A transpersonal care program has been developed at the Veterans Administration Medical Center in San Francisco to provide mental health care to veterans for whom spirituality is a significant focus in their lives. Traditional psychiatry has often ignored or pathologized religious and spiritual issues. Transpersonal psychiatry recognizes spiritual growth as an essential part of psychological health.

This program, which was founded at the medical center in 1995 by John F. Hiatt, M.D., has provided mental health services to 100 veterans. Currently 50 clients are participating in a variety of treatment modalities. They include individual psychotherapy, medication clinics, and group therapy; among the therapy groups is one for people with less developed ego strength. Veterans in the program who need primary care or substance use treatment receive such services elsewhere in the medical center; however, most participants in the transpersonal care program receive all their treatment under its auspices.

The program recognizes that human consciousness is evolving, and clients' issues are framed in this context. Many clients who are struggling to find meaning at midlife have benefited from group work that addresses spiritual concerns.

The program focuses partly on the meaning of life experience, illness, and health to the client. Characterological problems, existential issues, and psychotic experiences can all be effectively addressed in this framework. Veterans with posttraumatic stress disorder have learned to experience control over their anxiety through grounding and centering meditative techniques. For others, recognizing the transformative aspects of psychotic experiences has been an important part of their postpsychosis integrative work.

Breathing exercises and visualization are used to help clients access nonordinary states of consciousness in order to facilitate psychotherapy and spiritual development. Meditative practices develop clients' capacity for introspection and self-analysis by training their attention, which enhances and facilitates psychotherapy. Studies suggest that quiet breathing with prolonged expiration reduces the rate of nerve-cell firing in the amygdala, which may lower levels of subjective anxiety. Clients use a visualization technique to still the mind and allow a spontaneous image to arise into awareness. The client regards the image with nonjudgmental attention and then explores it. Guided imagery therapy employs a client's own internal imagery to uncover and resolve emotional conflicts.

The program receives referrals from throughout the medical center, including the program for homeless patients, the psychiatric day treatment center, the HIV clinic, the nursing home and hospice program, and the psychiatric consultation-liaison service. Providers are asked to screen their clients for spiritual interests, concerns, and practices.

The transpersonal care program makes a distinction between religion and spirituality and does not incorporate any particular religious system into its approach. It has been well received by the veteran population and is growing. The program is also involved in teaching psychiatric residents and medical students.

Dr. Moran formerly was affiliated with the department of psychiatry at the Naval Medical Center in San Diego. For more information, contact John F. Hiatt, M.D., Psychiatry Department (116C), Veterans Administration Medical Center, 4150 Clement Street, San Francisco, California 94121 (e-mail, [email protected]).