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Moral distress arises in the dynamic relationship between personal factors and the organizational and political contexts of care work. Whether moral distress actually leads to a reduced well-being of health care workers or a reduced quality of care in the sector depends to a large extent on how moral tensions are dealt with, also called moral resilience, and the protective conditions available. Research about moral distress and moral resilience within the field of health care has concentrated on staff nurses and physicians. Studies into palliative terminal care and/or about the role of coordinating staff are scarce. A study was conducted to gain insight into the moral challenges that coordinators in voluntary palliative terminal care encounter in their ambition to realize good care, how they deal with these challenges, and the individual and organizational characteristics that foster or hamper moral resilience. Interviews were conducted with 20 coordinators and were qualitatively analyzed. The results brought forward 3 moral challenges in working with volunteers and in collaborating with professional care, namely, striving for connection, negotiating autonomy, and struggling with open communication. However, coordinators seemed to face these challenges effectively. In conclusion, the relational narrative strategies used by coordinators to deal with these challenges, in combination with personal and organizational conditions, foster moral resilience.

Background There is a lack of existing research on grief following the intentional death of people suffering from a mental disorder. Our study aims to provide insight into grief experiences and social reactions of bereaved persons who lost their life partners, who were suffering from a mental disorder, to physician-assisted dying (PAD) or suicide. Methods For this mixed-methods research, we conducted a survey and in-depth interviews with 27 persons living in the Netherlands and bereaved by the death of their life partners. The deceased life partners suffered from a mental disorder and had died by physician-assisted dying (n = 12) or suicide (n = 15). Interviews explored grief experiences and social reactions. In the survey we compared self-reported grief reactions of partners bereaved by suicide and PAD using the Grief Experience Questionnaire. Results Compared to suicide, physician-assisted dying was associated with less severe grief experiences of the bereaved partners. Participants reported that others rarely understood the suffering of their deceased partners and sometimes expected them to justify their partners’ death. Following physician-assisted dying, the fact that the partner’s euthanasia request was granted, helped others understand that the deceased person’s mental suffering had been unbearable and irremediable. Whereas, following suicide, the involvement of the bereaved partners was sometimes the focus of judicial inquiry, especially, if the partner had been present during the death. Conclusion When individuals suffering from a mental disorder die by suicide or PAD, their bereaved partners may experience a lack of understanding from others. Although both ways of dying are considered unnatural, their implications for bereaved partners vary considerably. We propose looking beyond the dichotomy of PAD versus suicide when studying grief following the intentional death of people suffering from a mental disorder, and considering other important aspects, such as expectedness of the death, suffering during it, and partners’ presence during the death.

The COVID-19 lockdown of Dutch long-term care facilities between March and May 2020 affected the quality of lives of residents and opposed professional and personal ethics of care. This article, based on 25 in-depth interviews with healthcare chaplains, gives insight into what moral challenges appeared for care professionals. Moral challenges were related to: ‘family ruptures’, ‘residents’ loneliness and despair’, ‘cold-hearted deaths’ and ‘response and responsibilities’. The findings illuminate the complexity of providing care during the lockdown and show variation in the impact of these ethical experiences, in which both moral distress and moral resilience occurred.

Birth and death are fundamental human experiences [...]

Chaplaincy has become increasingly professionalized in response to both the standardization in healthcare and the changing religious landscape. Whereas several studies have paid attention to the professionalization of chaplaincy as a whole, no research has been found that describes the implications for individual chaplains. The present article describes the professionalization of Dutch chaplains in the last two decades. We compared the results of two surveys conducted with chaplains in the Netherlands in 1997 and 2017. We describe professionalization by distinguishing between the changed values, expertise, and positioning of chaplains. We found that chaplains’ expertise has been developed by a growing but highly diverse body of knowledge. Furthermore, a pluralization of chaplains’ worldviews was observed, including non-religious and non-affiliated positions. Lastly, no major changes were observed in the embedding of chaplains.

Purpose The aim of this study was to analyze the views of patients, police‐officers and emergency mental health workers on the use of the police cell as intervention in a mental health crisis. Design and Methods We analyzed interviews with individuals involved in police cell interventions, found first labels and categorized them in concordance with the four principles of biomedical ethics and compared them to relevant scientific literature. Findings and Practical Implications Professionals should know that emergency mental healthcare aimed at controlling the situation is not enough to provide good care. It probably generates better outcomes for patients in the short and long term when patient experiences are taken into consideration.

Background. Religious and spiritual (R/S) struggles may impact mental health treatment and recovery processes. The current study investigates how R/S struggles play a role in mental illness and what approaches are experienced as helpful. Methods. Thirty-five semi-structured interviews with clinical mental health patients in a Christian (N = 15) and a secular (N = 20) mental health clinic were narratively analyzed. Results. R/S struggles are common in people who suffer from mental illness and often coexist together with R/S support, mostly fluctuating over time. In summary, patients experience R/S struggles as negative feelings (e.g., loneliness, shame, mistrust) and the absence of positive feelings (e.g., hope and peace). These are influenced by someone’s R/S background and beliefs, as well as by the illness and other events. All participants appreciated a receptive approach (1) and many preferred an active approach (2) by mental health professionals. Some patients reported benefits from a directive approach (3). Conclusions. R/S struggles are tightly connected with other aspects that play a role in patients with mental illness. Mental health professionals are recommended to listen to patients’ narratives and carefully consider whether or not further interventions, in order to enhance R/S support and reduce R/S struggles, might be appropriate.

Persons with a diagnosis of personality disorder struggle to experience meaning in life. This article explores how meaning in life of patients with personality disorder changes during intensive psychotherapy. In a qualitative study, life stories of nineteen Dutch patients receiving intensive psychotherapy, written both before and after treatment, were analyzed using holistic content analysis. Here, meaning in life was understood and operationalized in terms of the concept of orientation towards visions of the good by philosopher Charles Taylor. The findings suggest that patients experience both positive and negative shifts concerning meaning in life. On the one hand, in comparison to the first life stories, there is more awareness and insight about the way the ‘good’ is missing in the second life stories. On the other hand, there are more descriptions about being vulnerable, guilty or ashamed, whereas particular sources of meaning are missing.

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important.

BackgroundPrevious research has provided insight into the grief of suicide survivors, but little is known about grief following physician-assisted dying (PAD), and no prior study specifically focused on grief following PAD due to a mental disorder. The current study aims to increase insight into experiences preceding PAD or suicide of a loved one due to a mental disorder and their impact on mental health symptoms.MethodsWe performed a survey study and in-depth interviews with 27 bereaved life partners. The deceased had been in treatment for mental disorders and had died by PAD (n = 12) or suicide (n = 15). Interviews explored grief experiences and experiences with mental health care. In the survey, we assessed self-reported symptoms of grief, post-traumatic stress, anxiety, depression, quality of life, and impairments in social, and occupational functioning.ResultsAll participants reported generally low levels of mental health symptoms. Longer time since death and death by PAD were associated with lower grief intensity. Interviews showed various degrees of expectedness of the partners' death, and a varying impact of being present at the death on bereaved partners.ConclusionExpectedness of the death of the partner, absence of suffering of the partner at the time of dying, and presence of physician support may in part explain the protective effects of PAD against severe grief reactions. Physicians considering their position regarding their personal involvement in PAD due to a mental disorder could take grief reactions of the bereaved partner into account.

The present study investigates ritualizing abortion in the Netherlands. Explorative, qualitative research was conducted with semi-structured interviews (n = 13) with women who looked for counseling and 43 online personal stories about the abortion from the website of a national care and expertise center. The results reveal three main categories of ritualizing: (1) creating and using symbols privately and online, (2) remembering or honoring the experience and (3) embodied ritualizing. The data reveal that respondents find meaning in the ritualizing through sharing the experience with others, expressing various feelings through symbolic and ritual forms, fostering a connection with the child-to-be, showing respect, seeking closure and transforming the experience in a meaningful way. This research reveals types of ritualizing practices in relation to a meaningful life event such as abortion. For a specific group of women experiencing decision difficulty or existential concerns in relation to the abortion, ritualizing might be an interesting tool to be incorporated into post-abortion care practices.

Title: SEE ME: Social inclusion by meaningful ageing Abstract: In this symposium, we report on the European SEE ME project (2020-2023, Erasmus+ funding) that aims to develop an educational model and an international training toolkit for different groups of caregivers. The project's goal is to accommodate better the needs of older people receiving care by developing a broader view of what it means to grow older. The project starts from a comprehensive view of ageing that acknowledges the potentials of older people, encompasses social and meaning dimensions of the ageing experience, and envisions old age as a life stage in which autonomy and wellbeing are accessible for individuals with and without care needs. The innovative toolkit emphasises the competences of caregivers to SEE the older person behind the patient, SEE care as something more than physical and medical care, SEE social and meaning needs, and SEE the positive talents and dreams of older adults. Attention to the potentials of older people for maintaining (and restoring) social connectedness and meaningfulness, is a fundamental goal of caregiving, with significant expected gains in the overall health and wellbeing of older people. By "seeing" older people, the project contributes to the social inclusion of older adults. The presentations in this symposium are based on extensive literature reviews, complemented by empirical results of qualitative interviews with older adults and (informal, volunteer, and formal) caregivers in 5 European countries (Belgium, Germany, Italy, Netherlands, Spain). 1. Prof. dr. Machielse presents a comprehensive perspective on ageing that takes into account the potentials of older people, their social and meaning needs, and its implications for the provision of care to older adults. 2. Dr. van der Vaart presents results on innovative approaches in 'good 'practice' care projects and the skills and competencies that caregivers need to "see" and respond to the needs of older adults. 3. Prof. dr. De Donder presents the educational model and accompanying training toolkit with a specific focus on the evaluation of the first test of the training toolkit. 4. Dr. Dury presents the interim results of the six learning areas that are applying the training toolkit in their organisations.

In long-term care for people with dementia, person-centred care (PCC) is widely promoted as an approach that contributes to the well-being of persons in psycho-geriatric care. The goal of PCC is to acknowledge the personhood of residents and to indicate the responsibility of others to ensure the personhood of persons with dementia. In 2016 and 2018, qualitative empirical research was conducted with the purpose to enhance PCC and meaningful care. Five Dutch nursing homes and a total of eight communities of practice participated in the research project ‘People and their Stories’. The aim of this project was to strengthen the hermeneutic competence of care practitioners, with a focus on informal everyday interpersonal interactions between residents and care professionals. This article highlights how care professionals, by enhancing their hermeneutical competence, can do justice to the unique personhood of residents in everyday care practice. Three distinguished features for strengthening the hermeneutic competence of care professionals were formulated: respectful curiosity as a prerequisite, being able to differentiate between fact and meaning, and the awareness of own perspectives and assumptions.

The current study focuses on care for West African Victims of human trafficking (VHTs) in The Netherlands and addresses the question of how (1) social and legal professionals and (2) religious leaders of African-led migrant (Pentecostal) churches perceive their relationship with these VHTs. Thematic analyses of qualitative interviews (N = 21) revealed that both groups share the perception that VHTs are vulnerable, especially in view of so-called voodoo spells. Social and legal professionals noticed that West African VHTs prototypically appear as ‘demanding’ in a rather pro-active manner. Religious leaders on the other hand indicated that the VHTs feel at ease in the church in a more adaptive sense and may find ways of changing their lives after experiencing the Pentecostal “deliverance” ritual. Keywords: Human trafficking, Pentecostalism, West-African, migrant churches, cultural and intercultural identity, religious coping

Every life has a beginning and an end. Natality and mortality are both profound existential fundaments of life that may lead us to question meaning in life as well as to find meaning. In spiritual care, the focus is often on mortality as a source of existential suffering, and on ways to deal with such suffering according to worldview traditions. In humanist traditions, mortality is not only seen as an existential threat but also as an existential given that people need to embrace to find meaning in life. Natality has received much less attention, both in spiritual care and in humanist thought. In this article, we build on philosophical ideas of Arendt and Butler to explore the significance of natality for a humanist perspective on meaning in life and spiritual care. We argue that taking natality into account results in a relational understanding of humanist spiritual care in which the notion of “relational transcendence” is a central element. Natality also means that we can initiate, create, and act in the world, which highlights the political dimension of humanist spiritual care. We reflect on the implications of natality and relational transcendence for humanist spirituality and chaplaincy and formulate some concrete building blocks for working from this perspective.

PurposeThis study sought to identify those approaches used by coaches that enable teachers' moral learning in professional learning communities (PLCs). Coaches who support moral learning focus on questioning values, beliefs and bias, which is in contrast with learning only (new) knowledge or skills.Design/methodology/approachThis was an exploratory case study. Eleven meetings of three PLCs were observed; each PLC consisted of four teachers and one teacher–coach. Semi-structured interviews with the coaches were conducted to gain information about their approaches. Data were analysed using supportive coaching approaches derived from educational literature.FindingsIn total, 14 specific approaches regarding the support given by coaches for teachers' moral learning were identified. Four characteristics of coaches' attitudes that guided their approaches and seemed valuable in supporting moral learning were also identified. The findings showed the tensions the coaches encountered – for example, when balancing between offering a safe environment and encouraging critical reflection.Practical implicationsWith coaches' support, teachers can develop a more thoughtful understanding of the meaning of values, beliefs and bias for their actions in teaching practice.Social implicationsMaking explicit, and exploring precisely, what coaches do to support teachers' moral learning are useful for designing and improving professional development programmes that promote moral learning.Originality/valueThe research reported in this paper outlines how coaches can encourage teachers' awareness of the impact of their actions on pupils, which, in turn, helps teachers to meet the complex moral challenges of their practice.

Within monotheistic religions, guilt and forgiveness have long been important themes. In The Netherlands, however, the influence of traditional religions is declining. This qualitative interview study explored how non-religious and multireligious inmates experience guilt and forgiveness, and how the humanistic chaplain could address these issues within counselling. Guilt and forgiveness are complex constructs that are individually and subjectively experienced. Most inmates experience personal guilt and regret for what they have done. Some inmates cope with these feelings in a repressive way, where others have an active coping style. Both multireligious and non-religious inmates have a need for interpersonal forgiveness, especially from close relatives. In addition, multireligious inmates also have a transcendent need for forgiveness from a personal god. The humanistic chaplain may help inmates with an active reflection on guilt and forgiveness, which can contribute to a development on an existential level. Guilt and forgiveness ought to be approached from a counselling perspective and attention should be paid to the multiple meanings of personal responsibility. An active and critical reflection on guilt and forgiveness may lead to new meanings of the (criminal) past and create a positive change in the behaviour of detainees.

There is a reluctance within humanist chaplaincy to critically reflect on power dynamics during conversations. This reluctance stems from the idea that every person is capable of finding meaning in equal contacts and that chaplains do not have aims or direct the conversation. A study was conducted to gain insight into power dynamics in conversations between chaplains and patients, and how these power dynamics influence the co-creation of meaning. Power in a conversation is dynamic because of changing positions of power between conversation partners and depends on their initiative and response in a conversation. Based on feminist relational theories, power is conceptualized as both dominating and transformative, and within transformative power a distinction is made between agential and receptive forms of power. A secondary analysis was performed on qualitative interview data of six humanist chaplains. Dominating strategies taken from the Initiative-Response theory and verbal responses from chaplaincy literature have been used to map the power dynamics between chaplain and client. The results showed that both chaplain and patient use dominating strategies, and that transformative power is necessary to foster the co-creation of meaning. This transformative power can take both agential forms, such as direct leading by questions and focusing, and receptive forms, e.g., listening and affirming. The receptive forms were still the dominant strategies used by chaplains, but the results made clear that agential forms have taken ground within humanist chaplaincy, although some strategies may need to be developed further in training, such as focusing and self-disclosure by the chaplain.

Introduction: When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. Material and methods: We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. Results: We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. Discussion: While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD.

Er is steeds meer aandacht voor zingeving in verschillende sectoren van onze samenleving. Maar hoe meet je eigenlijk of die zorg voor zingeving goed gebeurt? In dit artikel presenteren de onderzoekers een instrument om deze zorg te evalueren. Het instrument is ontwikkeld in een leergemeenschap in de eerste lijn en beoogt bij te dragen aan het versterken van de zorg voor zingeving in de thuissituatie.

There has been a limited amount of empirical research conducted in the past on how chaplains, and humanist chaplains in particular, actually interact with their clients during conversations as a part of spiritual care and counselling. The aim of the current study was to gain insight into the extent to which the verbal responses of humanist chaplains corresponded to Rogers’ nondirective approach during conversations with clients. Rogers’ approach has been commonly embraced since the beginning of the professionalization of humanist chaplains in the Netherlands. The study focused on humanist chaplains working at a general hospital in the Netherlands. Ten humanist chaplains took part in the study by audio recording their conversations with clients. The audio recordings were transcribed and analysed, and the verbal responses of humanist chaplains were compared to Rogers’ approach. Subsequently, the verbal responses were analysed via conversation analysis, which also provided insight into how the humanist chaplains actually conversed with clients. Most of the verbal responses (73%) were consistent with Rogers’ nondirective approach, though the ways in which some of the verbal responses were expressed were different; they were more compassionate and comforting. The remaining 27% of the verbal responses were directive and did not correspond to Rogers’ approach. The study shows that, compared to Rogers’ nondirective approach, the approach of the humanist chaplains was more direct and comforting.

SAGE: A new turn in mixed methods research is here: merged methods. This provocative book offers a novel analysis of current mixed methods research, complicating traditional approaches and challenging existing techniques. Moving beyond the binary quantitative-qualitative distinction, the book presents methodologically grounded ways to merge methods in social research and integrate interpretive and structural approaches in one instrument or procedure. The book: - Considers the importance of merging both epistemologies and methodologies. - Showcases eight merged methods research approaches, from the Delphi method to multimodal content analysis. - Explores the opportunities for merging methods using computational techniques, such as text mining. This innovative book is a must-read for any postgraduate student or researcher across the social sciences wanting to develop their understanding of mixed methods research.

Five diagnostic criteria sets for pathological grief are currently used in research. Studies evaluating their performance indicate that it is not justified to generalise findings regarding prevalence rates and predictive validity across studies using different diagnostic criteria of pathological grief. We provide recommendations to move the bereavement field forward.

In a growing number of countries, legislation permits physicians—under strict conditions—to grant a request for physician-assisted dying (PAD). Legally allowing for the possibility of granting such a request is in accordance with central humanistic values such as respect for autonomy and self-determination. The Netherlands is one of few countries where severe suffering from a psychiatric illness qualifies as a ground for a request for PAD. Central in this article is a case description of spiritual care provision in the Netherlands by a humanist healthcare chaplain to a patient requesting PAD because of psychiatric suffering. We discuss what we may learn from the case description about how spiritual caregivers may support patients who express a wish to die, and about their contribution to the care for patients with a psychiatric disorder who request PAD.

Mental health is closely related to religious and spiritual wellbeing. Not surprisingly, many mental health patients prefer attention to religion and spirituality (R/S). Several specific R/S interventions seem to contribute to successful treatment. However, in the field of R/S care many things also remain unknown. What are specific R/S care needs among clinical mental health patients for example? And is there any clinical relevance in taking note of what patients prefer in this regard? In the Netherlands – a multifarious country with respect to outlook on life – this topic has scarcely been studied. The current study describes how patients in two mental health care institutions (Eleos and Altrecht) prefer R/S to be addressed and why this might be useful. Results show that fourteen types of R/S care needs can be divided in three groups: 1) a similar outlook on life, 2) R/S conversations, 3) attention to R/S in program and recovery. Some patients have no troubles in addressing R/S issues during treatment, but others have, especially when they experience a lot of R/S struggles. This may contribute to the presence of unmet R/S care needs. R/S care needs that remain relatively often unanswered are: ‘explanation about R/S and illness by my practitioner’, ‘conversations about religious distress with a nurse’, and ‘contact between my practitioner and chaplain.’ Patients who are satisfied with R/S care report a better treatment alliance. Conversely, compared with other patients, those who are dissatisfied with it, report a lower treatment alliance. Additionally, when patients over a period of six months remain dissatisfied with R/S care, a slight decrease in compliance seems to be present, whereas patients who remain satisfied in this respect report increasing compliance. All in all, the current study offers various insights into ways of integrating R/S in clinical mental health care. The quantitative R/S care needs questionnaire could be used for training and professional development. Furthermore its use in clinical mental health care could be studied. Future studies may focus on the possibilities of integrating R/S struggles in treatment as well as on examining possible benefits of giving structural attention to R/S in clinical mental health care.

Background: Traumatic events can be related to severe transgressions or violations of moral boundaries. Moral injury (MI) has been described as ‘the lasting psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.’ These events can provoke emotions such as remorse, guilt and shame, and affects someone’s self-image and identity. Objective: The aim of the study is to evaluate a treatment protocol that addresses the specific characteristics of moral trauma in treatment of PTSD, next to anxiety. Method: Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) is an adaptation of the evidence-based Brief Eclectic Psychotherapy for PTSD (BEPP). BEP-MT integrates components of cognitive-behavioural, psychodynamic, constructivist, and systemic psychotherapy. In the current study treatment progress of a refugee Dusan was monitored. Prior to and after treatment the Clinical-Administered PTSD Scale for DSM-5, the PTSD Checklist (PCL-5), the Brief Symptom Inventory (BSI) and the Moral Injury Appraisal Scale (MIAS) were administered. Every session moral emotions were assessed on a Likert scale. Results: Whereas PTSD complaints and strong feelings of guilt and shame were manifest prior to treatment, during BEP MT a gradual decline in the intensity of the moral emotions was found. After BEP-MT Dusan no longer met criteria for PTSD and his psychological complaints diminished. Conclusion: The case of Dusan has shown it is worthwhile to address moral trauma and BEP- MT is a promising treatment protocol for patients suffering from PTSD after moral trauma. Further research is needed to examine the effectiveness of BEP-MT., HIGHLIGHTS BEP-MT is a promising treatment protocol that addresses moral injury, which encompasses emotions such as remorse, guilt and shame, and negative self-image, after traumatic events that include transgressions or violations of moral boundaries.

In his philosophical project of a “deconstruction of monotheism,” Jean-Luc Nancy explores the hypothesis that the historical roots of secularization should be traced back to the beginnings of the monotheistic traditions. The secular is not exclusively a feature of modern culture. The complex connections and tensions between secularity and religion in recent decades can only be analyzed effectively if one rethinks the notion of the secular along these historical lines. The author offers a brief introduction into Nancy’s project, before focusing on a theme that is central to one of the monotheistic traditions, Christianity: that of the resurrection. He reads and comments on parts of Nancy’s essay Noli me tangere, an innovative interpretation of John 20.11–18. In dialogue with Nancy he then develops a new view on the resurrection, in which paradoxically death is given a central meaning. This also involves a new insight in the immanence of transcendence. In the resurrection, it is death itself that resurrects. The idea is criticized that death would be vanquished into a life after death–as dominant approach in Christian doctrine has it, thereby expanding the modest little epilogue that the tale of the “empty tomb” actually is in the gospels, to a massive foundation of Christian redemption. Resurrection is affirmed as a life in death as well as a death in life. The resurrection of the mortal, earthly and vulnerable God that Christ is, invites an affirmation of the here and now, of humanity and of the human body: a “yes” to the world, not to an afterworld. Parallel to this analysis, the author takes up Nancy’s suggestion that the resurrection, and in fact the entire gospel, is a parable, and that its “truth” is a parabolic truth: playing with the impossible and the miraculous, in which truth and falsehood become entangled with each other.

Background Although bereavement is likely a common stressor among patients referred to a psychotrauma clinic, no study has yet examined the co-occurrence and relationships between symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder symptoms in this population. Method In a sample of patients seeking treatment following psychological trauma (n = 458), we used latent class analysis to identify classes of patients sharing the same profile of PGD, PTSD, and depression symptoms. We then used network analysis to investigate the relationships among these symptoms and with loss-related variables. Results Most participants (65%) were members of a class that exhibited elevated endorsement of PGD symptoms. PGD, PTSD, and depression symptoms hung together as highly overlapping but distinguishable communities of symptoms. Symptoms related to social isolation and diminished sense of self bridged these communities. Violent loss was associated with more difficulty accepting the loss. The loss of close kin was most strongly associated with difficulty moving on in life. Conclusions PGD symptoms are common in trauma-exposed bereaved adults and closely associated with symptoms of PTSD and depression, illustrating the importance of assessing bereavement and PGD symptoms in those seeking treatment following trauma.

Recent developments in Dutch society and its healthcare system pose new challenges to humanist chaplaincy. Thus far, chaplaincy has been predominantly rooted in institutionalized religion, but it now has to serve a diversity of people who are increasingly secularized with personal ways of worldviewing. Moreover, chaplaincy is increasingly becoming a profession like many others, reducing the focus on its worldviewing competencies. The main question this article addresses is what this implies for the education of chaplains, more specifically for humanist chaplains who are educated on a Master’s level course at the University of Humanistic Studies. Using the concepts of interprofessional learning communities (Stoll & Seashore Louis, 2007) and dialogical professionalism (Jacobs, 2010), two visions are put forward for developing the education of humanist chaplains that might also be relevant for other chaplaincy educational programs.

The perception of the impact of climate change on the environment is becoming a lived experience for more and more people. Several new terms for climate change-induced distress have been introduced to describe the long-term emotional consequences of anticipated or actual environmental changes, with ecological grief as a prime example. The mourning of the loss of ecosystems, landscapes, species and ways of life is likely to become a more frequent experience around the world. However, there is a lack of conceptual clarity and systematic research efforts with regard to such ecological grief. This perspective article introduces the concept of ecological grief and contextualizes it within the field of bereavement. We provide a case description of a mountaineer in Central Europe dealing with ecological grief. We introduce ways by which ecological grief may pose a mental health risk and/or motivate environmental behavior and delineate aspects by which it can be differentiated from related concepts of solastalgia and eco-anxiety. In conclusion, we offer a systematic agenda for future research that is embedded in the context of disaster mental health and bereavement research.

Cognitive behavior therapy (CBT) interventions are effective in alleviating disturbed grief. CBT is typically delivered face-to-face. Government policy during the coronavirus (COVID-19) pandemic (quarantine and social distancing) may impede access to face-to-face therapy. Psychotherapy is now widely delivered remotely. In this article, various points of attention related to the application of CBT for disturbed grief using telephone or videoconferencing (or video calling) services are discussed. Additionally, we explore possible ways in which individual risk factors and stressors connected with COVID-19 can be addressed in treatment. Remote treatment brings challenges but also opportunities to help people in shifting from unhealthy to healthy grieving.

Background: The coronavirus pandemic appears to put psychiatric patients with pre-existing symptomatology at risk of symptom increase, but evidence is scarce. While the pandemic and stringent governmental measures have accelerated the use of clinical videoconferencing (VCT), patient satisfaction with VCT is unclear. Objective: Aim of the study was to assess the wellbeing of patients in psychotrauma treatment during the coronavirus pandemic and to evaluate their use of and satisfaction with VCT. Method: This study used data from a routine outcome monitoring assessment completed by patients in treatment at a specialized psychotrauma institute and administered before the easing of governmental measures in June 2020. Wellbeing (Brief Symptom Inventory, Cantril Ladder, perceived stress level, and symptom change), VCT use and VCT satisfaction, and their association with demographic variables (gender, age, education level, and refugee status) were analysed. Results: Of the 318 respondents (response rate 64.5%), 139 (43.7%) reported a symptom increase, which was associated with a higher coronavirus-related stress level and general psychopathology as well as lower life satisfaction. There were significant effects of age and education level on wellbeing. VCT was reported to have been used by 228 (71.7%) patients. VCT satisfaction ratings were higher among women and those with lower levels of stress (r = −.20, p, HIGHLIGHTS The coronavirus pandemic may aggravate existing mental health problems and has quickened the implementation of clinical videoconferencing (VCT).In this study, the majority of patients in treatment for psychotrauma felt worse during the corona crisis, but VCT offered some relief.

Background: Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance. Aims: To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period. Method: 201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling. Results: R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (β = .25; p Conclusions: Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.