Existential groups led by healthcare chaplains within norwegian specialist mental health services. Patient and interdisciplinary perspectives

Background: In Norway, healthcare chaplains have a long history of leading existential groups (EGs) for patients in the Norwegian mental healthcare services. In EG practice, patients are invited to share stories about their life, reflect upon existential issues, talk about meaning in life or crisis of meaning, hope or hopelessness and share thoughts about faith. To the author’s knowledge, no previous study has explored this particular group practice in the field of chaplaincy, and only a few studies have explored existential meaning making in group practice within the research field of existential health. The role of existential meaning making and the experience of meaningfulness within treatment settings have gained interest in recent years. The existential dimension of health is believed to be of vital importance for humans’ well-being and mental health. A lack of meaning in life can be devastating and even lead to existential suffering and mental illness. Aim: The overall aim of the present study was to explore the characteristics of the EG practice led by healthcare chaplains within Norwegian specialist mental health services in light of group psychotherapy; groups and clinical traditions integrating existential, religious and spiritual issues; the healthcare chaplain’s role and professional practice; mental health professionals’ viewpoints; and patients’ existential meaning making. Design: A nationwide cross-sectional design was chosen as a research strategy and both qualitative and quantitative methodologies were used in three sub-studies. A web-based survey was used in sub-studies 1 and 2, whereas printed questionnaires were used in sub-study 3 because information was assumed to be sensitive. Materials: and method Data were gathered from Norwegian specialist mental healthcare services. A total of 101 mental healthcare professionals, including 21 healthcare chaplains, participated in sub-studies 1 and 2, while 157 patients within 44 EGs across Norway participated in sub-study 3. Data were collected via a web-based questionnaire (Questback) containing various scales developed for the purpose of exploring the EGs (sub-study 1) and the attitudes, practices, and perceptions of value among mental healthcare professionals when addressing the existential dimension (sub-study 2). Additional data were established from open-ended responses (substudies 1 and 2) to which the content analysis proposed by Graneheim and Lundman (2004) was applied as an analytical strategy. Patients’ participation and a list of 24 EG discussion topics grouped into four dimensions by an expert panel were examined (sub-study 3). Data were gathered using standardised, printed questionnaires examining psychological distress, crisis of meaning and meaningfulness. Univariate, and multivariate statistical data analyses were performed using the Statistical Package for the Social Sciences (SPSS) software. Results: Sub-study 1 revealed EGs led by healthcare chaplains to be a well-established and integrated eclectic group practice within the Norwegian specialist mental health services. Five different EG approaches provided room for patients’ existential meaning making during times of crisis, of which the psychodynamic approach was the most prominent. The narrative approach was the most distinctive. Sub-study 2 found that mental healthcare professionals’ attitudes towards addressing the existential dimension in treatment settings were open and positive. Nevertheless, a small gap between positive attitudes and the actual practice of addressing the existential dimension was identified. Sub-study 3 found a significant inverse association between lengthier EG participation and lower levels of psychological distress. The discussion topic of religious and spiritual issues was shown to have a significant positive association with the experience of meaningfulness. Conclusion: These findings indicate that EG practice led by healthcare chaplains is a well-established and eclectic group practice integrated in the Norwegian specialist mental health services. Mental health professionals reported positive attitudes towards addressing the existential dimension in treatment settings. Nevertheless, a small gap between those attitudes and the actual practice of addressing that dimension was discovered. A significant association was found between lengthier EG participation and lower levels of psychological distress. EG discussion topic of religious and spiritual issues were found to be to be significantly associated with the experience of meaningfulness. The findings may point clinicians and researchers towards the importance of creating spaces for existential meaning making, including space for discussion of spiritual and religious topics, and research in the same field. Paper I: Frøkedal, H., Stifoss-Hanssen, H., Ruud, T., DeMarinis, V., & Gonzalez, M. T. (2017). Existential group practice run by mental healthcare chaplains in Norway: A nationwide cross-sectional study. Mental Health, Religion & Culture, 20(8), 713–727. doi:org/10.1080/13674676.2017.1400528 Not in the file in Brage because of copyright restrictions. Paper II: Frøkedal, H., Sørensen, T., Ruud, T., DeMarinis, V., & Stifoss-Hanssen, H. (2019). Addressing the existential dimension in treatment settings: Mental health professionals’ and healthcare chaplains’ attitudes, practices, understanding and perceptions of value. Archive for the Psychology of Religion, 41(3), 253–276. doi:https://doi.org/10.1177/0084672419883345 Not in the file in Brage because of copyright restrictions. Paper IIi: Frøkedal, H., Stifoss-Hanssen, H., Ruud, T., DeMarinis, V., Visser, A., & Sørensen,T. Participation in existential groups led by Norwegian healthcare chaplains–relations to psychological distress, crisis of meaning and meaningfulness. (Submitted, revised)