Spirituality and Psychotherapy

1. Spirituality and Psychotherapy No thanks, we’re Psychologists!

2. 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

3. 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

4. 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)

5. Vaillant, 2008 • Spirituality is 8 positive emotions: • Awe • Love ( attachment) • Trust (faith) • Compassion • Gratitude • Forgiveness • Joy • Hope

6. Spirituality is the vehicle through which meaning is sought. Religion is that vehicle for some.

7. 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.

8. PSYCHOLOGY • PSYCHE – meaning “soul” • LOGY – from logos – “the study of “

9. 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)

10. 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)

11. 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

12. The History of Psychology • Founding fathers had no need to separate psychology and spirituality; roots in philosophy and theology • For example William James G. Stanley Hall

13. 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

14. 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.

15. 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”

16. 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”

17. 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

18. 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

19. 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

20. 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

21. Growing Recognition of S/R issues in the Psychology The majority of the general public in America identifies as religious or spiritual.

22. Plante, 2009 Gallup Poll • 95% of Americans believe in God • 40% of Americans attend religious services on a weekly basis

23. 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

24. 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.

25. 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

26. 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.

27. 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)

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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%

34. 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

35. 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

36. 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”

37. 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.

38. 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.

39. Ethical Issues Martinez et al. 2007 • Informed consent • Religious and spirituality identity • Dual relationships • Collaboration with religious leaders

40. Ethical Issues • Respect for client’s values/fear of imposing • Discomfort with subject • Lack of interest or awareness • Therapist competence

41. 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.

42. 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)

43. 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

44. 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

45. 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

46. 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

47. 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)

48. 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

49. Post and Wade, 2009 • Wisdom of Experienced clinicians who work with religious/spiritual issues • Pluralistic approach/Appreciation of diversity • Careful not to impose • Used a developmental lens or saw religious/spiritual issues as intertwined with psychological issues

50. 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.