Integrating Religion and Spirituality into Clinical Practice

1. Integrating Religion and Spirituality into Clinical Practice

2. 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

3. Book Information • Marsha Wiggins Frame (2003). Integrating Religion and Spirituality into Counseling: A Comprehensive Approach. Pacific Grove, CA: Brooks/Cole

4. 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

5. 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

6. 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

7. 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

8. Definitions: Spirituality and Religion • Religion • Set of beliefs and practices of an organized institution • Denominational • External • Public

9. Definitions: Spirituality and Religion • Cognitive • Behavioral • Ritualistic • Doctrine and dogma • Community • Polity

10. Relationships Between Spirituality and Religion • Spiritual, but not religious • Religious, but not spiritual • Spiritual and religious • Neither religious nor spiritual

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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).

18. 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)

19. 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

20. 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

21. 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

22. 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!

23. 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)

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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.

30. Models of Religious and Spiritual Development • GORDON ALLPORT: The development of religious sentiments (1950) • Three stages: Raw Credulity, Satisfying Rationalism, Religious Maturity

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. 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

48. Models of Religious and Spiritual Development • Conjunctive faith continued… • Develop a passion for justice • It is rare that one moves beyond this stage

49. 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

50. 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