Obsessive-compulsive disorder with religious themes: Clinician perspectives on collaboration with clergy in the treatment of religious scrupulosity

Abstract

Experts recommend collaborating with clergy when treating obsessive-compulsive disorder (OCD) with religious themes (religious scrupulosity) and have suggested various strategies for engaging clergy. However, the frequency with which these strategies are implemented by clinicians providing OCD treatment remains unclear, and little systematically collected evidence is available to guide interactions between clinicians and clergy. Clinicians providing OCD treatment (N = 115) reported how often they collaborate with clergy when treating religious scrupulosity, how useful specific collaborative strategies were, and what barriers they face when collaborating with clergy or incorporating clients' religious values into exposure and response prevention (ERP). Almost half the sample (n = 54) reported having collaborated with a client's religious leader when treating scrupulosity OCD. Of these, most reported their most recent collaboration with clergy was at least “somewhat” helpful (n = 49) and about half reported that the religious leader's counsel was at least “somewhat” consistent with ERP principles (n = 24). Only one reported that their most recent collaboration with clergy was harmful. Clinicians described several barriers to scrupulosity treatment, such as limited awareness of OCD and ERP among clergy, clergy accommodation of OCD symptoms, and clinicians' limited knowledge of religion. While many clinicians providing OCD treatment do not engage clergy, those who do generally find these interactions helpful. Future research should examine how treatment outcomes may be impacted by collaborations with clergy, OCD psychoeducation for clergy, religious literacy training for clinicians, and how to facilitate collaboration between experts in mental health and religion.