SPIRITUALLY INFORMED PRACTITIONERS:

EXPLORING CHALLENGES AND OPPORTUNITIES

pmonroe@biblical.edu

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: pmonroe@biblical.edu Visit:

www.biblical.edu www.wisecounsel.wordpress.com www.globaltraumarecovery.org