment on any situation/case in which the theme of religiosity, spirituality, and/or secularity was addressed in psychotherapy?
- In your opinion, what are the barriers/difficulties psychotherapists face in talking about religion/spirituality in psychotherapy?
- Would you like to comment on any situation/case in which you did not know what to do regarding anomalous experiences (AEs) in psychotherapy?
- Do you identify any difficulty in talking about AEs during the clinical intake interview? If so, what are they?
Application Recommendations:
For better visualization, the thesis presented the CRESEAP questionnaire with items grouped according to each factor. However, for administration, it is suggested that the items be presented in random order.
Regarding scoring, it should be noted that direct items (1, 2, 3, 4, 5, 6, 9, 16, 24, 25, 27, 28, and 29) are scored as follows:
Strongly Disagree | 1 |
Disagree | 2 |
Neither Agree nor Disagree | 3 |
Agree | 4 |
Strongly Agree | 5 |
Additionally, 16 of the 29 items are reverse scored. They are: 7, 8, 10, 11, 12, 13, 14, 15, 17, 18, 19, 20, 21, 22, 23, and 26. For these items, the scoring is as follows:
Strongly Disagree | 5 |
Disagree | 4 |
Neither Agree nor Disagree | 3 |
Agree | 2 |
Strongly Agree | 1 |