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SPIRITUALITY AND PSYCHOTHERAPY
No thanks, we’re Psychologists!
Spirituality: A Definition
A person’s thoughts, feelings and behaviors related to, concern about, a search or a striving for understanding and relatedness to the transcendent ( Hill et al. 2000)
Includes religious and non-religious strivings
Saunders et al., 2010
Religion: A Definition
A particular system of beliefs and behaviors formally sanctioned by an external entity such as a church body.
Narrower than spirituality
Saunders et al., 2010
Themes of Spirituality
Sense of purpose Sense of connectedness- to self, others,
nature/God/Divine Quest for wholeness Search for harmony or hope Belief is a higher being or beings Some level of transcendence or sense that
there is more to life than the material/practical Those activities give meaning and value to
people’s lives(Cornah, 2006)
Vaillant, 2008
Spirituality is 8 positive emotions:AweLove ( attachment)Trust (faith)CompassionGratitudeForgivenessJoyHope
Spirituality is the vehicle through which meaning is sought. Religion is that vehicle for some.
Sometimes people get the mistaken notion that spirituality is a separate department of life, the penthouse of existence. But rightly understood, it is a vital awareness that pervades all realms of our being.
Brother David Steindl-Rast.
PSYCHOLOGY
PSYCHE – meaning “soul”
LOGY – from logos – “the study of “
What is the soul?
The soul is the infinite depth of a person comprising all the many mysterious aspects that go together and make up our identity. The soul is the point of connection between the individual and God. (Moore , 1992)
What is the soul?
The soul is the essential animating dimension of living things, and as the overarching force that links and reconciles disparate aspects of our lives, thoughts, feelings, mind and matter, inner and outer, dark and light. (Hillman, 1975)
What is the soul?
Ten times a day something happens to me like this-Some strengthening throb of amazement-Some good empathic ping and swell.This is the first, the wildest and the wisest thing I know:That the souls exists and is built entirely out of attentiveness.
Mary Oliver
The History of Psychology
Founding fathers had no need to separate psychology and spirituality; roots in philosophy and theology
For exampleWilliam James G. Stanley Hall
The History of Psychology
Change in early 20th century to side more with natural sciences
Distancing from mesmerism, spiritualism, etc.
Began to see religion with more suspicion and hostility
Religion as an impediment to the scientific study and rational efforts to improve the human condition
The History of Psychology
Psychology began to attract young people who were disaffected from their religious upbringing
Emergence of models of personality and psychotherapy that depicted spirit in oversimplified, stereotypical terms.
The History of Psychology
BF Skinner: Fundamentalist background which he rejected
“God is the archetype pattern of an explanatory fiction”
“Religious faith becomes irrelevant when the fears which nourish it are allayed and hopes fulfilled – here on earth”
The History of Psychology
Freud: rejected traditional beliefs and practices of his Judaism Saw religion as rooted in the child’s sense
of helplessness in a world of dangerous forces
“ Surely this infantalism is destined to be surmounted”
Religion is “the universal obsessional neurosis of humanity”
The times they are a-changing
Moving from a Psychology of control- trying to maximize the control people have in their lives ( e.g. CBT, behavioral, psychodynamic, etc.)
Pargament, 2007
The times they are a-changing
More recent movements to a psychology that helps people come to terms with their human limitations- a different way to seeing the world with a broader transcendent perspective (e.g. positive psychology, ACT, mindfulness, MBSRP, etc.)
Pargament, 2007
Growing Recognition of S/R issues in the Psychology
Recognition of the positive association between measures of Religion/Spirituality and health (spurred by health and sliding over to mental health)
Post and Wade, 2009; Saunders et al., 2010
Growing Recognition of S/R issues in the Psychology
Realization that S/R issues are essential aspects of individual and cultural diversity (provoked by the multicultural competence movement)
Post and Wade, 2009; Saunders et al., 2010
Growing Recognition of S/R issues in the Psychology
The majority of the general public in America identifies as religious or spiritual.
Plante, 2009
Gallup Poll95% of Americans believe in God
40% of Americans attend religious services on a weekly basis
Martinez et al. 2007
Over 80% of Americans consider themselves affiliated with a religion
Over 75% of Americans affirm the existence of God and pray at least weekly
The question is no longer “whether” to address the sacred in psychotherapy but rather the questions are “when” and “how” to address the sacred. Post and Wade,
2009.
APA code of ethics- Principle E
“Psychologists are aware of and respect cultural, individual, and role differences and consider these factors when working with such groups.” 2002
Saunders et al., 2010
APA 2010
We understand diversity to include religion and spirituality as important dimensions of human diversity, and practitioners are expected to attend to religious and spiritual variables when assessing and treating clients.
Aten at al., 2011.
APA (2002)
APA Ethics code states that psychologists must be aware of, respect, and understand individuals’ religious backgrounds (with the term religion appearing four times in lists along with attributes such as gender identity, race and ethnicity).
(as quoted in Crook-Lyon et al., 2012)
Clinicians’ concerns about addressing SRBPs
APA surveys suggest that we are hesitant and uncertain
We recognize that SRBPs are beneficial to mental health and treatment
Saunders et al., 2010
Clinicians’ concerns about addressing SRBPs
Psychologists report discussing SRBPs with only about 30% of clients
Concern about competence, undue influence and other potential ethical issues
Saunders et al., 2010
Delaney et al., 2007
Relative to the general population, psychologists were: more than twice as likely to claim no religion three times more likely to describe religion as
being unimportant in their lives five times more likely to deny belief in God less likely to attend religious services, be a
member of a congregation or engage in prayer
Shafranske, 2001
90% of US population report a belief in a personal God
24% of clinical and counseling psychologists report a belief in a personal God
Shafranske, 2001
58% of a national sample report that religion is very important to them
26% of clinical and counseling psychologists report that religion is important to them
Delaney et al., 2007
Psychologists today are more likely than the general population to describe themselves as “spiritual but not religious.
Spirituality was very important – 52%
Spirituality was fairly important – 28%
Rose et al., 2001
People expressly desire to discuss S/R issues with care providers 63% of clients felt it was appropriate to
discuss religious/spiritual concerns 55% of clients expressed an interest in
addressing religious/spiritual concerns 18% preferred not to discuss such
topics
Cornah 2006
Interviews with clients indicated that many felt their religious and spiritual beliefs are not understood or explored in psychotherapy
Found that clinicians either ignore their spiritual life completely or treat their spiritual life as a manifestation of psychopatholgy
Pargament, 2007
Many clients are reluctant to inform their therapist about their SRBPs.
“They already think I’m crazy”
You have to be very cautious about what you say because being not main stream, a little off track, you have to be very careful you are not condemned for what you believe by the professionals”
O’Connor and Vanderberg, 2005
Found a bias among mental health professional against less familiar religious traditions.
Given vignettes of beliefs and practices of Roman Catholics, Mormons and Moslems and asked to rate for psychotic pathology.
The members of the less familiar religions were rated as more pathologized than Catholics.
The differences held even when the beliefs & practices in all 3 sets were described as harmful.
McVittie and Tiliopoulos, 2007
Practicing therapists tended to underestimate the significance of religious beliefs, to stereotype religious clients as intransigent and to marginalize and exclude the religious dimension in the context of therapy.
Ethical Issues
Martinez et al. 2007
Informed consentReligious and spirituality identity
Dual relationshipsCollaboration with religious leaders
Ethical Issues
Respect for client’s values/fear of imposing
Discomfort with subjectLack of interest or awareness
Therapist competence
Competence
Surveys of APA accredited clinical programs and internships ( 2006) 13% of clinical programs had a course on
religion and spirituality 17% of clinical programs reported that the
topic is covered systematically Few addressed Religion and Spirituality
systematically and some not at all. Tended to be addressed only in
supervision and only if the client brought it up.
Crook-Lyon et al. 2012
82% of counseling psychology training directors report that, in their programs, R/S issues are not regularly discussed as issues of diversity and not considered as important as other kinds of diversity ( as quoted from Schulte et al., 2002)
Crook-Lyon et al. 2012
In their survey of 340 psychologists in related APA divisions found that
65% said that R/S issues should be included in graduate training
Clinical & Training Implications
Understanding and effectively addressing issues related to individual and cultural diversity including: Respectful attention to spiritual issues Being aware of one’s own attitudes,
assumptions and biases on issues of spirituality, religion and faith.
Ability to work with other professions including clergy.
Saunders et al., 2010
Clinical & Training Implications
More advanced but general competencies Openness and tolerance Self-awareness Authenticity (openly embrace our own SRBPs
to reduce likelihood of undue influence)
Saunders et al., 2010
Clinical & Training Implications
Specific Competencies Demonstrate similar respect and sensitivity to
SRBPs ( don’t assume- we don’t assume re: race or sexual orientation, etc.)
Competence in SRBPs: various spiritual/religious beliefs and immense diversity
Training: ongoing professional development on relevance of SRBPs to our lives
Saunders et al., 2010
Religious and spiritual competency includes familiarity with differences between spirituality and religion, ability to differentiate between a healthy and pathological religious or spiritual experience, and an understanding of how spirituality can be both a problem and a helpful dimension.
Serlin, 2004 (quoted in Delaney et al., 2007)
Significance of Self-Awareness
3 main reasons: More inclined to be spiritual not religious Unlikely to have explored
religious/spiritual bias in graduate school May have poorer judgment regarding
religious beliefs than are unfamiliar
Post and Wade, 2009
Post and Wade, 2009
Wisdom of Experienced clinicians who work with religious/spiritual issuesPluralistic approach/Appreciation
of diversityCareful not to imposeUsed a developmental lens or saw
religious/spiritual issues as intertwined with psychological issues
Post and Wade, 2009
Techniques typically used: meditation, scripture, prayer
Most important intervention –
An explicit statement or discussion communicating openness to explore religion/spirituality with the client.
Spiritually Oriented Interventions ( SOIs)
Overall research has shown that SOIs can serve as powerful healing resources for clients during treatment.
Aten et al., 2011; Post and Wade, 2009
Spiritually Oriented Interventions ( SOIs)
Making meaning and life calling Addressing value conflicts Addressing problematic
spirituality Sacredness of life Working with prayer
Spiritually Oriented Interventions ( SOIs)
Role of forgiveness Meditation Mindfulness Yoga and yoga techniques Sacred writings and texts Spiritual journaling
Smith et al., 2007
Results of a meta-analytic review found that spiritual or religious adaptions to psychotherapy effectively benefit clients.
31 studies between 1984 and 2005
Overall effect size of 0.56 ( moderately strong magnitude) – higher than the average value of 0.48 typical of psychotherapy outcomes when compared to control groups.
Smith et al., 2007
Interesting finding:
Spiritual therapeutic approaches appeared to have a greater impact of measures of well-being than on other measures of mental health symptoms.
Importance of clients learning to apply their own SRBPs to their mental health or well-being concerns.
Wachholtz & Pargament, 2005
Compared spiritual meditation to secular meditation and to relaxation
All subjects told how to relax physically and how to create a relaxing atmosphere
Measure impact on affect, spirituality, pain perception and tolerance, cardiac reactivity
Wachholtz & Pargament, 2005
Spiritual meditation group reported Lower anxiety More positive mood Greater spirituality Able to withstand pain for longer periods of time
Secular meditation group and relaxation group were not significantly different from each other.
Wachholtz & Pargament, 2005
Pain Perception No difference among the groups in perception
of pain
Pain ToleranceSpiritual meditation group endured pain level
almost twice as long as other 2 groups.
Cardiac reactivityNo group differences but all groups showed
decreased heart rate when practicing their techniques
Margolin et al., 2007; Avants et al., 2005
Examined a “spiritual “self-schema therapy for the treatment of addiction and HIV risk behavior ( versus an “addict” self –schema)
3-S ( www.3-Sus)
An 8 week manual guided intervention
Margolin et al., 2007; Avants et al., 2005
T he treatment program consists of meditation, mindfulness as well as cognitive behavioral therapy techniques evolved from the self-schema theory.
The goal is to decrease automaticity of “addict” self-scheme and construct a “spiritual” self-schema powerful enough to supplant “addict” self-schema.
Margolin et al., 2007; Avants et al., 2005
Found drug use and other HIV risk behaviors decreased
Evidence of a shift from “addict” to “spiritual” self-schema
A shift in self-schema was correlated with changes in drug use and other HIV risk behaviors.
Daily spiritual experiences and practices and the perceived influence of spirituality on behavior increased
Emmons and McCullough, 2003
Examined the influence of grateful thinking on psychological well-being in daily life in 65 adults with a chronic disease ( Neuromuscular Diseases)
Randomly assigned to 2 GROUPS: Gratitude and control
Emmons and McCullough, 2003
Gratitude condition: “There are many things in our lives, both large and small, that we might be grateful about. Think back over the day and write down on the lines below up to five things in your life that you are grateful for.”
Control group only completed questionnaires each day.
Emmons and McCullough, 2003
Daily records of:
Positive and negative affect, Activities of Daily living,Health behaviorPhysical symptomsOverall life appraisal
for 3 weeks
Emmons and McCullough, 2003
Observational reports of well being by spouse or significant other at the end of the study-
Positive and negative affectSatisfaction with Life Scale
Emmons and McCullough, 2003
Gratitude condition elicited more gratitude than control condition
Gratitude condition elicited significantly more positive affect and less negative affect than control condition
Gratitude Ss had a significantly more positive appraisal of life as a whole and their future
Emmons and McCullough, 2003
Physical Well Being: Gratitude Ss had significantly more hours of
sleep and felt more refreshed on awaking No differences in terms of physical pain,
exercise and functional status
Observer Effects:Gratitude Ss were seen as having more positive affect and life satisfaction than the control Ss .No difference on the negative affect.
Emmons and McCullough, 2003
Conscious focus on blessings may have emotional and interpersonal benefits.
The benefits of being grateful go beyond self-perception.
Delaney at al., 2007
Religion is an aspect of culture which psychologists may be especially predisposed to unfamiliarity, and one for which stereotypic biases have been present and tolerated in our discipline’s past. We therefore have a particular responsibility to ensure that we are well prepared to understand, honor, and competently address religious diversity.
No need to say No Thanks anymore
Pargament (2007) Spirituality is a natural and normal
part of life. The yearning for the sacred is a primary irreducible aspect of human nature.
Spirituality is a therapeutic fact of life. The question is not “whether” to address it but “how”
A spiritual person tries less to be godly than to be deeply human.
Rev William Sloane Coffin, Jr.
All people have a spiritual life and most are happy to talk about it - if you can just discover their language for it. Let them teach you their language.
Gerald May, 1992.