spiritually informed practitioners: exploring challenges and opportunities [email protected]
TRANSCRIPT
www.wisecounsel.wordpress.com
www.globaltraumarecovery.org
www.biblical.edu
Objectives Review historical divide between MH and
F/S/R Explore the relationship between F/S/R
and MH Examine our own biases Consider core spiritual competencies
First reaction? Faith Spiritual Religion
Vignettes Adult male struggling to forgive hurt by
parent 17 year old with same sex attraction 46 year old who believes he is a prophet 14 year old Jewish girl with OCD 31 year old veteran with moral injury
shame 29 year old woman in full hijab
Disconnect between MH and faith?
Now for a little history
René Descartes, 1596-1650 Ideas are universal truths God is a clear and
distinct universal truth and our ability to have ideas proves he exists
Mind and body are two distinct entities
Mind-Soul connection?
Current modern dogma division(thanks to Descartes)
Science: Facts Objective Public Reason Reasonable Men Nature’s God Deist faith
Religion: Values Subjective Private Emotion Irrational/faith Women and children Family God Pietism
Relationship between faith and science?
There isn’t a clear line between the objective and the subjective, yet faith and science are not the same:
So, who controls? Foundationalist approach
Scientific materialism vs. biblical literalism Nonfoundationalist approach
Two diverse ways of knowing but having no contact with each other
Following Descartes
The rise of clinical psychology Antagonism towards Avoidance of
Don’t ask….Don’t tell
Positives from these developments
Evidenced based practice Ethical mandates for diversity, dignity,
autonomy
But some problems still F/S/R seen as insignificant areas of study Suspicion between clergy and MHPs Myth of therapist neutrality
When it comes to religion and spirituality, no one is neutral. Ken Pargament, PhD
Divide today? 92% of population believe in divine
being 75% pray regularly
But Only 23% of MHPs believe in divine
being
More recently some good news Mindfulness growth Growth in religious psychologies Spiritual assessments requires in JCAHO Latest polls show increase in spiritual
competencies amongst MHPs
RECOMMENDATIONS
•Spirituality in Clinical Practice•Spiritual Functioning Among Veterans Seeking Residential Treatment for PTSD•The Morally-Injured Veteran•Spiritually Oriented Disaster Psychology•Anger Concepts and Anger Reduction Method in Theravada Buddhism•Enchanted Agnosticism
Good reads
Faith, Spirituality, and Religion
Defining Terms
Faith Belief in what cannot be seen
Spirituality Part of the human experience of the
transcendence Relationship with the divine? Meaning, purpose?
Religion Set of practices
Community oriented Extrinsic v. Intrinsic?
A better division? Behavior rituals, lifestyles, deeds,
holidays Belonging community, culture,
history Believing faith, meaning, theology Being experience of
transcendence
92% believe in spiritual beings16% are unaffiliated72% are “spiritual”
Benefits to Mental Health
What if 84% of your clientele found exercise beneficial? Would you talk about it?
Benefits Positive spiritual coping associated with
lower depression and anxiety (Gall, 2006)
Absence of benefits (spiritual struggle) lengthen treatment
Enhances social support; provides hope
Positive religious coping
Derive meaning and purpose from worship and engagement of the Sacred
Connect to others: Community bonding
Forms of positive coping Use of private and corporate worship Reading sacred texts Meditating on God’s nearness/love
David Brooks, Theologian?
Suffering calls us to : Accept personal limits Acknowledge self-deception Answer the call to the greater good Submit to the moral drama of life
It is a community effort!
Community helps• re-telling of stories • point to transcendence
Sacred texts: Laments
Purpose: Complaints about injustice and loss Questioning God Asking for rescue, calling on promises Waiting expectantly
Benefit of laments?
Increased communion and intimacy Kim Snow
Holding communion and complaint together in our “winter of faith”
R. Beck
Elie Wiesel on lament
I have not lost faith in God. I have moments of anger and protest.
Sometimes I’ve been closer to him for that reason.
Night
Faith and Pathology?
Not all faith responses are helpful Desecration…rejection…angry/ominous Passive spiritual responses
Predict depression, anxiety, and earlier death
Spiritual Struggles
Two categories Discontent Questioning
Relationship with trauma symptoms?
Jennifer Wortmann- University of CT
Moral Injury
War-related moral injuries Weakened faith and increased guilt
predict greater usage of VA services
Fontana and Rosenheck, VA National Center, 2004
Civilian Moral Injury?
Trauma WITHIN faith communities
“I feel like a spiritual orphan, betrayed by what I loved, and I feel lost and alone”
Kusner & Pargament, Trauma Therapy in Context, 2012
Result: Shame
Common Refrains I can’t forgive myself; I can’t forgive them I shouldn’t fear…I should trust
Veterans who cannot forgive self are more symptomatic
Joseph Currier, Fuller Seminary
Soften problematic beliefs?
“…cognitive techniques aimed at softening client beliefs about right and wrong or disputing the validity of the client’s guilt might paradoxically deprive a religiously committed client of rituals such as the confession of sin as an avenue to grace.”
W. Brad Johnson (USNA)
Soften problematic beliefs?
“therapists who strip away the language of sin from Christian clients may unwittingly take away a source of peace and hope by foreclosing the possibility of grace and forgiveness.”
Mark R. McMinn (George Fox U.)
Bridging the Training Gap
Spiritual Competencies
Learn 16 competencies:Vieten, Scammel, Pilato, Ammondson, Pargament & Lukoff (2013). Spiritual and Religious Competencies for Psychologists. Psychology of Religion and Spirituality, 5, 129-144
Competency requires Becoming self-aware Understand (and value) cultural
differences Implement spiritually sensitive
interventions tat engage client F/S/R practices
Attitudes Demonstrate empathy, respect, and
appreciation for clients from diverse spiritual and religious backgrounds
Be aware of views, experiences, and personal practices that influence clinical practice
Questions to ask yourself Experience F/R/S as a source of strength Experience F/R/S as source of injury
Knowledge Know and explore diverse forms of
spirituality, religions, and practices important to your clients
Know the empirical data on positive and negative spirituality as it relates to health
Skills Inquire about the spiritual backgrounds
of all clients Help clients explore and access spiritual
and religious resources
Cross-cultural Engagement
Utilize literature, anthropology, and related disciplines to arrive at a more accurate view of person of faith
Learn local “language” of distress and develop agreed upon goals
Study local healing interventions and healers Choose set of integrated interventions in order to do
no harmAdapted and modified from Siddarth Shah’s unpublished
essay on ethnomedical competence
Examples Ask clients to write their prayers What faith practices are important to
you? Ask them who they like to read/listen to
Consider: Health professionals
Passage meditation Repetition of holy word/mantram Slowing down One point attention Training the senses Putting others first Spiritual association Inspirational reading
Doug Oman, Oakland Public Health Institute
WWYD?
Difficult Cases
Vignette: Faith as protective factor?
• Male, 36 years old, victim of child sexual abuse.
• History of substance abuse and depression
• Referred to therapy by his pastor after he disclosed that his substance abuse and depression had intensified.
• Told his therapist that in spite of his condition he had hope and saw himself as a true survivor in large part because of his faith in God
50
Vignette: Two worlds17y/o African American man whose lifelong church community has been the only source of stability in his lifeHe has recently come to understand himself as gay and worries that if he reveals this publically his church may kick him out.
51
Religious delusions? 46 year old man, believes he is John the
Bapt Brought by family after Dx of Delusional
Disorder Wants to know whether you are a
Christian and whether you believe he is a prophet
Concluding thought
What is your tendency? Nihilism/despair Messianism/presumption
Warren Kinghorn (Duke)
Despair?
Consider Job’s “friends”Curse God and die!When will you end this ranting?
Presumption?
“For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to
harm you, plans to give you hope and a future”Jeremiah 29:11
For slides: Email: [email protected] Visit:
www.biblical.edu www.wisecounsel.wordpress.com www.globaltraumarecovery.org