Spirituality and the threat to therapeutic boundaries in psychiatric practice

There is a determined campaign to make exploration of patients’ spiritual experience an intrinsic and necessary part of routine psychiatric care. This has support from the Royal College of Psychiatrists, though there has been no consultation with psychiatrists. Whilst many of the proposals are uncontroversial, some involve serious breaches of normal professional boundaries of behaviour as set out in General Medical Council guidance. The contentious proposals are that a spiritual history should be taken from all patients, even where they resist; that it is sometimes acceptable to pray with patients; and that clinicians should support “healthy” religious beliefs and challenge “unhealthy” ones. The proposals are based on a model of universal spirituality which, we argue, is culture bound and lacks neutrality. This paper explores these issues and the consequences that might flow from altering professional boundaries in psychiatry. We conclude that the changes are unnecessary and should be resisted.