Religious Therapy for Depression

In my last column I discussed the devastating effects that depression can have on a person’s life and the role that religious resources and a supportive faith community may play in helping to prevent or assist recovery from depression.  In this article, I address the possibility of seeking help for depression from one’s faith community and integrating one’s religious resources into therapy.

An article recently appeared on the front page of the New York Times titled “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” (March 6, 2011) in response to a decreasing trend by psychiatrists to provide psychotherapy and increasing emphasis on drug treatments. This is not because psychiatrists are no longer trained to do psychotherapy or have any less desire to do therapy.  In reality, it is the reimbursement system that encourages them to prescribe medications, instead of taking up valuable time talking with patients.  However, while drugs help enormously in the treatment of emotional disorders, they are seldom effective alone.  Drugs cannot correct the difficult life circumstances that are often at the root of emotional problems, e.g., the loss of a spouse or child, financial disaster, or the diagnosis of a terminal or chronic physical illness.  Who, then, will provide the talk therapy that patients need to help them cope with and adapt to sometimes overwhelming life circumstances?

The task of talk therapy today falls primarily on licensed counselors and psychologists.  Unfortunately, the cost of therapy is prohibitive for many.  Health insurance, if it covers counseling at all, seldom pays more than 50% of the $75-120 per session, leaving the patient to pay the balance.  Given poor reimbursement rates and mountains of paperwork, many therapists are now no longer accepting patients with Medicaid or Medicare.  This means that those in need of help often have to pay for it out-of-pocket.  For the vast majority, then, the possibility of talk therapy is becoming less and less affordable.

Other than the formal mental health care system, are there other resources that those experiencing emotional distress can turn to for support?  There is a long tradition of religious organizations helping the poor, the sick, and the suffering. Many faith communities have specific programs devoted to helping those in need.   Studies have shown that 10 to 20% of a clergy person’s time is spent counseling.  There is no cost to such therapy, and it does not carry the stigma of having a mental illness.  Volunteers from within the faith community may also be willing to take time to listen and provide support.  Unfortunately, the training that clergy undergo to provide counseling is highly variable, and volunteers may have minimal or no training at all.  However, having someone listen, encourage, and point to religious resources for support may be quite helpful during such times.

We at Duke University’s Center for Spirituality, Theology and Health are now enrolling for a randomized clinical trial in central North Carolina and Los Angeles, California, that is examining whether including a person’s religious resources as part of counseling is more or less effective than simply dealing with psychological and social issues in isolation from faith resources.  While religious faith is not usually discouraged in conventional counseling, it is also not typically supported and integrated into a person’s treatment.  Doing so may or may not make a difference, and that is what this study is about.

This study is important because it may provide rationale for including a patient’s religious faith in their psychotherapy, if this is what a person.  There is evidence that many people might prefer this, especially the two-thirds of Americans who indicate that religion is important in their daily lives.  The psychotherapeutic approaches that we are testing might easily be integrated into pastoral types of interventions that community clergy and even trained volunteers could provide.  Thus, one possible solution to the declining accessibility and affordability of talk therapy is the faith community.  If psychiatrists are no longer doing psychotherapy, then perhaps the kinds of religious psychotherapy that we are testing might be utilized by pastors to help those with emotional disorders not only cope better with difficult life situations but also deepen their spiritual lives as well.

However, will churches be willing to play a role in the care of those with emotional distress or disability?  Such people often do not fit the picture of the typical church member.  Their lives are often chaotic and can disrupt the normal flow of church life.  So the question is, given the opportunity, will faith communities embrace those who can no longer obtain care from the formal mental health care system?  Will pastors be willing to take the time (and obtain the training) to address people’s emotional needs using the techniques that we are now developing at Duke?  We will see.  The challenging days ahead of us will certainly put this to the test.

If you are currently suffering from depression, have any kind of chronic physical health problem, live in either central North Carolina or Los Angeles County, and wish to be part of our randomized clinical trial examining the effects of conventional vs. religious psychotherapy, contact Betsy at 919-323-1349 (North Carolina) or Sally at 818-409-8547 (Los Angeles County) to see if you qualify.  Be prepared for the possibility (50%) that you might be assigned to the conventional group that does not integrate your faith resources (remember, this is a research study).  If you do qualify, the counseling is free and ten 50-minute sessions are delivered by telephone (so people with health problems don’t have to leave their homes and travel to counselors’ offices).  For more information, see http://www.spiritualityandhealth.duke.edu/resources/pdfs/CBT_Study_Flyer.pdf.

Harold G. Koenig, MD

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Harold G. Koenig, MD, MHSc., completed his undergraduate education at Stanford University, his medical school training at the University of California at San Francisco, and his geriatric medicine, psychiatry, and biostatistics training at Duke University Medical Center. He is board certified in general psychiatry, geriatric psychiatry and geriatric medicine, and is on the faculty at Duke as Professor of Psychiatry and Behavioral Sciences, and Associate Professor of Medicine, and is on the faculty at King Abdulaziz University, Jeddah, Saudi Arabia, as a Distinguished Adjunct Professor. He is also a registered nurse. Dr. Koenig is Director of the Center for Spirituality, Theology and Health at Duke University Medical Center, and is considered by biomedical scientists as one of the world's top experts on religion and health.

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  • Richcross52

    There is also the Recovery International organization that provides group work for people with depression. Their services are free. They also go by the name Abraham Low Self-Help Systems. 

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