A recent issue of Psychiatric Annals was devoted to the integration of spirituality with the practice of psychiatry. This appears to reflect a recent movement among physicians to appreciate the spiritual dimension in the lives and needs of our patients and to make an effort to address it and perhaps make appropriate and meaningful interventions along those lines.

So what does this have to do with early career psychiatrists (ECPs)? Simply this: ECPs and issues of spirituality in psychiatry have a common thread; they both reflect the future of psychiatry. ECPs need to be on the cutting edge of psychiatry; they need to know who’s pushing the envelope and in what ways its bulging. Since spirituality is one of these cutting edges, one of these envelopes being bulged, it behooves ECPs to get up to speed regarding this spirituality-psychiatry interface. It behooves ECPs not only to develop their spiritual skills and tools, but also to put them into practice, to be at the forefront of this movement, the vanguard, if you will.

This is important, because the field of psychiatry expands and grows by example, by anecdotal data. Yes, we do our best to follow protocols, algorithms, and double-blind data analyses. But the fact remains that much of what we do involves taking chances, trying higher doses, alternative paths, "rational polypharmacy" (to put it kindly). If we hear from a colleague that something works, we’ll try to work it ourselves, in the hopes of alleviating suffering in our patients, some of whom can be quite refractory to standard algorithmic treatments.

That being the case, it will be very important for the future of psychiatry that ECPs start integrating the spiritual dimension into the practice of psychotherapy (and psychopharmacology as well). Just as a good therapeutic relationship can improve a patient’s compliance with medications, so is it possible that a good spiritual relationship between doctor and patient can improve a patient’s medication compliance as well.

What exactly constitutes a "good spiritual relationship" between doctor and patient? It is a relationship in which the physician respects the patient as a whole person, appreciating that the patient has spiritual issues as well as emotional and psychosocial ones and that those spiritual issues impact both the disease and the healing process. A good spiritual relationship can be viewed as a good therapeutic relationship taken to the next level, the end result being a more profound and powerful therapeutic alliance, which translates into greater psychotherapeutic progress, perhaps by accelerating the process of empathic attunement and repair of empathic breaks.

In a good spiritual relationship the physician makes an effort to identify and explore the patient’s spiritual concerns if the patient is willing to engage in such a dialogue. What might an appropriate spiritual intervention look like? Consider a patient who presents with anger, resentments, and grievances underlying his or her depression. A simplistic spiritual intervention might suggest the idea embodied in the phrases "Forgive them for they know not what they do" or "Do not judge, lest you be judged." Certainly before that intervention is made the physician needs to establish that the patient has a spiritual concern and willingness to discuss it. The doctor also needs to clarify whether there is a spiritual or religious ideology that the patient favors and, if so, frame the intervention in the context of that ideology.

Obviously, for spiritual interventions to be effective, the psychiatrist needs to have a base of spiritual knowledge and terminology that encompasses a variety of disciplines. Medical schools and CME course developers are beginning to focus on programs to teach physicians about spiritual decisions in a form in which they can use them to help their patients.

As ECPs demonstrate to themselves and then their colleagues the value of good spiritual communication and appropriate spiritual interventions, regardless of whether the task is psychotherapy or pharmacotherapy, word of mouth will spread, anecdotal reports will abound, and this will lend confidence and courage to those who are reluctant and ambivalent about taking psychiatry to this next level, which is where it needs to go.

That being said, I encourage all ECPs to ride the wave, to lead the way into the future of psychiatry, to be the future of psychiatry, to make sure that psychiatry never loses its relevance and its connection with the human spirit as well as the human psyche.

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Dr. Jacobson is in private practice in Los Angeles and Northridge, Calif., and is on the staffs of Northridge, Cedars-Sinai, and Brotman medical centers.