The interface between spiritual experience and psychosis: inter-professional negotiation in early intervention services

Phenomenological similarities between spiritual crisis and psychosis have proved problematic for clinicians. Difficulties in discerning between the two are particularly challenging as is knowing how and when to intervene. Research has suggested these experiences hold potential for growth and transformation and has recommended that Early Intervention for Psychosis (EIP) clinicians facilitate these conversations with clients. Little has been published about how EIP clinicians might respond to a client presenting with a spiritual crisis and how this might be understood from a team or individual perspective, which this study aimed to address. Twenty-seven clinicians from four EIP teams were recruited using a purposive sampling strategy. Focus groups were conducted with each team using a vignette of a possible spiritual crisis to stimulate discussion. Thematic analysis was used to analyse data, which produced four main themes: 'Tentative exploration of client belief system', 'Discerning the spiritual and/or psychotic nature of the experience', 'Managing limited resources' and 'Religion as taboo'. Results suggest that clinicians struggle to meet competing demands from the client, team, profession and society. Although they attempt to categorise the experience, some spoke of tolerating ambiguity and holding a not-knowing position. Discussing spirituality and drawing on their own beliefs was discussed as something potentially helpful and potentially damaging. Fear of reprisals in terms of serious case reviews was particularly salient and often formed a barrier to engaging with spirituality. Lack of training and clear guidelines regarding how to ethically and appropriately engage with spirituality was discussed. Provision of training and formal guidance is recommended. Once clinicians feel more comfortable with this, suggestions from other research about reframing the experience as transformative with potential for growth can be evaluated empirically. However, implementation is unlikely to succeed currently given clinicians reservations about engaging with spirituality.