Poustinia

1. Introduction

Version followed: Catherine de Hueck Doherty, Poustinia (1975), as practised today by the Madonna House Apostolate (founded 1947, Combermere, Ontario) and described on Madonna House pages and in Catholic press accounts. This is a Catholic lay adaptation of a Russian Christian tradition. It is not a liturgical rite of an Orthodox Church. [source: Madonna House "tour19" page; Catholic Register 2025 and anniversary article; Hermitary review]

Poustinia is Russian for "desert". In Doherty's account it means three things. First, the Russian practice of withdrawing into the "desert" to meet God in silence and solitude. Second, the bare cabin or room where this happens. Third, the "poustinia of the heart": an inner stillness carried back into ordinary life. [source: Madonna House; Catholic Register; EWTN reprint of L'Osservatore Romano 2014] Doherty, who was born in Russia and settled in Canada after the Revolution, began sharing the practice with her community in the early 1960s. Press accounts link it to the Desert Fathers and to Russian monastic and village tradition. [source: Catholic Register anniversary article] She described the Russian poustinik (the person who lives in a poustinia) as someone who stayed at the edge of the village with an unlatched door, welcomed anyone who came, and prayed for their own sins and for the world. [source: Plough 2021; Hermitary]

How change happens, in the tradition's terms: the person sets aside activity, talk and reading other than Scripture. In silence and solitude they become available to God, who, in this view, "waits" there. The fruit is meant to come back to the community as intercession, peace and service. Doherty speaks of folding "the wings of your intellect" so that the heart can open. [source: EWTN/L'Osservatore Romano; Catholic Register 2025] These are religious claims belonging to the tradition. This guide neither affirms nor disputes them.

The psychotherapist's role: poustinia is a prayer practice taught and supervised within a Catholic community. The therapist does not teach it, prescribe it or set its terms. The therapist's job is client-led integration, preparation and screening before a solitary retreat, medical routing for any fasting, making sense of what the client experienced afterwards, telling apart difficult spiritual experience and mental illness, and referral to the client's director or host community. [synthesis]

2. Framework

2a. The practice as Madonna House publishes it

1. Formation and direction. Madonna House staff "make a poustinia" regularly, and every Madonna House has one. Guests and volunteers who have lived and worked with the community may go, but only under direction. The community stresses that newcomers need to be firmly grounded in community first. [source: Madonna House tour19; Catholic Register anniversary article] One local director offers newcomers an introduction before their first poustinia. [source: Catholic Register 2025]
2. Entering. The room or cabin is deliberately bare: a hard bed, a small table and chair, a Bible, a plain cross, and perhaps an icon of the Mother of God. On entering, the person bows low before the cross as a sign of approaching a mystery. [source: Madonna House tour19]
3. Within the desert. The person brings only Scripture and prays with it. Work, other reading and communication are set aside. The person is free to sleep, walk outdoors, sit, write, or speak to God with complaint or thanks. Writers stress that there is "no specific way of praying" and "no formula". The person keeps a simple fast on bread with water or a hot drink. Prayer is also held for others: the Church, the world, and those who asked for prayer. [source: Madonna House tour19; Hermitary; Catholic Register 2025; Plough] The usual modern format is a short, bounded period of solitude, arranged by the host community and the person's director. [source: Catholic Register anniversary article; EWTN; Hermitary] This describes the tradition. It is not a recommendation. A therapist should never set the length of a fast or of solitude.
4. Returning. The person goes back to the community or the "marketplace", carrying the desert inward as the "poustinia of the heart". [source: Hermitary; Catholic Register; EWTN]

Qualitative picture of the solitude: practitioners describe the solitude as stripping and bare. Without roles, tasks or company, the mind often fills with chores and distractions; one staff member said her thoughts buzzed "like flies", and Doherty called this natural. Sessions vary: some bring a sharp sense of insight or mercy, others feel dull, bored or restless. Buried hurts, resentments, fears and doubts can surface. A long-term practitioner called it frightening but valuable, a stripping away of illusion and persona. [source: EWTN; Catholic Register 2025; Catholic Register anniversary article]

Qualitative picture of the fasting: the fast is plain and simple, not a test of endurance. Bread and a drink are supplied. The fast is penitential and intercessory, offered for others. Hunger and tiredness are described as part of the experience. One first-timer slept, ate the bread and left early, and wrote about it without shame. [source: Madonna House tour19; Hermitary; Catholic Register 2025] Catholic fasting norms excuse people who are physically or mentally ill, including those with chronic conditions such as diabetes, and people who are pregnant or nursing. [source: USCCB fasting information sheet]

2b. The therapist's work alongside, in phases [synthesis]

No source gives a number of therapy sessions for this work. The table is a working structure, not a protocol. [uncertain]

3. Guiding principles

• The tradition defines the practice. Practical meaning: take descriptions from the client, their director and Madonna House-type sources. Never redesign the practice. [synthesis]
• Client-led, with consent. Practical meaning: raise poustinia only as the client brings it. Agree explicitly on how prayer, Scripture or silence may be discussed in therapy. [synthesis; cf. Vieten et al. 2013 competencies]
• Under direction, rooted in community. Practical meaning: the tradition itself expects guidance and community grounding. A client planning solitary fasting retreats alone, without any director or host, is a reason to slow down. [source: Madonna House tour19]
• No prescriptions of austerity. Practical meaning: the therapist never recommends fasting, a length of solitude or sleep changes. Fasting questions go to the client's doctor and to their pastor or director. [synthesis; USCCB exemptions]
• Permission to stop is part of the tradition. Practical meaning: "no formula", sleep allowed, leaving early described without shame. Use these as the tradition's own grounds for flexibility. [source: Catholic Register 2025; Hermitary]
• Solitude is not isolation. Practical meaning: the poustinik is pictured as available, hospitable and praying for others. Chosen, bounded solitude that returns to community differs from withdrawal driven by depression, anxiety or shame. Assess which one you are seeing. [source: Plough; Hermitary; synthesis]
• Difficult experiences are expected and not shameful. Practical meaning: normalise interior noise, boredom and painful memories, while watching for the minority of adverse effects that last or impair. [source: Catholic Register 2025; Lindahl et al. 2017; Farias et al. 2020]
• Neither pathologise nor miss illness. Practical meaning: assess religious experience in its cultural context. Use the DSM "Religious or Spiritual Problem" code (V62.89/Z65.8) where it fits, not a disorder label. [source: Barrett 2020 Current Psychiatry]
• Role clarity. Practical meaning: the therapist is not the client's spiritual director, confessor or poustinia host. Refer and collaborate rather than substitute. [synthesis; Vieten et al. 2013]
• Even-handedness. Practical meaning: use the client's words ("desert", "God's word", "intercession"). Keep your own beliefs out unless disclosure clearly serves the client. [synthesis]

[source for section: pages listed under Sources]

4. Intervention inventory

The poustinia itself (2a) is taught and hosted by the client's community. Everything below is the psychotherapist's own work alongside it. No published secular or clinical adaptation of poustinia specifically was found in the sources consulted. Nearby adaptations live elsewhere in this guide set: silent retreat days in MBSR/MBCT (Domain II), contemplative and spiritually integrated psychotherapy (Domain VII), and trauma-sensitive practice (Domain IV). Use them as cross-references, not as replacements for the client's own tradition. [synthesis]

4.1 Exploring what poustinia means to the client

• Purpose / when: at first mention. The aim is to understand the practice as the client lives it: their community (Madonna House staff, guest, or a parish or home adaptation), their director, their hopes, and earlier experiences. [synthesis; cf. Vieten et al. 2013 on spiritual assessment]
• Steps: (1) Ask the client to describe the practice in their own words: where, with whom, how they prepare, what they bring. (2) Ask what it is for them: penance, intercession, meeting God, rest, discernment. (3) Ask about past poustinias: what was consoling, what was hard. (4) Ask who guides them. (5) Ask whether and how they want it in therapy. (6) If useful, use the spirituality, religion and moral traditions questions of the DSM-5-TR Cultural Formulation Interview. [uncertain: CFI module not verified]
• Example language (illustrative): "You mentioned going to the poustinia next month. Would you tell me what that is like for you, in your own words? Who helps you prepare, and what do you hope happens there?"
• Watch for: the client's own vocabulary ("desert", "the Word", "intercession"). Use it back. Notice whether the practice sounds chosen and supported, or pressured, secret or self-punishing. Working when: the client speaks freely about the practice and sets the terms for including it.

4.2 Consent and role clarity for spiritually integrated work

• Purpose / when: before any session work that touches prayer or the retreat.
• Steps: (1) Name what you will and will not do. You will help with feelings, safety, health coordination and meaning-making. You will not direct prayer, interpret Scripture with authority, or decide whether to go. (2) Agree whether the director or host may be contacted, and record written consent. (3) Clarify your own position briefly if asked, keeping the focus on the client. [synthesis; Vieten et al. 2013 competencies; APA ethics code: uncertain: not verified]
• Example language (illustrative): "I'm not your spiritual director, and I won't be telling you how to pray or whether to go. What I can do is help you think through how you're doing, and make sure your body and mind are looked after so the time can be what you hope."
• Watch for: clients asking the therapist to act as director or to "bless" the plan; dual relationships if you share the client's parish or community. Working when: the client knows who to turn to for which question.

4.3 Screening before a solitary retreat

• Purpose / when: before a first poustinia, a longer stay than usual, or any poustinia after a change in mental or physical health. Retreat-intensity and psychiatric or trauma history are among the factors teachers and researchers name. They do not predict every case, and difficulties can occur in people with no prior history. [source: Lindahl et al. 2017; Farias et al. 2020; Britton lab safety toolbox headings]
• Steps (screening areas):
  1. Psychosis and bipolar spectrum: past episodes, current subtle signs (reduced need for sleep, unusual beliefs or perceptions, pressured religious preoccupation), family history. [synthesis]
  2. Mood and suicide risk: current depression, hopelessness, suicidal thoughts. Do a standard risk assessment. Long unstructured solitude with no contact is a poor fit during active suicidal crisis. [synthesis]
  3. Trauma and dissociation: PTSD, history of confinement, isolation or neglect, dissociative episodes. A bare room and silence can echo past isolation. [synthesis]
  4. Eating disorders and food relationship: any history of restriction, binge-purge, or using fasting to control weight. A religious fast can be a route back into disordered eating. [synthesis]
  5. Medical conditions affected by fasting: diabetes, pregnancy or nursing, other chronic illness, any condition where missed meals matter. Route to the doctor (4.4). Catholic norms already excuse the ill, pregnant and nursing from fasting. [source: USCCB]
  6. Sleep and substances: recent sleep loss, alcohol or other substance use or withdrawal. [synthesis]
  7. Scrupulosity: rigid penitential beliefs, fear of "failing" the poustinia (see 4.10). [synthesis]
  8. Supports: is there a director or host? Does someone know where the client is? Is there a way to leave or call for help? The tradition itself expects guidance and community grounding. [source: Madonna House tour19]
• Example language (illustrative): "Spending time alone in silence is something many people find deeply good, and some find unexpectedly hard. Can we go through a few things that sometimes make solitude or fasting tougher, so you and your director can plan for them?"
• Watch for: minimising ("it's nothing much"), secrecy from the director, or a wish to use the retreat to "fix" an acute crisis. Working when: risks are named, and the client, with their director and doctor where relevant, has decided whether to go, postpone or adapt.

4.4 Routing fasting questions to the doctor and the tradition

• Purpose / when: any client with a medical condition, pregnancy or nursing, an eating-disorder history, or medicines that interact with eating patterns.
• Steps: (1) Do not advise on the fast or on medicines. (2) Tell the client that their own Church excuses the physically or mentally ill (including chronic conditions such as diabetes) and the pregnant or nursing from fasting. [source: USCCB] (3) Encourage a conversation with their physician before the retreat. With consent, coordinate. (4) Suggest they discuss non-food forms of penance or an unfasting poustinia with their director or pastor. [synthesis]
• Example language (illustrative): "Your own Church's guidance excuses people with conditions like yours from fasting. Would you be willing to check with your doctor, and talk with your director about what the poustinia could look like without the fast?"
• Watch for: guilt about taking the exemption, or using the exemption question to probe whether the client is restricting. Working when: the medical question is settled by the doctor and the spiritual question by the director, not by the therapist.

4.5 Preparation and safety plan

• Purpose / when: after screening, for clients who go ahead.
• Steps: (1) Confirm the host's arrangements: who knows the client is there, and how to reach someone. (2) Agree on early-warning signs that mean "come out and contact someone": sleeplessness, unusual perceptions, panic that does not settle, thoughts of self-harm, faintness. (3) Rehearse the tradition's own flexibility: sleep is allowed, walks are allowed, there is "no formula", and leaving early happens. (4) Pick one or two grounding actions the client is comfortable with (4.7). (5) Book a debrief session. [source for 3: Catholic Register 2025; Hermitary; rest synthesis]
• Example language (illustrative): "If you notice you haven't slept, or things start to feel unreal or frightening and don't settle, that's the signal to step out and call [named person]. That isn't failing the poustinia. People who've practised for years describe leaving early too."
• Watch for: a client who rejects any exit plan as "lack of faith". Explore this gently and, with consent, involve the director. Working when: the client can say when they would come out and whom they would contact.

4.6 Normalising the ordinary difficulties of solitude

• Purpose / when: before and after. The goal is to reduce shame about noise, boredom, hunger, sleepiness and distraction, which the tradition itself describes as natural.
• Steps: (1) Share, as the tradition's own reports, that the mind often fills with chores and distractions, that some days are dull, and that hunger and tiredness come. (2) Invite the client to treat these as part of the desert rather than as failure. Use their director's framing where known. [source: EWTN; Catholic Register 2025]
• Example language (illustrative): "Doherty's own staff described their thoughts buzzing like flies in the poustinia. She called that natural. How did it go for you?"
• Watch for: perfectionism and self-criticism. Working when: the client describes distraction or boredom without self-condemnation.

4.7 Grounding and dose reduction

• Purpose / when: for clients with screening flags, or after a difficult poustinia. Dose reduction and grounding are among the standard ways of managing meditation-related difficulty. [source: Britton lab safety toolbox headings (screening, monitoring, management); Cheetah House resources; specific steps synthesis]
• Steps: (1) Let the client and director decide on a gentler form: a shorter period, a poustinia without the fast, staying near others, or more time walking outdoors. The tradition already allows walks, gardening and sleep. [source: Hermitary] (2) Agree on grounding the client can use alone: noticing feet and seat, naming objects in the room, a slow walk, eating the bread, a warm drink, holding the cross or icon if that steadies them. (3) If the client is distressed, suggest stopping intensive contemplative time until they are stable. [synthesis]
• Example language (illustrative): "It sounds like the silence got very loud last time. Would it help to talk with your director about a gentler version, maybe staying nearer the house, or not fasting this time?"
• Watch for: the client feeling that a lighter practice is spiritually inferior. Use the tradition's own "no formula" stance. Working when: the client can stay present in solitude or step out without escalation.

4.8 Trauma-sensitive adaptation

• Purpose / when: for clients with trauma histories, especially of confinement, isolation, neglect or religious abuse. Practitioners report that buried hurts and fears surface in poustinia. [source: Catholic Register 2025]
• Steps: (1) Borrow the principles of trauma-sensitive mindfulness: choice, a window of tolerance, open eyes and orienting to the room, permission to move and to stop. [source: Treleaven 2018, Trauma-Sensitive Mindfulness, uncertain: not verified; Treleaven co-taught the Brown safety training] (2) Help the client choose a room or setting that feels safe; for some, nature feels easier than a city room. [source: Catholic Register 2025] (3) Plan contact and an exit. (4) Process surfacing material in therapy, not alone in the retreat. [synthesis]
• Example language (illustrative): "If memories come up in the silence, you don't have to work them out there. You can note them, ground yourself, and bring them here."
• Watch for: flashbacks, dissociation, shutdown, or the bare room echoing past confinement. Working when: difficult material comes back to therapy at a pace the client can manage.

4.9 Debrief and adverse-effect check

• Purpose / when: at the first session after each poustinia, especially the first.
• Steps: (1) Ask open questions about consolation, difficulty and anything unexpected. (2) Check across the domains research describes: perception (sensitivity to light or sound), emotion (fear, anxiety, panic, loss of feeling), body (insomnia, involuntary movements, unusual energy), thinking, sense of self, and social life. [source: Lindahl et al. 2017] (3) Ask whether any effect has persisted or affects work, sleep or relationships. Such effects can last days to months, sometimes longer. [source: Lindahl et al. 2017] (4) Keep in mind that across 83 studies, about 8% of participants reported adverse events (most often anxiety, depression or cognitive anomalies), including people with no prior mental-health history. [source: Farias et al. 2020] (5) If difficulties persist, reduce the dose (4.7), assess (4.11), and consider specialist support such as Cheetah House. [source: Cheetah House]
• Example language (illustrative): "Before we talk about what it meant, can I check how you've been since? Sleep, how things look and sound, how you feel in yourself, how you are with people?"
• Watch for: clients hiding difficulties out of shame or loyalty to the community; meditators in difficulty often feel isolated and ashamed. [source: Cheetah House] Working when: the client can speak about both the good and the hard, and lasting effects are being addressed.

4.10 Scrupulosity and penitential distress

• Purpose / when: poustinia includes penance and prayer for one's own sins. In clients with scrupulosity (religious OCD), this can feed compulsive confession, fear of having done it "wrongly", or extra fasting to make up for a failure. [source for penance: Plough; Madonna House tour19; clinical content synthesis]
• Steps: (1) Screen for intrusive moral or blasphemous doubts and reassurance seeking. (2) If present, use ERP adapted for scrupulosity. With consent, ask the client's priest or director to set clear, sufficient practice boundaries, so that the client has an authoritative "enough" and is not left to answer the doubt themselves. (3) Do not argue theology. Let the religious authority define what is required. [synthesis]
• Example language (illustrative): "It sounds like the worry is that you didn't do the poustinia properly. Would it help to ask your director what 'enough' looks like, and then we can work on what happens when the doubt comes back anyway?"
• Watch for: repeating poustinias or lengthening fasts to quiet guilt. That is a red flag; involve the doctor and director. Working when: practice follows the director's guidance rather than the doubt.

4.11 Distinguishing spiritual experience from mental illness

• Purpose / when: when the client reports visions, voices, intense unity, "darkness", or a sense of God's absence or presence that worries them or others.
• Steps: (1) Begin by respecting the experience as religiously meaningful to the client. (2) Ask how it fits their tradition, and whether their director or community recognises it as within the range of prayer experience. (3) Assess duration, impairment, sleep, mood, risk, insight and flexibility of belief, and for mania, psychosis, depression or dissociation. Do not interpret religious content alone as illness. [synthesis] (4) Where distress is spiritual and no disorder is present, record it as a religious or spiritual problem (DSM V62.89 / Z65.8) and provide support. [source: Barrett 2020] (5) If a disorder is likely, refer for psychiatric assessment and, with consent, inform the director.
• Example language (illustrative): "What you experienced sounds very significant to you. To help me understand, how have you been sleeping since, and how have your days been?"
• Watch for: reduced need for sleep, grandiose mission, command voices, inability to function. These need urgent assessment. Working when: the client feels taken seriously, and any illness is treated.

4.12 Solitude or withdrawal?

• Purpose / when: when poustinia, or a wish for more of it, coincides with depression, social anxiety or relational avoidance.
• Steps: (1) Contrast the tradition's picture of the poustinik as open-doored, hospitable and praying for others with what the client is doing. [source: Plough; Hermitary] (2) Ask what draws them to solitude now, and what they return to afterwards. (3) If solitude is mainly avoidance, work on that directly while respecting the practice. [synthesis]
• Example language (illustrative): "Doherty pictured the poustinik with a door that had no latch. When you come out of the poustinia, what are you going back towards?"
• Watch for: rising time alone, dropping contact, using retreat to escape conflict. Working when: solitude returns the client to relationships rather than replacing them.

4.13 Supporting the "poustinia of the heart" in daily life

• Purpose / when: for clients who want to carry the practice into ordinary life, which is the tradition's own goal. [source: Catholic Register; EWTN; Hermitary]
• Steps: (1) Ask how the client, with their director, understands the inner poustinia. (2) Help them plan brief, realistic moments of recollection that fit their life. The content is set by their tradition, not the therapist. (3) Link to therapy goals only as the client wishes, for example patience with family, or calm before hard conversations. [synthesis]
• Example language (illustrative): "You said the poustinia is meant to come home with you. What would that look like on an ordinary Tuesday?"
• Watch for: turning the inner poustinia into a demand to be constantly prayerful, which can become scrupulous. Working when: the practice supports daily functioning and relationships.

4.14 Referral and collaboration with director, host or clergy

• Purpose / when: for questions of prayer, Scripture, penance or discernment; for planning adaptations; when difficulties arise.
• Steps: (1) With written consent, contact the director or host. Share only what is needed (for example health limits on fasting, warning signs, contact plan). (2) Respect their authority over the practice. (3) If the client has no director, suggest they find one through their parish or a Madonna House or similar community, rather than trying solitary fasting retreats alone. [source: Madonna House "under direction"; rest synthesis]
• Example language (illustrative): "Would it be useful if I spoke with your director about the plan for your sleep and the fast? I'd only share what you're comfortable with."
• Watch for: conflicting advice. Name it and let the client hold both. Working when: clinical and spiritual guidance support each other.

4.15 The therapist's own commitments and boundaries

• Purpose / when: throughout, especially if you share or reject the client's faith.
• Steps: (1) Examine your own attitudes to Catholic or Orthodox piety, fasting and penance. (2) Disclose only briefly and when it serves the client. (3) Avoid dual roles, such as being the client's fellow parishioner and therapist, where you can. (4) Seek consultation on religion and spirituality, as competency frameworks recommend. [source: Vieten et al. 2013; APA ethics code: uncertain: not verified]
• Example language (illustrative): "My own beliefs aren't what matters here. I'm interested in what this practice means for you."
• Watch for: subtle encouragement or discouragement of the practice. Working when: the client's tradition, not yours, shapes the work.

5. Handling problems

The tradition's sources cover inner noise, boredom, hunger, sleepiness and leaving early. Everything else below is [synthesis] unless a source is tagged.

• Client came out early and feels a failure. Normalise this with the tradition's own accounts: sleeping, eating the bread and leaving early are reported without shame, and there is "no formula". [source: Catholic Register 2025] Explore what made it hard. Plan any changes with the director.
• Client insists on fasting despite a medical exclusion. Do not argue the fast. Point to their Church's own exemptions for illness, pregnancy and nursing [source: USCCB]. Ask them to speak with their doctor and pastor, and coordinate with consent. If eating-disorder features are present, treat those directly and involve the treating team.
• Eating-disorder history and a wish to fast. Treat as high risk. Explore whether the fast serves restriction. Agree with the director on a poustinia without the fast, or postpone. Monitor closely afterwards.
• Overwhelm, panic or dissociation during or after. Ground first (4.7). Check sleep and safety. Pause intensive contemplative practice. Assess (4.11). If symptoms persist, consider specialist meditation-difficulty support such as Cheetah House and psychiatric review. [source: Cheetah House; Lindahl et al. 2017]
• Possible mania or psychosis after solitude and fasting. Arrange urgent psychiatric assessment. Involve family or supports with consent where possible. Inform the director only with consent unless risk requires otherwise. Later, help the client make sense of the episode within their faith without shaming either the faith or the illness.
• "Dark night", or feeling God is absent. Do not pathologise this by default. Ask how their tradition and director understand it. Screen for depression and suicide risk alongside. Use the religious or spiritual problem code where no disorder is present. [source: Barrett 2020]
• Stuck: repetitive, flat poustinias. Treat this as spiritual material for the director. In therapy, explore expectations: practitioners themselves report dull days as part of it. [source: Catholic Register 2025]
• Non-adherence to the safety plan (for example no one told, no exit plan). Explore beliefs behind it ("needing help means weak faith"). With consent, involve the director, since the tradition itself expects guidance. [source: Madonna House tour19]
• Solitary practice without any community or director (a home or online "poustinia"). Gently note that the originating community offers it under direction and after grounding in community. Encourage finding a director. Reassess risk more carefully. [source: Madonna House tour19]
• Rupture: client feels the therapist is suspicious of their faith. Name and repair it. Restate respect for the practice and the limits of your role (4.2). Invite the director's perspective.
• Therapist pressure in either direction. Use supervision or consultation on religion and spirituality. [source: Vieten et al. 2013]
• Pressure from a group or leader. No documented misconduct concerning the poustinia practice was found in the sources consulted. In any religious setting, watch for coercive control: pressure to go against medical advice, being cut off from family or outside help, punishment for leaving early, secrecy. Support the client's autonomy and, where needed, their exit and recovery from religious harm. Cheetah House lists religious trauma among its topics. [source: Cheetah House]
• Minors. Any fasting or solitary retreat involving a child or adolescent raises safeguarding, medical and consent questions. Catholic fasting norms apply only to adults within set ages [source: USCCB; exact ages: uncertain: not verified]. Involve parents or guardians, the doctor and the safeguarding lead as appropriate.
• Grief or crisis as the motive. A client seeking poustinia right after a bereavement or acute crisis may be better served by accompanied prayer and community support first. Discuss timing with them and their director.

Sources

Web sources:

• Madonna House: poustinia (tour stop 19)
• Catholic Register: 50 years of Poustinia's solitude
• Catholic Register (2025): Learning a whole new way to pray
• Plough (2021): The Poustinik Option
• EWTN, reprinted from L'Osservatore Romano (2014): The Breath of Prayer
• Hermitary: House of Solitude (review of Doherty, Poustinia)
• USCCB: Fasting and Lent information sheet
• Brown University (2017): Study documents range of challenging meditation experiences (Lindahl et al. 2017, PLOS ONE, doi:10.1371/journal.pone.0176239)
• PubMed: Adverse events in meditation practices and meditation-based therapies: a systematic review (Acta Psychiatr Scand 2020;142(5):374-393)
• Britton lab: Meditation Safety Toolbox
• Cheetah House: Resources
• Barrett (2020), Current Psychiatry: COVID-19's religious strain: differentiating spirituality from pathology
• IONS: Spiritual and religious competencies for psychologists (Vieten et al. 2013)

Books and articles cited:

• Doherty, C. de Hueck (1975). Poustinia.
• Lindahl, J. R., et al. (2017). The varieties of contemplative experience. PLOS ONE.
• Farias, M., et al. (2020). Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatrica Scandinavica, 142(5), 374-393.
• Vieten, C., Scammell, S., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2013). Spiritual and religious competencies for psychologists. Psychology of Religion and Spirituality, 5(3), 129-144.
• Treleaven, D. A. (2018). Trauma-Sensitive Mindfulness. [uncertain: not verified]
• American Psychiatric Association. DSM-5-TR, Cultural Formulation Interview. [uncertain: not verified]
• ICD-10-CM Z65.8, Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem'), https://www.unboundmedicine.com/icd/view/ICD-10-CM/945432/all/Z65_8___Other_specified_problems_related_to_psychosocial_circumstances