While a psychology intern at McLean, David H. Rosmarin, PhD, ABPP, was regularly approached by patients wanting to talk to him about God. An orthodox Jew, the yarmulke on his head signaled that he might be available to speak about spiritual matters. He could only advise them to talk to their case manager about arranging a visit with an outside chaplain. At the time, McLean did not have one of its own.
“Early in my career, I was surprised by how little discussion there was of religion and spirituality,” said Rosmarin. “In my psychology textbooks, there weren’t more than two or three references, and they pertained only to spiritual symptoms of mental health disorders like religious OCD or religious delusions.”
Fifteen years later, Rosmarin is now director of McLean’s Spirituality and Mental Health Program (SMHP), which brings spiritually integrated care to patients who desire it.
He has published over 100 scientific papers and chapters on the topic and was recently elected president of the Society for the Psychology of Religion & Spirituality, part of the American Psychological Association.
The SMHP also provides consultation to staff in addressing patients’ spiritual/religious concerns, conducts research, and educates clinicians and trainees about spirituality and mental health.
The program also employs two chaplains—one full-time on the main campus and one part-time at McLean SouthEast—who provide spiritual care to patients, families, and staff. The program is almost entirely funded through philanthropy.
Angelika A. Zollfrank, MDiv, BCC, ACPE, reads messages written on stones in McLean’s new prayer and meditation space
Since its inception, donors have recognized the importance of integrating spirituality into mental health care and generously given to the program.
Fifteen years ago, The Reverend Dr. Barbara H. Nielsen was the program’s earliest supporter. Over the years she has been joined by long-time McLean supporters Susan and David Fowler, Anne O’Keefe, and Esther Mulroy of the Tamarack Foundation, and many others. The program also has received significant support from donors who have chosen to remain anonymous.
In sum, donor resources together with strong support from hospital leadership enabled the SMHP to evolve and grow in a number of important ways.
Prayer and Meditation Space
In December 2023, the hospital opened a tranquil, light-filled space on campus where staff, patients, and families can pray, meditate, or simply sit quietly. Angelika A. Zollfrank, MDiv, BCC, ACPE, says the room is both calming and welcoming to all. Zollfrank serves as hospital chaplain and runs McLean’s clinical pastoral education (CPE) program.
Now in its third year, the fully accredited program trains spiritual leaders and theological students of all faiths to provide spiritual care to people struggling with mental health conditions.
Clinical Pastoral Education Program
McLean is now home to one of just a handful of accredited psychiatric hospital-based Clinical Pastoral Education programs. This 400-hour commitment provides students with supervision from Zollfrank, didactic teachings from clinicians and researchers, and hands-on clinical practice across the hospital.
“The students learn about different mental health disorders, and how to make use of clinical skills—like cognitive behavioral therapy—adapted for spiritual care,” said Zollfrank. “They come away with greater self-awareness, learn to articulate their own spiritual orienting system, overcome their own biases, and practice a wide range of communication skills.”
Twenty-five people have graduated from the program thus far. They include a rabbi, two university chaplains, and the founder of an equine therapy program, among others.
Under Zollfrank’s supervision, students work with patients in assigned areas. Patients wonder, “Why is this happening to me?” “Why is God not listening?” or “Will my life ever have meaning?”
In addition, students support patients’ religious needs, offer careful assessments of whether religion or spirituality will help or hinder patients’ recoveries, and provide ways patients might connect with spiritual communities after discharge.
“Patients don’t want a theological lecture,” explained Zollfrank, “they want someone to sit with their fear and pain.”
The Work of the Chaplain
In addition to supervising CPE students, Zollfrank works directly with patients from a wide range of spiritual and religious identities who struggle from a variety of conditions.
One Christian patient was struggling with depression after losing four important people—including his father and mother—in a short period of time. Isolated in his church, he also had few hobbies.
Zollfrank talked with him about ways he could reach out to people in his faith community, prayed with him as his parents once had, provided psychoeducation about grief, and suggested he take an automotive class to stay connected with his car-loving father and meet other auto enthusiasts.
Zollfrank also supports McLean staff individually and in groups—especially during unsettled times such as the COVID-19 pandemic, the protests following the murder of George Floyd, and the current election season. Staff have weekly opportunities to engage in contemplative prayer or meditation in the hospital’s Prayer and Meditation Space.
Her regular video message called “Spirit Matters” touches on topics such as generosity, grief, solitude, and joy. These brief recordings are available to all McLean staff.
Filling the Training Gap
Research has shown that many psychiatric patients yearn to talk with someone about matters of the spirit. According to a 2015 paper co-authored by Rosmarin, almost 60% of McLean patients desire spiritually integrated care. Yet, most mental health professionals have received little to no training in how to discuss the spiritual and religious dimensions of life with their patients.
So, in 2017, Rosmarin and collaborators created Spiritual Psychotherapy for Inpatient, Residential and Intensive Treatment (SPIRIT). This group-based therapy aims to help patients understand the relationship between their spirituality and their mental health, identify spiritual or religious concepts they can leverage to bring about emotional change, and integrate religion or spiritual goals into their treatment plans.
Three dozen McLean and Mass General Brigham staff have been trained in SPIRIT, and the therapy has been provided to more than 5,000 patients.
Rosmarin said he’s tremendously appreciative of how the hospital has integrated spirituality into high-quality psychiatric care. “This is not a performative program. For the statistical majority of patients, spirituality is part and parcel of mental health treatment,” said Rosmarin.
“In many ways, this is exemplary of what makes McLean a cut above. Guided by evidence-based research, we are an open-minded institution ready to do whatever is needed for our patients. And none of this would have been possible without the generosity of McLean’s donors.”
Making Behavioral Health Research More Inclusive
McLean Assistant Psychologist Caroline C. Kaufman, PhD, has recognized a lack of spiritual or religious diversity among research participants, and she is seeking to change that.
“The problem with the underrepresentation of religiously and spiritually diverse individuals is that it precludes us from making generalizations,” said Kaufman. “It hinders the applicability of our results if they’re not relevant to the portion of our population who are religious or spiritual minorities and/or religiously observant individuals. This potentially leads to health disparities or gaps in research knowledge.”
Supported by a $50,000 grant from Harvard Catalyst, a funder of Harvard-affiliated researchers, Kaufman, SMHP Director David H. Rosmarin, PhD, ABPP, and Chaplain Angelika A. Zollfrank, MDiv, BCC, ACPE, will collaborate on a first draft of guidelines to more effectively recruit subjects belonging to religious and spiritual minorities as well as religiously observant individuals.
A “Delphi panel,” comprising 10-30 leaders Kaufman has recruited from the five major religions—Christianity, Hinduism, Buddhism, Islam, and Judaism—will review the draft and arrive at a final set of guidelines through an iterative process, using questionnaires, rounds of feedback, and revisions.
“I hope these recommendations will serve as a guide for researchers who are dedicated to engaging diverse participants in their research and maximizing the impact, applicability, and generalizability of their results,” said Kaufman.
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