Three Doors to Spiritual Reflection

Ethnographic Research on the Role of Emotion, Images and Sacred Texts in

Spiritual Reflection done by non-chaplaincy Health Care Professionals

CASC/ACSS April 15, 2011

Authors

Thomas St. James O’Connor, ThDMichael Chow, MA, MDivElizabeth Meakes, MTS Janet Young, MTS Gary Payne, MDiv Myrta Rivera, MA Laura MacGregor, MSc Janet Howitt, MDiv/MSW

Introductions of Presenters

• Michael Chow, M.Div, MA

Director, St. Joseph’s Health System, Diocese of Hamilton

Specialist & Teaching Supervisor (CASC)

• Gary Payne, M.Div

Professional Practice Leader, Spiritual Care

St. Joseph’s Healthcare Hamilton

Specialist & Teaching Supervisor (CASC)

Introductions of participants

• Who am I?

• Professional practice?

• Special interest in this workshop …

Our Plan

Our Plan• Stepping Back a Little

– Overall Research Question– Review of Literature – Sources– Definitions– Findings and Discussion

• Moving Forward– Role of Emotions, Images & Sacred Texts– Discussion

Stepping Back a Little• Ethnographic qualitative study• 2 articles published

– “In the Beginning: A Canadian Study on Sources and Definitions of Spiritual Reflection used by Health Care Professionals who are not Chaplains”

In Journal of Pastoral Care & Counseling, Vol 64, No 1 (2010)

• Focus on Sources & Definitions

– “Three Doors” Has been accepted for publication by Journal of Healthcare Chaplaincy, NY (March 2011)

• Focus on Images, Emotions and Sacred Texts

Overall Research Question

What are the practices of spiritual reflection

for health care professionals who are not chaplains

who provide spiritual care to their clients?

Interview Guide1) What are the sources you use for spiritual reflection?2) How do you define spiritual reflection? Any spiritual authors you

use?3. How much time weekly on spiritual reflection?4. Similarities & differences between prayer & spiritual reflection5. Goal of spiritual reflection?6. How important is spiritual reflection for identity?7. Which groups-colleagues, clients, & other profession.?8. Role of emotion and images in spiritual reflection? Is there an

image or verse from a sacred text that describes spiritual reflection?

9. Give me an example of spiritual reflection from your practice10. Image or verse from a sacred text and/or any other source that

describes it.11. Any other comments.

Review of Literature

From “In the Beginning” publication:• No empirical research found on definitions,

sources or methods of spiritual reflection used by health care professionals who are not chaplains.

• Interviewees preferred “spiritual reflection”, whereas chaplains & pastoral counsellors also used “theological reflection”

Lit Review findings (cont)• Spiritual care and spirituality have become

more important to many health care disciplines in the last thirty years

• In the health care disciplines, there is an emphasis on reflective practice

• Don Schon’s Reflective Practice is a common text used in many health care disciplines.

Lit Review findings (cont)• Literature Review focused on three health

care disciplines:– nursing, – social work – occupational therapy

• Examining barriers to practice of spiritual care which includes spiritual reflection

Barriers in Nursing• Lack of conceptual clarity of “spirituality”• Frequent assumption that spiritual care is

same as religious/faith based care • Demands placed on bedside nurses in terms

of patient care • Lack of confidence in dealing with spiritual

matters• Lack of education regarding spiritual care and

reflection

Barriers in Social Work• The notion that social work, like other health

professions in recent decades, has distanced itself from religious belief

• Increased emphasis on evidence-based practice

• Lack of appropriate education in the realm of both spiritual care of clients and the role of spirituality as a health professional

Occupational Therapists:a philosophical dilemma

• Canadian Model of Occupational Performance [CMOP], the model that describes the human participant in occupational therapy and the corresponding domain of concern for the profession, spirituality is placed at the central core of the person and model (Baptiste, 2005)

Barriers for OT’s• Debate within the profession:

– How to define spirituality

or

– Whether spirituality belongs in the centre of the occupational therapy model

• Lack of training in spiritual aspects of care • The fear of intruding on another’s beliefs

Barriers for OT’s (cont)• Discomfort by the treatment team when

professions explored spirituality • Confusion about the role of spirituality • Lack of time• Their role in terms of spirituality was to refer

to pastoral care • An assumption that discussing spirituality

with clients is taboo or inappropriate • Too emotionally charged

Other findings• In some cases, nurses & OT’s became more

comfortable providing spiritual care with experience

• That therapists who considered themselves religious were more likely to have positive attitudes regarding exploring spirituality in their professional life

• Spiritual reflection has not been addressed nor has the methods and sources for reflection. Nonetheless, spiritual care requires some level of reflection

Sample details• 20 interviews • Occupational Therapists, Nurses, Social

Workers, Physiotherapists, Music Therapist, Recreation Therapist, Physician, Psychologist

• Faith groups included: United Church , Evangelical Christian , Christian Reform , Mennonite, Buddhist , spiritual but no faith group

• Gender mainly females 17:3• Age: mainly over 40

Brief Check In

For a few minutes please consider:

• Is Spiritual Reflection part of your own practice?

• What are some sources for Spiritual Reflection for you?

• How do you define Spiritual Reflection?

Findings

Research Findings: Sources• Music 9/20• Sacred text esp. Bible 6/20• No sacred text mentioned 4/20• Personal & client experiences 7/20 -

(much of this was personal journey) • Variety of spiritual authors used• Nature – 4/20

Research Findings: Definitions

• Connecting to Self & others…balance & grounded 9/20

• Accessing & discovering the divine 8/20

• Meaning and purpose 6/20• Related to daily life 6/20

Unexpected Findings

• Many mentioned no education in spiritual care/reflection

• None mentioned receiving adequate education

Comparison against study on Theological Reflection

Sources for Theological vs. Spiritual Reflection

Chap/Past Counsellor OT, Nurses, SW1. Sacred texts 63/75 1.Mus, Art, Lit 11/20 2. Pers. Exp. 50/75 2. Sacred text 11/203. Experience/Clients 42/75 3. Per/Prof Exp. 7/204. Faith Tradition 39/75 4. No sacred txt 4/205. Lit. & Soc. Sci. 26/75 5. Nature 4/20

Discussion on DefinitionsDefinitions of Theological vs Spiritual Reflection

Chap./Past. Coun. OT., Nurses, SW.

• Both struggle to define• Meaning making Connecting with

Self/Other

• Discovering Divine Discovering Divine• Discipleship Meaning/purpose

Three Doors

Three Doors

• Role of Emotion, Images & Sacred Texts

• In the process of Spiritual Reflection

• By non-chaplaincy health care professionals who offer spiritual care

Three Doors

Main Finding:

• That emotion and images are main doors,

• With sacred texts being a side door

5 minute Check InPlease consider:

• What has been your experience with Spiritual Reflection?

• What are the roles of emotion, images and sacred texts in Spiritual Reflection for you?

• Is there an image or verse from a sacred text that describes Spiritual Reflection for you?

Transformation

TRANSFORMATION

Outcomes of Spiritual Reflection

• Deeper sense of peace

• Grounding and Letting Go

Some form of Transformation results from Spiritual Reflection

The 3 Doors“In our research, we found that emotion and

images were the two main doors to spiritual reflection …

…A third door used by some was sacred texts but most participants acknowledged that they had little education in the sacred texts.

Sacred texts were more of a side door and not the main doors.

Also a consequence of this spiritual reflection … was transformation.”

Role of Emotion, Images and Sacred Texts

• Affirmed by many writers (Killen & de Beer, 2002; Kinast 1996; Whitehead and Whitehead, 1995)

• Anton Boisen coined “Living Human Document” (1952)

• Gerkin expanded and insisted on hermeneutics (1984)

From Human Sciences

Goleman, Emotional Intelligence (1995) – Cites work of Salovey & Mayer, 1990

• 5 Domains

Fosha, Siegel & Solomon, 2009

• Emotions facilitate integration & motivation

Spiritual Needs

“… many healthcare professionals … believe that addressing the spiritual needs of clients and patients is within their scope of practice and part of holistic care.”

“Most research on spirituality and health is done by these non-chaplaincy professionals and researchers…”

Is there a gap?

“However with these professionals, there is a gap between research, the interest and the actual practice.”

“It is not known how much spiritual care is actually done by the non-chaplaincy disciplines.”

Spiritual Care & Therapy

• Spiritual Care & Therapy traditionally domain of chaplains and community clergy

• Some are critical of these other professionals doing spiritual care when many have little education and training in this area (Sloan et al., 2000)

Care involves Reflection• Spiritual Care involves Spiritual

Reflection(Schon, 1983; Mezirow, 1997; Mamede & Schmidt, 2004)

• “Reflective practice is important in all health care disciplines. Spiritual reflection can happen in the midst of a visit with patient, in a prayerful time after or in conversation with a colleague.”

Research lacking?

“However, there has been no empirical research on the role of emotion, images and sacred texts in spiritual reflection among non-chaplaincy health care professionals.”

Rationale for study

• Given lack of empirical research, qualitative study employed

• Descriptive and ethnographic

• Goal is to understand and explore the role of emotion, images and sacred texts

Secondary Rationale

• Investigate if there are any similarities and differences between chaplains and other health care professionals in areas of spiritual and theological reflection

Methodology

• Research questions

• Context

• Sampling & Participants

• Procedures and Analyses

• Standpoint of Researchers

Research Questions

• “What are the roles of emotion, images and sacred texts in Spiritual Reflection?”

• “Is there an image or verse from a sacred text that describes Spiritual Reflection for you?”

Context

Ethnography studies cultures within their contexts

• 3 different Canadian health care institutions in Southern Ontario– Large teaching hospital in urban centre– Community hospital in different urban setting– Long term care facility in same city as community

hospital

Sampling Methodology• Varied health care disciplines represented• Purposeful sampling by invitation• Criteria:

– Health care professional– Outside chaplaincy– Engaged in spiritual care and reflection as part of

practice

• Sampling ended when data saturation occurred after 20 interviews

Participants descriptionInterviewees fall into 3 groups of spiritual

practice:• 9 identified as spiritual but not religious, using

spiritual practices from Christian, Buddhist, Hindu and Muslim traditions

• Another group of 9 from particular Christian denominations (3 United Church of Canada, 4 Evangelical, 1 Christian Reform, 1 Mennonite)

• 3rd group: 2 Buddhists

Procedures

• Researchers made field notes and were participant observers

• Ethical approval received from Research Ethics Board of Wilfrid Laurier University in Waterloo, Ontario, Canada

• Interviews audio-taped & transcribed

• Field notes also part of data

Analyses

• Data analyzed for themes using constant comparative method (inductive data analysis)

• Then recorded under these emerging themes (deductive data analysis)

Validity of Analysis

• Increased validity through 2 types of triangulation: data and investigator

• Multiple researchers were involved in designing, interviewing, coding and discussion

• 6 researches interviewed participants and offered observations on cultures

Procedure• Another researcher did literature search and

involved in discussion of the findings relative to literature

• Yet another researcher was an observer (no interviewing nor involved with literature search) coded data independently

• Principal investigator also coded data and met with outside observer to discuss the themes that emerged

• Consensus achieved, themes presented to wider research team for discussion

Researchers• All researchers engage in either theological

or spiritual reflection and value this practice• 4 researchers work as chaplains and/or

pastoral supervisors in health care• 1 occupational therapist• 1 completed joint MSW/Mdiv degree• 2 family therapists and pastoral counsellors• Various Christian denominations and

respectful of all faith groups

Findings

Findings• Emotion & imagination: 2 main doors• Transformation is outcome of reflection• Professionals led to spiritual reflection

primarily based on their emotional response to patient or situation, including anger, awe, sadness, joy

• Images brought out in session also primary as door to spiritual reflection

Findings (cont)

• Emotion and images linked, but not for all

• However, 70% could not identify a sacred text that described process of spiritual reflection

• For 30%, sacred texts were an avenue for spiritual reflection

Emotion

• Description of data– Emotion crucial part of spiritual experience

and reflection for most (13/20)– Quotes (pp 7, 8)

Critique of Emotion• Minority of health care professionals are

critical of the role of emotions in spiritual reflection

• “One has to be wary of emotions and one’s emotions might have nothing to do with the client or patient with you had a session.”

• Quotes from study

Images

• Description of data– 14/20 mention that images lead to or are

part of spiritual reflection– Quotes from #88, #76, #82, #79, #93 & 94

• Some didn’t use images– Quotes: #83, #91

Emotions & Images

• “While there are some who don’t use images and some who don’t use emotions in spiritual reflection, the majority (11/20) use both emotion and images as their doors to spiritual reflection.”

Sacred Texts

• Summary of data– 14/20 can’t remember or don’t use

• Samples

– 6/20 named sacred text (all from Bible)– Other sources include works of art, various

songs, serenity prayer, various writers, poem “Footprints”

Outcomes using Emotion, Images and Sacred Text

• “Transformation in one form or another was the overall outcome of this use of emotion, images and sacred texts in spiritual reflection.”– Quotes:

• #90 a music therapist• #86 recreation therapist & #79, #87 SW

Outcomes

“The transformation that takes place in some ways is beyond the control of the professional and in many ways paradoxical.”– “letting go of control” #77 SW– “paradox” “being comfortable with

discomfort” #91 PT

Discussion of Findings

Discussion of Findings

• First purpose was to explore non-chaplaincy health care professionals’ use of emotion, images and sacred texts in spiritual reflection on provision of spiritual care

• Several significant findings in this uncharted area

Discussion of Findings

• Emphasis on emotion & images as 2 doors to spirituality and spiritual reflection

• These invite reflection on the sacred without the use of sacred text

Discussion of Findings

• Pargament 2007:– “search for the sacred”– “… humans in our contemporary society

experience the sacred inside and outside of religion. For those outside of religion, the experience of the sacred which is most important is not usually connected to sacred texts.”

Discussion of Findings

“The experience of these health care professionals is that sacred texts are not a requirement for spiritual reflection.

However, emotion and images are required for spiritual experience and reflection.”

Discussion of Findings• Focus similar to Boisen and Gerkin re Living

Human Document– Gerkin used Bible, systematic theology and is own

tradition to interpret experience and understanding the living human document (O’Connor 1998)

• Traditional spiritual care professionals agree– emotion and imagination essential (O’Connor &

Meakes, 2008)

Discussion of Findings

• Second purpose of study was to compare previous study on Theological Reflection (spiritual care professionals) with this study on Spiritual Reflection by non-chaplaincy health care professionals

Theological vs Spiritual Reflection

• In the study on Theological Reflection:– Sacred texts are bigger than the 2 doors of

emotion and images– Both studies found that the groups share

the common components of emotion, images and sacred texts in reflection process

Opportunity?

• Could there be collaboration and mutual learning between chaplains and health care professionals on theological and spiritual reflection?

Final thoughts

• Cannot generalize this research to all non-chaplaincy practitioners in health care

• Sample too small

• Other areas and cultures?

“One finding of the previous study on theological reflection is that the chaplains and other participants had gone beyond the methods and science of theological reflection that they had learned in their graduate studies into a creative and poetic imagination learned from experience, from the living human document.”

“We recommend, based on the current study, that the various health care professionals who engage in spiritual care collaborate with chaplains on further study of the role of emotions, images and sacred texts in spiritual and theological reflection.”

Reflections & Questions

We welcome your thoughts, comments…

Thank you!