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Section 26 Question
26 found at the bottom of this page The thesis of this article is that clinicians could use a phenomenological approach to exorcism, which is an expulsion technique that would be beneficial to certain clients with demonic possession experiences. In the current treatment of DID, therapists use their patients perceptions of what the patients visualize, hear, and remember from the past. Generally, therapists do not take a stand on the reality or truthfulness of what their patients report. The same phenomenological approach is suggested here. This avoids tackling the theological question of the actual existence of demons. The therapist works within the belief structure of the patient. Note how Witzum and van der Hart (1993) explain their treatment philosophy toward the previously mentioned Jewish client: Instead of trying to convince [him] of the irrational nature of his hallucinations, we used culture-sensitive therapeutic techniques based on the patient s explanatory model that consisted of traditional religious and mystical sources congruent with his belief system and cultural background (pp. 84-85). It should be noted at this point that if the therapist shares the patient’s worldview, the treatment alliance may be strengthened; however, this author does not believe it is mandatory for a successful outcome. Many patients report the perception of demons, or some foreign evil entity, in their head or body. Some of them believe demons were called on by a cult to inhabit their body, and the patients were coerced into calling on them or agreeing to accept them. In addition, many patients come from evangelical, Catholic, or charismatic church backgrounds that already believe in the existence of demons or evil spirits. Therapists can use the rationale that if something alien was put into them, it can be expelled. Exorcism is a very emotion laden word that connotes scenes from the movie The Exorcist or highly charged services of television evangelists. This word is purposely used in this article. Some Christians prefer the word deliverance or spiritual warfare; however, the distinctions of these terms are not well-defined. Exorcism is used here because it has been the term derogatorily used by others in the literature. The term is meant here only as a word to describe a non-coercive expulsion technique. With patients, it is suggested that therapists may not even want to use the word exorcism unless that is a term with which the patient is comfortable. Likewise, therapists should use the word the patient uses to describe the perceived foreign entity, such as monster or creature. It is suggested to not use the word demon, unless that is the word the patient uses, nor the concept of demon possession unless that is the construct of the patient. The patient should not be pressured, coerced, or subtly led into accepting the view of the therapist, whatever he or she believes. This is only ethical. Some non-religious therapists tend to be biased against a spiritual view of psychopathology, just as some Christians tend to be biased against psychological perspectives of spirituality. Everyone has his or her own biases, not just therapists with a strong religious value system; thus, this author contents that value free therapy does not exist. Nevertheless, therapists should generally work within the values and belief system of the patient, attempting to keep their own value intrusions to a minimum. It seems ironic that calling on a higher power is standard fare for work with patients who have addictions, yet it is frowned upon and somehow seen as illegitimate for other kinds of psychiatric disorders. If a Christian faith is already part of a patient s life, why not utilize it? Patients may need to renew their past beliefs or practices, but therapists are not introducing something new or foreign. Certainly therapists must refrain from imposing their own particular faith or lack thereof, but therapists can help patients cultivate and apply what spirituality they already have in place as a beneficial tool used in the service of improved mental health. Prest and Keller (1993) support this position in a secular journal by suggesting the use of spirituality in family therapy. In addition to taking a phenomenological approach, the strong suggestion is that the exorcism be noncoercive and patient-initiated based on the previous study of Bull, et al. (1997). Hill and Goodwin (1993) give several reasons why the exorcism of Barbara proved successful. In addition to their reasons, other important variables that facilitated success should be added. Barbara sought out the exorcism for herself. It was not forced upon her. The clergyman who performed the ritual used a calm and gentle verbal approach. Finally, he taught her and her husband to use the technique on their own. The whole process was noncoercive and empowering for the patient. Ethical And Legal Questions Exorcism rituals have not been shown to be an effective treatment for DID, have not been shown to be effective for removing alternate personalities, and have been found to have deleterious effects in two samples of DID patients that experienced exorcisms outside of psychotherapy. Exorcism rituals may provide a way for some patients to rearrange images of their personality system in a culturally syntonic manner. Note that the two samples referred to are most likely Fraser (1993b) and Bowman (1993). These guidelines have not taken into account the more recent study by Bull et al. (1997). In the Christian realm, Ohlschlager and Mosgofian (1994) state, ... Christian counselors have an obligation before God and the right before the State to engage in the ethical practice of evangelism, prayer for and with clients, Bible reading and reference to Scripture, encouragement in the practice of spiritual disciplines, and assistance in spiritual warfare (p. 50). The Code of Ethics of the Christian Society for the Healing of Dissociative Disorders (CSHDD, 1998) directly addresses the use of exorcism as an appropriate technique and ethical practice within the parameters of the patient s cooperation and permission. The American Association of Christian Counselors has published its provisional AACC Christian Counseling Code of Ethics (AACC, 1998) which states: “Close or special consent is obtained for more difficult and controversial practices. These include but are not limited to: deliverance and spiritual warfare activities; ... These interventions require a more detailed discussion with patient-clients or client representatives of the procedure, risks, and treatment alternatives, and we secure detailed written agreement for the procedure.” These statements imply that exorcism is a legitimate but controversial procedure. Following the guidelines of AACC and APA, a written statement of informed consent is recommended to be signed by the client where the possible consequences of exorcism are explicitly stated. According to APA, 4.02: “... Informed consent generally implies that the person (1) has the capacity to consent, (2) has been informed of significant information concerning the procedure, (3) has freely and without undue influence expressed consent, and (4) consent has been appropriately documented.” Because the mind of a DID patient is divided or dissociated, it can be difficult to get full consent. One solution is for the therapist to get the verbal consent of an alter personality who may be involved. It is the author s experience that any resistance present should be addressed first before attempting an exorcism. A resistant alter can sabotage at a later time work that has been previously done. It is tempting to assume that no consent will be given due to the nature of spiritual warfare. However, full consent can be obtained after differentiating what the patient perceives as a demon versus an alter. Even a demonized alter can learn to see the negative effects of demonization and can choose to get help. The negative results of exorcism have largely been stated with only the use of anecdotal material (e.g., Fraser, 1993b). The one research article (Bowman, 1993) describing negative results has been countered with the study by Bull, et al. (1998), which provides evidence that exorcism may be therapeutic when done within the parameters outlined in this article. The negative results shown by Bowman are explained by the authoritarian and controlling style of exorcisms, not by the technique itself. Phenomenologically, exorcism can also be viewed as a cognitive behavioral approach to dealing with patients distress in a culturally sensitive manner. It is a cognitive restructuring of a patient s mental imagery to work within their internal metaphors and to expel what they experience as ego dystonic. Using a psycho-spiritual method that reduces psychological distress and moves patients toward integration of their fractured psyches is certainly ethical and qualifies the therapist for third party reimbursement. Legally it is wise to use a signed informed consent statement with patients before using exorcism. Another advantage of using a phenomenological approach is that the therapist avoids taking a stand on the veracity of the patients reported experiences of ritual abuse. This neutral approach is the one recommended by DID experts. This approach avoids the potential charges that therapists are creating false memories in their patients by taking on the role of patient advocate at one extreme. It also avoids hard core skepticism at the other extreme, which has left patients feeling discounted and misunderstood. Exorcisms are contraindicated and unethical when there is anything less than full and complete permission from the patient. The research has shown exorcism to be harmful in this situation (Bowman, 1997; Fraser, 1993b). In a similar vein, a counselor of any type should not unilaterally conclude that a person s symptoms are the result of demonic activity without fully discussing this with the person. Denial and lack of cooperation is not an automatic sign of demonic opposition. It has been the author s experience that demonized people still have a rational side to them that can intelligently interact with the counselor about their internal experience. Counselors should be aware that there could easily be purely psychological explanations for the symptoms expressed. It is also recommended that psychological explanations be explored first before spiritual warfare is engaged in. This is especially true when there are reasons to suspect that dissociation is being used as a defense. For instance, in any cases of severe childhood abuse or neglect, there is a likelihood of the presence of dissociation. For example, Ross (1997,p. 120-121) reviewed five studies of DID patients who reported rates of sexual abuse from 68% to 90%. Fully developed alter personalities can appear as demons to the uninformed and inexperienced. Anyone thinking of engaging in deliverance should inquire about severe childhood abuse. When it is present, appropriate psychotherapy should be entered into first before exorcism is tried. Exorcism is appropriate when a person has been treated with competent psychotherapy and the person still experiences feelings of being controlled or inhabited by an egodystonic entity. In addition, the person should give consent to the use of exorcism after being informed of the possible consequences. Following these guidelines, it seems exorcism could be defended legally on the basis of positive research, informed consent, the presence of no explicit or specific prohibition against using it, while addressing the cautions mentioned by the ISSD or the AACC. Personal
Reflection Exercise #12 QUESTION
26 Answer Booklet for this course Forward to Section 27 Back to Section 25 Table of Contents Top |
