Spiritually Integrated Psychotherapy:

A Partial Map of a Small Piece of the Territory for Pastoral Counselors and

Their Colleagues

Agenda

• Introduction, results, questions (45)

• Group conversation (5-7 people, 20 min)

• Responses from groups (20)

Rob Gonsalves“Unfinished Puzzle”

Met

hodo

logy

Exp

lain

ed

Grounded Theory

• Qualitative research

• Extension of ethnography (Strauss, Corbin, Charmaz)

• Constant-comparative method

• Construction of intermediate theory grounded in data (vs. testing a theory with data)

Procedures I• Proposal & MAP Grant in Collaboration with TSCTF

• Identifying general boundaries – Search of academic institutions with SI in description– Search of counseling agencies with SI in description– Search of counselors’ websites with SI in description– Defining “Pastoral Counselors and those who work with them”

• Sample– Maximum diversity frame (note limitations)– Email blast to all AAPC members asking to ID self and someone in community not AAPC

who practices SIP– Ed. Institutions selected from websites that met criteria– Counseling centers selected that met criteria– Individual practitioners from email blast & referred from email blast, center or ed.

Institution (you really should talk to…)

11%

9%

13%

18%9%

9%

4%

16%

11%

Age

26 - 3031 - 3536 - 4041 - 4546 - 5051 - 5556 - 6061 - 6566 - 70

44%56%

Gender

MaleFemale

Sample Characteristics

4%

16%

2%

78%

Race/Ethnicity

AfricanAfrican Amer-icanAsianEur/Amer

7%

38%56%

1st Degree

Sem MAUniv MAM.Div.

2%2%2%2%4%

18%

18%24%

27%

Term Degree

MSWDOMDUniv R PhDMA+Sem PhDD.Min.Univ. NR PhDNone

9%2%

13%

11%

11%2%

31%

4%

4%

11%

Prof ID

LPC

LPC & MFT

LPC & PC

MFT

MFT &PC

MSW & PC

PC

PC & Psychologist

Psychiatrist

Psychologist

2%4%

8%

13%

15%

15%

19%

25%

Work Location

Congregation

Hospital

Group Practice

Academic

Acad & Priv Prac

Acad/Priv Prac

Private Practice

Agency

2%2% 2%2%

4%

4%

4%

7%

9%

9%9%

9%

16%

20%

RelIGIOUS ID

Adventist Buddhist

Bud/Chris Episcopal

Black Baptist PC(A)

UCC Catholic

ABUSA Evang. Christian

PC(USA) UMC

Baptist Christ. NOS

27%

11%

16%13%

4%

7%

9%

2%

11%

Years of Practice

0 - 56 - 1011 - 1516 - 2021 - 2526 - 3031 - 3536 - 4040+

4%9%

11%

16%

22%

38%

Region

NECentralAtlanticWest/RMMidwestSE

6%

16%

19%

22%

38%

AAPC Rel

NoneFellowMemberDipClinical

Procedures II

• Interviews– Open questions; Recorded– Continuous coding using NVIVO; constant comparison in

scheduling interviews– Note limitations…diversity, Canada

• Interpretation of results (constant-comparison method)– Axial coding, building categories, using NVIVO– Model building using NVIVO– Now testing validity/truthfulness

Som

e Re

sults

Gen

eral

The

oreti

cal F

ram

ewor

k

Alternative Medicine

PC Traditional Prof.

SIP & Spiritual Direction

Phenomenological-Existential

Multicultural framework for

SIP

Faith Based Practice

Humanistic

Sacramental Assumptions

General Theoretical Frameworks for SIP

Black Church

Community

A Multiversal Construction Implicit/organic understanding of spirituality

PC Traditional

• Part of Christian ordained ministry & training• Rooted in religious community & hospitality• Strong theological training• CPE & Psychodynamic/conflict theories• Strong sense of counseling as sacred• Christian heritage (but not Christian Counseling)• Connects people to God• Not spiritual director, but open to big questions• SIP a new way to market PC

Faith-Based Framework• Religious people want religious counseling• God incarnated in therapist for salvation of others• Strong theological training• Salvation is health• Kerygma perspective• Spirit of God talks– What does God want for this person– Seeking God in each session

• Christ is active presence in therapy• Therapy grounded in human fallenness

Humanistic Framework

• Spirituality & therapy = self-discovery• Absolute client centered approach• Therapy helps client generate own theology• Therapy expresses grace in human

relationships• Human connection between therapist & client

is central

Phenomenological Framework

• Focus on mystical presence• Therapy empowers transcendence • Existential therapy—mindfulness, meditation• Sacred is revealed in therapeutic vulnerability• Self-transcendence is central

Multicultural Framework• Spirituality is one of many multicultural factors• Working with spirituality IS multicultural

counseling; one competency among others• Deals with differences• Attends to faith or faiths of “others”• Requires competency in multicultural counseling– Utilizes microskills

• Respectful of and conversant with various spiritual traditions

Spiritual Director & SIP Framework

• Therapy begins in spiritual direction• Spiritual direction as certified discipline used

throughout process of therapy• Focus on preventive care

Black Church Community

• SIP in the action of preaching in Black Church• SIP in the action of the community in Black

Church• SIP in the action of pastoral counselors

serving, often without license in Black Church• Black Church as therapeutic experience

“Sacramental”-- Mediating Variable*• God is present in sessions

– Christ’s active presence– Connects people to God– God-focused incarnation– God’s desire for people central

• TX Sacred safe space– Casts goodness – Rigorous self-exploration– People reveal selves– For the spirit to grow

• TX is process of surrender to Holy/God/Deity– Seeking God in each session

• Priestly dimension of TX– Ministerial identity– TX mediates forgiveness– Grace made real in TX

relationship– Grace linked to positive

psychology– Counseling as sacrament– TX empties self for client

• TX creates conditions for Holy Spirit activity– Spirit is motivating energy– Follows the spirit’s lead– The “glue” in personality & TX

*Mediating in the sense that it creates important connection between categories

Prac

tices

…..

Prac

tices

…

General Therapy-orienting Practices

Attend Carefully to

Belief System

Trust Therapist’s instincts & intuition

Use-refer religious

community

Create place of safety

Everything in therapy is spiritual

Use of religious symbols

Who initiates?

Client-Centered never

therapist

Therapist initiates

Loving the Client

Transcends Boundaries of Traditional TX

Specific Practices in

Therapy

Uses Spiritual-Religious Symbols

Assessment

Black Church Preaching-Communal Experience

Teach-use Xn Spiritual Practices

Proactively Raise

Spiritual Questions

ScriptureTeaches Spiritual Practices

Models Therapist’s

own Spiritual Practices

Assessment

Formal Methods-

Alternative Med

Therapist Language

Music as Spiritual Mediator

Prayer

Therapist Use of Self

Use of Self

Guided by Psychological

TheoryTherapy anchored in TX own Spiritual and religious life

Spirituality is the core connection between client &

TX

Priestly Presence/Action

Culturally Aware & Competent--

Bilingual

Questions for Groups (20 min.)

• How does this description/model fit your experience?

• Whose voices are we missing?

• What would you want the research team to know from your group’s discussion?

• What questions did we forget to ask?

Group Feedback…

Implications for PracticeEspecially with Strategic Plan’s Mandate in Mind

• Multiversal/polydoxy—not one model/not one truth

• Plurality of models requires contextual definition by clinicians– Claiming-defining location and meanings– Similar to identifying models of therapy used– Transparency for self, clients, supervisees and other clinicians

• Plurality of models requires consideration and research– Clarity—better description and definition of approaches/models– Contextualization—what model is appropriate for whom and in what context?– Contextualization—multicultural factors and religious plurality – Contextualization—models, intended outcomes and populations– How to communicate model/location– Generous listening

• Plurality of models points to care in PC training and collaboration– Plurality and defining terms– Clarifying procedures, practices and outcomes– Clarifying and contexualizing therapist use of self and resources– Generosity– Communicating model/location

Survey….

Assessment• No specific assessment or reference to assessment (30%)• Religious-Spiritual questions on intake form (25%)• Therapist intuition (17%)• Overtly asks clients in first session (13%)• Attend carefully in session (11%)• Fitchett’ assessment model (2%)• Pargament’s assessment sometimes (2%)• Center has them, don’t use them…

Teach-Use Christian Spirituality• Christian prayer (29%)• Scripture reading (10%)– Use for in-session reflection– Reciting scripture as homework– Useful examples from Christian tradition– Meditation

• Devotional practices (2%)• Fasting (2%)• Laying on hands (2%)• Meditation on Christian principles (2%)• Practices of Ignatius (2%)

Formal Practices-Alternative Medicine:Teaching and Using:

• Acupuncture• Biofeedback• Body work-Yoga &Tai Chi• Brainspotting • Breathing techniques• Cranial-sacral Therapy• Emotional Freedom

Therapy• Energy medicine• Guided Imagery

• Healing touch• Heart Math• Ignatius practices• Meditation• Mindfulness• Reiki• Rejects medical model• Relaxation • Spiritual Direction• Wellness & exercise

Prayer57 references to prayer by 23 respondents*

• Christian prayer as practice (6)• Always prays for clients & therapy (8)• Tells every client that she/he prays for them (3)• Never prays in or for therapy (5)• Encourages Centering Prayer (2)• Asks clients if they want to pray (2)• Prays with clients in session (4)• Prayer used as alternative medicine (2)• Ethical concerns about covert prayer (1)

*Numbers in parenthesis are higher than 23 due to Some respondents falling in more than 1 category

Priestly Presence/Action

• Use of self as ordained minister– Interpreting scripture, tradition, etc.– Sacraments, etc.

• Called to do what God did—incarnate presence with others

• Mediator of God’s grace through therapy• Counselor is a symbol of God’s grace• Counseling itself is sacramental presence/action

Therapy an Expression of Therapist’s Own Religious/Spiritual Life

• Genuineness about spiritual life• Personal theology and beliefs guide therapy• Therapist brackets personal beliefs and theology• Therapists trusts own instincts and intuitions • Therapists own spirituality is at the center of therapy

encounters• Uses own spiritual practices—teaches, models

Age Gender 1st Deg Term Deg Prof ID R/Ethnic Rel ID Wk Locat Yr Pract AAPC Rel Region

26-30 5 Female 20 Mdiv 25 None 12 LPC 4 African 2 ABCUSA 4 Ac & PP 7 0-5 12 Clin Memb 4 Atlantic 5

31-35 4 Male 25 Sem MA 3 Dmin 8 LPC & MFT 1 Af/Amer 7 Adventist 1 Acad/PP 4 six-10 5 Fellow 15 Central 4

36-40 6 Univ MA 17 MA+ 2 LPC & PC 6 Asian 1 Baptist 7 Academic 6 11-15 7 Dip 3 Midwest 10

41-45 8 MSW 1 MFT 5 Eur/Am 35 Black Bapt 2 Agency 12 16-20 6 Member 1 West/RM 7

46-50 4 DO 1 MFT & PC 5 Buddhist 1 Congreg 1 21-25 2 None 22 NE 2

51-55 4 MD 1 MSW & PC 1 Bud/Christ 1 Group Pct 4 26-30 3 SE 17

56-60 2 Sem PhD 8 PC 14 Catholic 3 Hospital 2 31-35 4

61-65 7 Univ NR PhD 11 Psychiatrist 2 Christ. NOS 9 Priv Prac 9 36-40 1

66-70 5 Univ R PhD 1 Psychologist 5 Episcopal 1 40+ 5

Pscyhol & PC 2 Evang. Christian 4

PCA 2

PCUSA 4

UCC 2

UMC 4

45 45 45 45 45 45 45 45 45 45 45

Sample Characteristics

Procedures• Proposal & MAP Grant in Collaboration with TSCTF

• Identifying general boundaries – Search of academic institutions with SI in description– Search of counseling agencies with SI in description– Search of counselors’ websites with SI in description– Defining “Pastoral Counselors and those who work with them”

• Sample– Maximum diversity frame (note limitations)– Email blast to all AAPC members asking to ID self and someone in community not AAPC who practices SIP– Ed. Institutions selected from websites that met criteria– Counseling centers selected that met criteria– Individual practitioners from email blast & referred from email blast, center or ed. Institution (you really

should talk to…)

• Interviews– Open questions; Recorded– Continuous coding using NVIVO; constant comparison in scheduling interviews– Note limitations…diversity, Canada

• Interpretation of results (constant-comparison method)– Axial coding, building categories, using NVIVO– Model building using NVIVO– Now testing validity/truthfulness