Transcript Slide 1

Integrating Religion and
Spirituality into Clinical Practice
Objectives
To become familiar with empirical
data that connects religion and
spirituality in clinical practice
To gain understanding on how
people grow and develop from a
religious and spiritual perspective
Book Information
Marsha Wiggins Frame (2003).
Integrating Religion and Spirituality
into Counseling: A Comprehensive
Approach. Pacific Grove, CA:
Brooks/Cole
Objectives
To develop skills on specific
strategies for working with patients’
religious and spiritual issues
To acquire expertise in using
spiritual interventions that promote
healing and transformation
Objectives
To refine skills in applying religious
and spiritual counseling strategies
with families
To explore ethical concerns related
to religious and spiritual
interventions in clinical practice
Definitions: Spirituality
and Religion
Spirituality involves:
Animating life force
Images: wind, breath, vigor,
courage
Innate capacity that moves people
toward love, meaning, hope
transcendence, connectedness &
compassion
Definitions: Spirituality
and Religion
Capacity for growth, creativity, values
Encompasses religion
May or may not involve God or a
Higher Power
Less a method than an attitude
Definitions: Spirituality
and Religion
Religion
Set of beliefs and practices of
an organized institution
Denominational
External
Public
Definitions: Spirituality
and Religion
Cognitive
Behavioral
Ritualistic
Doctrine and dogma
Community
Polity
Relationships Between
Spirituality and Religion
Spiritual, but not religious
Religious, but not spiritual
Spiritual and religious
Neither religious nor spiritual
Pelikan’s Paradigm: Spirit
vs. Structure
Pelikan (1968) used paradigm to
describe Luther’s role in the Protestant
Reformation
Institutional structures squelching God’
spirit
Free-floating spirituality needs
structure to mediate its power
Clinical Implications
Avoid making assumptions about
patients’ worldviews, spirituality, or
religion
Inquire about how patients’ make
meaning in their lives—especially the
meaning about illness, trauma and
death
Clinical Implications
Ask how you may best serve patients’
religious or spiritual needs given your
professional role
Actively invest in learning about
patients’ religious or spiritual
perspectives
Empirical Data on Religion,
Spirituality & Health
Extensive empirical studies reveal that
acitvely religious people have lower
rates of many physical disorders
ranging from cancer to heart disease.
Mortality rates are lower.
Coping with death and other stressors
is better
Empirical Data on Religion,
Spirituality & Health
Recovery rates from almost
everything, including surgery are
better for religiously active individuals
(Larson & Larson, 1994)
A TIME survey in 1996 revealed that
over 70% of patients polled believed
that spiritual faith and prayer help in
illness recover
Empirical Data on Religion,
Spirituality & Health
64% of those surveyed believed
physicians should talk to patients
about spiritual issues as part of their
care and pray with patients if they
request it
Empirical Data on Religion,
Spirituality & Health
One of the strongest predictors of
survival after heart surgery is the
degree to which patients draw
strength from religion or spirituality,
and the more religious they are the
greater their protection from death
(Oxman, Freeman, & Manheimer,
1995).
Empirical Data on Religion,
Spirituality & Health
Weekly church attendees have been
found to have 50% fewer deaths from
coronary artery disease, 56% fewer
deaths from emphysema, 74% fewer
deaths from cirrhosis and 53% fewer
suicides (Comstock, & Partridge, 1972)
Why?
Levin (1995) suggested:
Religiously affiliated people have a
secure sense of identity which lowers
their anxiety level and facilitates
resiliency under stress
Religion & spirituality provide meaning
and purpose that allow for rational
interpretations of life problems
Why?
Positive emotions of hope, faith,
optmism, and catharsis emerge from
beliefs and ritualis, including the
process of forgiveness and the hope of
healing and redemption.
Religious people experience social
support through community
Why?
Religion and spirituality that offer
prayer, ritual, worship provide
experiences of communion between
the individual and the Higher Power
Many beliefs lead to a healthy and
responsible lifestyle
Empirical Data on Religion,
Spirituality and Mental
Health
There is a favorable association
between religiousness and suicide risk,
drug use, alcohol abuse, delinquent
behavior, and criminal behavior
(Gartner, Larson & Allen, 1991)
Couples who attend church regularly
as less likely to divorce—of course
they may stay unhappily married!
Empirical Data on Religion,
Spirituality and Mental
Health
However, further research revealed
religious folk were more satisfied in
their marriages than were the less
religious. (Gartner, et. al, 1991)
In fact, church attendance predicted
marital satisfaction better than any of
8 other variables (Glen & Weaver,
1978)
Empirical Data on Religion,
Spirituality and Mental
Health
There is a positive relationship
between religion & spirituality and
overall well-being.
Religious persons reported lower levels
of depression than did those who were
not so religious (Gartner, et. al, 1991)
Conclusion: Religion & spirituality are
integral to clinical work
Models of Religious and
Spiritual Development
 Why they are useful:
Provide framework for
understanding how patients
incorporate their faith
Assist in assessing patients’
religious and spiritual growth
Models of Religious and
Spiritual Development
Why they are useful
Externalize religious and
spiritual perspectives and
reduce practitioner reactivity
Provide tools for practitioners to
make sense of their own
religious and spiritual journeys
Models of Religious and
Spiritual Development
Make practitioners more open to a
variety of religious and spiritual
beliefs and expressions
May be useful in helping patients or
clients understand their own
perspectives vis a vis these
frameworks
Models of Religious and
Spiritual Development
CAVEATS:
These models are linear and
hierarchical. As such they imply
that higher stages are “better.”
They do not allow for circularity
or movement between stages
Models of Religious and
Spiritual Development
These models are all based on
western world views. That is,
they are more focused on
individualism rather than
collectivism. As such, they are
not particularly useful with
patients who hold eastern
worldviews.
Models of Religious and
Spiritual Development
GORDON ALLPORT: The
development of religious sentiments
(1950)
Three stages: Raw Credulity, Satisfying
Rationalism, Religious Maturity
Models of Religious and
Spiritual Development
 STAGE 1: RAW CREDULITY
Children believe everything they
hear about religion and spirituality
Children cling to their beliefs
because of the bond with their
parents
“Authority based” approach
Sometimes continues to adulthood
Models of Religious and
Spiritual Development
 STAGE 2: SATISFYING RATIONALISM
Begins in adolescence
Questioning previously held beliefs
Rebellion/rejection of parental
values
Some youth retain their childhood
values & beliefs
Models of Religious and
Spiritual Development
 STAGE 3: RELIGIOUS MATURITY
Occurs after adolescence
Ability to remain connected to a
tradition but approach it critically
Keep meaningful beliefs; reject
those that do not make sense
Religion & spirituality are positive
Models of Religious and
Spiritual Development
Some adults retain childhood faith
Other adults have more faith than
doubt
Other adults have equal amounts of
doubt and faith
Some never reach “religious maturity”
Some have meaningful life without
religion or spirituality
Models of Religious and
Spiritual Development
JAMES FOWLER: Faith Development
Influenced by Piaget’s theory of
cognitive development
Influenced by Kohlberg’s theory of
moral development
Also influenced by Erik Erickson and
John Dewey
Models of Religious and
Spiritual Development
Based on an empirical study of 359
individuals
For Fowler faith has more to do with
a dynamic, trusting orientation toward
life, others, and God, than with the
more static notion of faith as believing
beliefs
Models of Religious and
Spiritual Development
About the stages:
There are 7
They are invariant, sequential,
hierarchical
It is not possible to skip stages
Some people stay in one stage
for long period of their lives
Models of Religious and
Spiritual Development
 About the stages:
Sometimes they overlap as people
transition to the next stage
They are not content specific
Fowler claims that lower stages are
not inferior, but he has been
challenged on this point
Models of Religious and
Spiritual Development
STAGE 1: PRIMAL FAITH (Infancy)
Trust in caregivers is developed
in infancy
They learn that caregivers are
reliable
Corresponds to Erikson’s stage
of trust vs. mistrust
Models of Religious and
Spiritual Development
STAGE 2: INTUITIVE PROJECTIVE
FAITH (Early Childhood)
Images of God and faith are
reflections of children’s relationships
with parents and other significant
adults
Children in this stage do not have
the capacity for logical thinking
Models of Religious and
Spiritual Development
STAGE 3: MYTHIC-LITERAL (Middle
Childhood and Beyond)
Concrete thinking
People appropriate the myths,
stories, beliefs, symbols of their
traditions
God’s characteristics are
anthropomorphic
Models of Religious and
Spiritual Development
Stage 3: Mythic-Literal continued…
God rewards good, punishes evil
Many people in this stage get
disillusions when they discover that
“bad things happen to good people.”
Adults can also remain in this stage
Some entire congregations (often
fundamentalist) are in this stage
Models of Religious and
Spiritual Development
STAGE 4: SYNTHETIC-CONVENTIONAL
(Puberty to Adulthood)
Ability to think abstractly
Faith is constructed in terms of
conformity to a set of values and
beliefs with deference to authority
Faith stabilizes identity & worldview
Models of Religious and
Spiritual Development
Synthetic Conventional continued…
Beliefs and values are typically
unexamined
Yearning for a personal relationship
with God or Higher Power
Models of Religious and
Spiritual Development
STAGE 5:
INDIVIDUATIVE=REFLECTIVE Faith
(Young Adulthood)
Critical examination of faith
Take responsibility for their
worldview
Commit through conscious choice
rather than unexamined acceptance
Models of Religious and
Spiritual Development
STAGE 6: CONJUNCTIVE FAITH
Usually emerges in midlife and
beyond
People acknowledge multiple
perspectives as valid
Integrate polarities
Openness to difference while
grounded in own worldview & belief
Models of Religious and
Spiritual Development
Conjunctive faith continued…
Most adults do not reach this stage
God is experienced as both personal
and abstract
Life is considered both rational and
mysterious
Second naivete—reclaiming past
Models of Religious and
Spiritual Development
Conjunctive faith continued…
Develop a passion for justice
It is rare that one moves beyond
this stage
Models of Religious and
Spiritual Development
STAGE 7: UNIVERSALIZING FAITH
Only a few people in this category
(2-3 people/1000)
People are “grounded in oneness
with the power of being or God”
(Fowler, 1991).
Activists for justice
Examples: MLK, Jr. Mother Teresa
Models of Religious and
Spiritual Development
VICKY GENIA’S THEORY
Based on psychoanalytic theory
Acknowledges that development is
not always linear or smooth
Peaks and plateaus
Emotional problems may cause
people to adopt unhealthy faith
forms
Models of Religious and
Spiritual Development
STAGE 1: Egocentric Faith
Religion is rooted in fear and needs
for comfort
People here reenact their
relationships with their parents in
their relationship with God
Self deprecation or perfectionistic
Models of Religious and
Spiritual Development
STAGE 2: Dogmatic faith
Devotion to earning God’s love and
approval
Gravitate toward groups that focus
on self-denial
Allegiance to religious authority
Often intolerant of diversity and
ambiguity
Models of Religious and
Spiritual Development
STAGE 3: Transitional Faith
Examine tenets of faith
Open to exploring new spiritual
paths
Might switch affiliations
Doubt leads to spiritual growth
Models of Religious and
Spiritual Development
STAGE 4: Reconstructed Faith
People at this stage choose a faith
that meets their needs
They are aware of human
limitations
Strong sense of internalized morals
and ideals
Conform to religious behavior codes
Models of Religious and
Spiritual Development
Reconstructed Faith continued…
They relate to God as a caring,
reliable parent who is an ally and
source of sustenance
They may still have trouble with
ambiguity and multifaceted
dimensions of spirituality
Models of Religious and
Spiritual Development
STAGE 5: Transcendent Faith
Committed to universal ideals and
experience community with others
of diverse faiths
This stage is rare
Lifestyle consistent with values
Integration of reason & emotion
Models of Religious and
Spiritual Development
Transcendent faith continued…
They are committed without
absolute certainty
Eliminated egocentricity, magical
thinking and anthropomorphisms
Acknowledge the reality of evil and
suffering
CASE STUDY
Betty is a 42 year old White female
who has been hospitalized because of
a blood clot in her leg. The hospital
chaplain visited Betty and they spoke
about her faith. Betty indicated she
wasn’t sure anymore about her belief
in God. Although she was raised in a
strict Presbyterian home, she said she
CASE STUDY
Had doubts about whether God really
hears prayer. She also wonders if
Christianity is really the only “true”
religion. She admits that her illness
has caused her to think about things
she has previously accepted “on faith.”
CASE STUDY
Which of Fowler’s stages seems to
best fit for Betty?
Which of Genia’s stages seems to best
represent Betty’s story?
How would you suggest the chaplain
talk with Betty about her faith?
Working with Patients’
Religious and Spiritual
Issues
Refrain from assuming that you do not
have the ability or experience to talk
with patients’ about religion or
spirituality
Be careful not to impose your own
belief system on patients
Working with Patients’
Religious and Spiritual
Issues
View the patient as a whole person.
Avoid splitting religious and spiritual
issues from health or psychological
concerns.
Accept patients’ religious or spiritual
stories as just that without attempting
to reframe them as psychological
Working with Patients’
Religious and Spiritual
Issues
A Social Contructionist Perspective
Holds that our thoughts and images
about reality are subjective creations
rather than objective
representations (Luken & Lukens,
1988)
Allows multiple points of view about
a single issue or problem
Working with Patients’
Religious and Spiritual
Issues
People construct their worldview as a
result of interactions with others in a
social context and the belief systems,
values, fears, prejudices, hopes and
disappointments of the constructor.
It involves working within the patients’
own belief systems and values
Working with Patients’
Religious and Spiritual
Issues
Three umpires are sitting around and
one says, “There’s balls and there’s
strikes and I call ‘em the way they
are.” Another says, “There’s balls and
there’s strikes and I call ’em the way I
see’ em.” The third says, “There’s balls
and there’s strikes and they ain’t
nothing until I call ‘em.” (Anderson,
1990)
Working with Patients’
Religious and Spiritual
Issues
CHALLENGES:
Should I disclose anything about my
religious/spiritual beliefs?
What about patients’ religious
authorities?
What about my own issues?
Working with Patients’
Religious and Spiritual
Issues
SHOULD I DISCLOSE?
Patients often ask about caregivers’
personal beliefs. Why?
Interest
Fear of being devalued
Testing trust
Working with Patients’
Religious and Spiritual
Issues
Other reasons:
Nonreligious patients may worry
that caregivers will judge them
negatively
They may worry that nonreligious
caregivers may not understand or
respond to their belief systems
Working with Patients’
Religious and Spiritual
Issues
Another reason…
Some patients fear that religious
caregivers may use their situation as
an opportunity to convert them
Working with Patients’
Religious and Spiritual
Issues
 SHOULD I SELF-DISCLOSE?
Some experts believe that caregivers’
self-disclosure interferes with patients’
own self-exploration
Others believe exposing one’s beliefs
build rapport and offers clarity
Kelly (1995) suggests deflection of direct
questions may be helpful:
Working with Patients’
Religious and Spiritual
Issues
Example 1:
“I value your question, especially
because it suggests something of
importance to you. Rather than
respond directly, I think it might be
helpful if you were to talk more about
your belief and how it is helpful to
you.”
Working with Patients’
Religious and Spiritual
Issues
Example 2:
“ It sounds like you are concerned that
if my beliefs are different form yours
that I might try to convince you to
change them and that would not be
acceptable to you.”
Working with Patients’
Religious and Spiritual
Issues
Example 3:
“Maybe you are worried that I won’t
take your religious or spiritual
concerns seriously or that it isn’t safe
to raise these topics with me. I want
you to know you can trust me to
respect your beliefs.”
Working with Patients’
Religious and Spiritual
Issues
WHAT ABOUT PATIENTS’ RELIGIOUS
AUTHORITIES?
Definition: the power to influence or
command thought, opinion, or
behavior
Working with Patients’
Religious and Spiritual
Issues
WHAT ABOUT PATIENTS’ RELIGIOUS
AUTHORITIES?
Parents
Bible
Doctrine
Clergy/ Bishops/Pope
Catechism
Working with Patients’
Religious and Spiritual
Issues
The more significant the authority, the
less power I have in client’s life (unless
I happen to be an authoritative person
such as clergy)
Be careful about direct challenges to
patient authorities because you may
not be taken seriously
Working with Patients’
Religious and Spiritual
Issues
Talk openly with patients about their
religious/spiritual authorities so you
can learn about how they function
Use religious/spiritual authorities as
tools in clinical practice.
Example: Talk with patients’ about
Biblical texts that are important to
them
Working with Patients’
Religious and Spiritual
Issues
Consult with religious or spiritual
authorities themselves. It may be
helpful to invite them to participate in
your work with a particular patient
Some patients will respond only to
religious authorities whom they trust.
Referral can be in order
Working with Patients’
Religious and Spiritual
Issues
WHAT ABOUT MY OWN ISSUES?
It is imperative to become aware of
one’s own issues as a clinical
practitioner
Clients issues may become “clinical
triggers” for caregivers
Working with Patients’
Religious and Spiritual
Issues
When patients have issues that are
similar to the caregivers’ issues the the
caregivers are more vulnerable to
being pulled into their patient’s system
Countertransference reactions are
common
Working with Patients’
Religious and Spiritual
Issues
Examples:
Nonreligious practitioners
Rejection of family religion/values
Being in a similar stage as patient
Loss and trauma
Social and/or political difference
Clergy abuse
Working with Patients’
Religious and Spiritual
Issues
Addressing one’s own issues:
Seek peer consultation
Embrace supervision
Enter personal therapy
Refer patient
Strategies for Addressing
Religion & Spirituality
GENERAL GUIDELINES
Address personal issues first
Avoid imposing your values
Establish a trusting relationship
Know the norms of your setting
Strategies for Addressing
Religion & Spirituality
GUIDELINES CONT’D…
Be gentle with confrontation
Seek consultation with peers and
experts
Uncover patients’ sources of support
Keep patients’ best interest at heart
Strategies for Addressing
Religion & Spirituality
SPIRITUAL JOURNALING
1. Tool for self-discovery
2. Safety valve for emotions
3. Mirror for the spirit
4. Some patients may write prayers
5. Some may want to share contents
Strategies for Addressing
Religion & Spirituality
SPIRITUAL BIBLIOTHERAPY
Allows patients to express concerns
that may be outside awareness
Compare own thoughts to those of
others
Problem-solving information
Promotes anxiety reduction
Strategies for Addressing
Religion & Spirituality
GUIDELINES FOR SPIRITUAL
BIBLIOTHERAPY
Read the books you recommend!
Be sure the book is a good fit for
the patient
Avoid books that present “band-aid”
solutions to complex problems
Strategies for Addressing
Religion & Spirituality
GUIDELINES CONT’D…
Select books that support patients’
emotional and spiritual health
Seek recommendations for
colleagues, clergy, mental health
professionals
Strategies for Addressing
Religion & Spirituality
SCRIPTURE & SACRED TEXTS
Work within patients’ belief systems
Avoid power struggles & debates
Be prepared to refer
Make use of metaphor and narrative
(Richards & Bergin, 1997)
Strategies for Addressing
Religion & Spirituality
 Jonathan is a 34-year-old Jewish attorney
and local politician. He came to counseling
because he was "torn apart by guilt over an
affair he had had with a colleague."
Although he and his wife, Patti, are currently
involved in couples therapy with another
counselor, Jonathan sought out Joshua, a
Jewish chaplain, to help him address his
guilt and self-loathing.
Strategies for Addressing
Religion & Spirituality
 Because Jonathan specifically asked for a
religious dimension to be included in the
counseling, Joshua consulted with his rabbi
for a text that might be instructive for
Jonathan. Rabbi Rosen suggested using the
text from 2 Samuel 5-12:7 that includes the
stories of David's kingship, his victories, and
his adultery with Bathsheba.
Strategies for Addressing
Religion & Spirituality
 First, Joshua asked Jonathan to read the
text the rabbi had recommended. Next, he
asked Jonathan, "How is your life like that
of King David?"
 Immediately, Jonathan saw the connection.
He said, "I am a successful businessman
and a leader in my community, but I am
also human.
Strategies for Addressing
Religion & Spirituality
 Just because I am capable and contributing
doesn't mean I am without my faults. And,
just because I made a lousy mess of my
relationship with Patti by having an affair
doesn't mean that I am worthless garbage
either." Joshua then asked, "Based on your
understanding of the David story, what do
you think God would have you do in your
life?"
Strategies for Addressing
Religion & Spirituality
Jonathan responded, "There will have
to be consequences. I won't be able to
weasel out of this one easily. I will
have to demonstrate to Patti my
remorse and I'll have to figure out
some way to make amends. And, I will
need to start trusting God more for
guidance, rather than relying solely on
myself."
Strategies for Addressing
Religion & Spirituality
PRAYER AND MEDITATION
90% of Americans say they pray
86% believe prayer makes them
better people
97% believe prayers are heard
(Gallup Organization, 1993)
Strategies for Addressing
Religion & Spirituality
PRAYER AND MEDITATION
Who prays the most?
Women
African Americans
Older persons
(Gallup Organization, 1993)
Strategies for Addressing
Religion & Spirituality
PRAYER AND MEDITATION
Types of Prayer:
Contemplative
Ritualistic
Petitionary
Intercessory
Strategies for Addressing
Religion & Spirituality
PRAYER AND MEDITATION
Prayer used by patients
Prayer by practitioner for patient
Prayer with patient
Consider the setting and purpose
Strategies for Addressing
Religion & Spirituality
MEDITATION
Concentrative—focus on something—
mandala, candle, breath
Mindfulness—open self; await insight
Strategies for Addressing
Religion & Spirituality
MEDITATION
Helps in stress management and
relaxation
Aids with health problems
Assists in managing depression &
anxiety
Strategies for Addressing
Religion & Spirituality
VISUALIZATION AND IMAGERY
Used in a meditative posture
Patients imagine scenes or
images that call up issues or
concerns
Some imagery is guided
Strategies for Addressing
Religion & Spirituality
Meditation on Matt. 13:45-46
Here is a picture of of the Kingdom
of Heaven. A merchant looking out
for fine pearls found one of very
special value; so he went and sold
everything he had and bought it.”
Strategies for Addressing
Religion & Spirituality
… You become aware that you are
searching for something of great
value…Following your intuition and
God's guidance, choose your path and
do whatever is necessary in order to
find that for which you are
searching…Let yourself experience any
struggles or barriers along the way
Strategies for Addressing
Religion & Spirituality
Also, bring in any help or assistance
that you want…Finally you find this
thing of great value for which you
have been searching…You discover
that you must sell or get rid of
everything else in your life if you are
to obtain this one thing…Become
aware of your inner experience as you
make this discovery…( Stahl, 1977).
Strategies for Addressing
Religion & Spirituality
FORGIVENESS & REPENTANCE
To give up or give away anger and
the actions associated with it,
retribution and revenge (Sanderson
& Linehan, 1999)
A willingness to abandon one’s right
to resentment
Strategies for Addressing
Religion & Spirituality
FORGIVENESS results in
Patients experiencing positive affect
Improved mental health
More personal power
Freedom to grow
Strategies for Addressing
Religion & Spirituality
Process of Forgiveness:
Shock & denial
Awareness of hurt
Acknowledgement of grief & anger
Validation of feelings
Justice and restitution if possible
Strategies for Addressing
Religion & Spirituality
Process of Forgiveness cont…
Prevention of further offenses
Forgiveness and moving on
Short-cutting process can result in
depression & anxiety
(Richards & Bergin, 1997)
Strategies for Addressing
Religion & Spirituality
Forgiveness does not require
reconciliation
An apology may be necessary for
reconciliation, but not for forgiveness
Forgiveness can occur without the
offender’s knowledge or involvement
(Freedman, 1998)
Strategies for Addressing
Religion & Spirituality
Four patient choices:
1. Forgive and reconcile
2. Forgive and not reconcile
3. Not forgive and interact
4. Not forgive and not reconcile
Strategies for Addressing
Religion & Spirituality
SURRENDER
First attempt to change
circumstances
Next, willingness to change self and
to accept the direction life takes us
Strategies for Addressing
Religion & Spirituality
Patient approaches to life’s difficulties:
Deferring
Pleading
Self-direction
Spiritual surrender
(Pargament, Smith, Koenig, & Perez,
1998)
Strategies for Addressing
Religion & Spirituality
When patients are faced with
situations in which there is little
personal control such as chronic or
terminal illness, death or accidents,
surrender might be appropriate for
them to consider…
Strategies for Addressing
Religion & Spirituality
SURRENDER
involves not only a cognitive shift,
but an experiential one as well in
which one is in touch with selftranscendence that leads to serenity
(Cole & Pargament, 1999).
Strategies for Addressing
Religion & Spirituality
Guidelines for using Surrender as a
strategy:
Assess patient’s situation
Avoid using surrender as a means of
control
Distinguish between surrender and
learned helplessness
Strategies for Addressing
Religion & Spirituality
Explore patients’ religious and spiritual
beliefs to determine if surrender is
appropriate in their context
Explore patients’ receptivity by asking,
“What would it be like for you to
surrender to God?” (Cole &
Pargament, 1999).
Spiritual Strategies with
Families
For most Americans, the interface
between family life and religion or
spirituality is very important.
Religious/spiritual beliefs are critical
aspects of healthy family functioning
(Beavers & Hampson, 1990)
Spiritual Strategies with
Families
In a Gallup Poll (1996) 75% of those
surveyed said that religion has been a
positive, strengthening force in family
life.
Spiritual Strategies with
Families
Life Cycle Transitions as Opportunities
Marriage/Coupling
Birth of Children
Adolescence
Young adulthood
Midlife
Death & Dying
Spiritual Strategies with
Families
A Family Systems Approach
Problems or difficulties are
understood to be located BETWEEN
people instead of WITHIN
individuals.
In a family, the whole is greater
than its parts
Spiritual Strategies with
Families
A Family Systems Approach:
An emphasis on what, rather than
why
Reciprocal causality rather than
linear cause and effect
Subjective rather than objective
Patterns and context
Spiritual Strategies with
Families
SPIRITUAL GENOGRAM
Map of multiple generations
Used to identify religious/spiritual
issues in the extended family
View of tradition & heritage as well
as current practice
 Four Steps:
1. Construct the genogram
2. Questions for reflection
3. Connect with family of origin
4. Integrate into the clinical endeavor
Spiritual Strategies with
Families
Procedure:
Map the family and record
significant events
Color-code the religious/spiritual
traditions
Note important religious/spiritual
events
Spiritual Strategies with
Families
Procedure cont…
Indicate if family members left a
church or other religious
institution/organization
Indicate closeness or distance or
conflict
Spiritual Strategies with
Families
 Genogram-Related Questions:
 1. What role, if any did
religion/spirituality play in your family
of origin?
 What specific religious/spiritual beliefs
are most important for you now? How
are they a source of connection or
conflict between you and other family
members?
Spiritual Strategies with
Families
How is gender viewed in your
religious/spiritual tradition?
Ethnicity? Sexual orientation? How
have these beliefs affected you and
your extended family?
Spiritual Strategies with
Families
 What patterns emerge for you as you
study your genogram? How are you
currently maintaining or diverting
from those patterns?
Spiritual Strategies with
Families
How does your religious/spiritual
history connect with your current
distress, or with the problem you
presented for counseling? What new
insights or solutions may occur to you
based on the discoveries made
through the genogram? (Frame,
2000).
Spiritual Strategies with
Families
God as a Member of the Family
Using Circular Questions (Griffith,
1986):
When Dad stops working and
attends to Mom, what happens to
Tyler’s relationship with God?
Spiritual Strategies with
Families
More circular questions:
Does Tyler move closer to God or
farther away?
If Tyler moves away from God, who
else makes a similar move?
Who would be the most upset if the
family did not stay close to God?
Spiritual Strategies with
Families
More Circular Questions:
About which relationship in the
family do you think God would
express the most satisfaction?
The least satisfaction?
If you worked out your sexual
relationship with your partner
Spiritual Strategies with
Families
 so that you both found it to be
satisfying, would you feel closer or
farther away from God?
To whom in the family can you talk
about God?
With whom would you feel it
awkward?
(Griffith & Griffith, 1992)
Spiritual Strategies with
Families
Using a Spiritual Framework
Example: A 25 year old son was
overly enmeshed with his mother.
He could not work without her
supervision and she wasn’t able to
travel because she needed him to
protect her.
Spiritual Strategies with
Families
Intervention: (Griffith, 1986)
Reframe the son’s obsession with
his mother as a sin because he
lacked faith the God would protect
her.
To son: “By protecting your mother,
you are trying to be her God”
Spiritual Strategies with
Families
TRIANGLES
The notion that a 2 person
relationship is unstable.
To manage the anxiety generated
by emotional reactivity, one person
brings in a 3rd to moderate or
reduce anxiety (Papero, 2000)
Spiritual Strategies with
Families
Sometimes one partner in a couple
brings in God to create a triangle and
diffuse conflict and balance the
relationship
Types:
Coalition—each partner competes
for the allegiance of God but neither
is sure they have it
Spiritual Strategies with
Families
Types, cont…
Displacement: Couple unites against
a common enemy. God is blamed for
the adversity in the marriage and
the couple may be connected by
their mutual anger at God
Spiritual Strategies with
Families
Types contd…
Substitutive: God is brought in to
the partnership to minimize conflict
by diverting attention and intimacy
to God rather than to the partner.
Case Examples (pp. 219-220)
Spiritual Strategies with
Families
RITUALS
Common to both religion and
spirituality
Identify a patient’s experience
Find significant symbols
Create symbolic acts
Spiritual Strategies with
Families
RITUALS cont…
Possible uses:
Healing from abuse
Grief and loss
New relationships
Coming out process
Transitions
Spiritual Strategies with
Families
NARRATIVE APPROACHES
Religious/spiritual language to invite
conversations between self and God.
Build on work of Karl Tomm (1987)
and Michael White (1986)
Spiritual Strategies with
Families
 NARRATIVE APPROACHES cont…
 Sample Questions:
 Had you possessed the
relationship you now have with
God when you first married, how
do you suppose your different
behavior might have altered the
way the relationship evolved?
Spiritual Strategies with
Families
If God were to restructure this
interaction, how do you think it
would go?
If you were to discover that God
had in fact been present and active
in this situation all along, where
might that have been? (Griffith &
Griffith, 1992, p. 73).
Spiritual Strategies with
Families
 Has there ever been even a brief
moment when, contrary to your
expectations, you did sense approval
coming from God?
 Can you recall a time when your
husband might have criticized your
relationship with God but didn’t?
Spiritual Strategies with
Families
In view of all the betrayals you
experienced in your life growing up,
are you surprised to discover that you
have learned to trust God? (Griffith &
Griffith, 1992, p. 73-74).
Spiritual Strategies with
Families
 What difference will your having
learned how to trust God make in
your learning how to trust your wife?
 If you see yourself as the person God
sees, what new possibilities might
you imagine for this relationship?
Spiritual Strategies with
Families
If you were to agree with the outcome
you believe God wants for this
relationship, what might be the next
step in getting there? (Griffith &
Griffith, 1992, p. 74).
Ethical Issues
ETHICS
Our beliefs about what constitutes
right behavior
How practitioners’ behavior affects
patient welfare, social networks, and
the helping profession
Ethical Issues
 Four Dimensions:
 having sufficient knowledge, skill,
and judgment of use efficacious
interventions
 respecting human dignity and
freedom of the client
Ethical Issues
using the power inherent in the
counselor's role responsibly
acting in ways that promote public
confidence in the profession of
counseling
(Welfel, 1998)
Ethical Issues
WELFARE OF THE PATIENT
Address religious/spiritual issues
when the arise
Become familiar with religious
language and concepts
Work within patient belief systems
Ethical Issues
INFORMED CONSENT
Patients’ right to know what will
transpire during a procedure or
helping moment
Let patients’ know about religious
affiliations
Ethical Issues
Protect patients’ rights to decline
the use of spiritual interventions
Provide referrals to other persons
for religious/spiritual guidance and
support
Ethical Issues
COMPETENCE AND TRAINING
Do not practice beyond the level of
competence and training
Get supervision at the beginning of
this work
Consult, consult, consult!
Ethical Issues
PERSONAL ISSUES
Address own religious/spiritual
issues
Get therapy if needed
Seek spiritual guidance, if
appropriate
Ethical Issues
PERSONAL ISSUES cont
Be careful not to place your own
needs above those of the patient
Practice self-evaluation
Clarify your values
Ethical Issues
IMPOSITION OF VALUES
Imposing or exposing?
When exposing becomes imposing
Evaluation one’s interventions for
possible value imposition
Avoid passing judgment on patient
values
Ethical Issues
DUAL RELATIONSHIPS
When practitioners have other
types of relationships with
patients besides their professional
one
Potential for conflict of interest
Ethical Issues
Reduction in objectivity
Possible impairment to clinical
judgment
Possible harm
Ethical Issues
Examples:
Blurred social and professional
boundaries—role confusion
Counselor as priest, rabbi
Chaplain as parishioner or friend
Ethical Issues
Guidelines (Geyer, 1994)
Give notice if clinician is providing
consultation or supervision—
likelihood of confidentiality breaches
Collaboration between religious
organizations to provide mental
health services to each other’s staffs
Ethical Issues
Clinicians in leadership roles in
churches could reserve the right not
to comment when they have
information that would jeopardize
client confidentiality
Avoid dual relationships where
possible
Ethical Issues
Establish personal boundaries
Define financial arrangements (if
any) clearly
Maintain regular supervision and
consultation
Ethical Issues
WORK-SETTING BOUNDARIES
1. Public, govt funded agencies
may have policies that prohibit
religious/spiritual interventions
2. Obtain informed consent
3. Be careful not to usurp or
displace religious leaders
Ethical Issues
4. Take care not to denigrate or
criticize religious leaders’ values or
belief systems
Ethical Issues
CONSULTATION AND REFERRAL
Know your limits of effectiveness
Develop a network of “friendly
clergy”
Become cross-culturally
knowledgeable