Spirituality and practice with Andrea Murray-Lichtman, LCSW 3/18/2019 UNC-CH School of Social Work Clinical Lecture Series 1 Integrating Spiritual Sensitivity into Therapeutic Practice Andrea Murray-Lichtman, LCSW UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORK MATTHEW O. HOWARD MEMORIAL LECTURE Agenda Defining Spirituality Defining Religion Spirituality and your client’s wellness journey Preparation to integrate spirituality in treatment Integration of spirituality into treatment Anchoring our Time Integrating Spirituality into Therapeutic Practice Honoring our story to honor the story in others =
Transcript
Spirituality and practice with Andrea Murray-Lichtman, LCSW 3/18/2019
UNC-CH School of Social Work Clinical Lecture Series 1
Integrating Spiritual Sensitivity into Therapeutic Practice
Andrea Murray-Lichtman, LCSW
UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORKMATTHEW O. HOWARD MEMORIAL LECTURE
Agenda
Defining Spirituality Defining Religion
Spirituality and your client’s wellness journey
Preparation to integrate spirituality in treatment
Integration of spirituality into treatment
Anchoring our Time Integrating Spirituality into Therapeutic Practice
Honoring our story to honor the story in others
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How do you define
Religion?
What is Spirituality?
Spirituality refers to any way of relating to that which is sacred or transcendental.
Religion refers to institutionalized or culturally bound ways of relating to that which is perceived to be sacred.
Ask an Atheist - https://the1a.org/shows/2019-01-21/atheism
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FICA for Self-Assessment
F - Faith and Belief• Do I have a spiritual belief /practice that helps me cope with stress, with illness?
What gives life meaning? Earliest memory /experience of spiritual beliefs or practice?
I - Importance• Is my belief / practice important to me? Does it influence how I think about my
life, health and illness? Does it influence my life, self-care, healthcare decisions?C - Community• Do I belong to a spiritual community (church, temple, mosque, etc.)? Am I happy
there? Do I need to do more with the community? Do I need to search for another community? If I don't have community, would it help me if I found one?
A - Address in Care• What should be my action plan? What changes do I need to make? Are there
spiritual practices I want to develop? Would it help for me to see a chaplain, spiritual director, or pastoral counselor?
Adapted from Puchalski, C. (1996)
adapted tool can help you think about your spiritual history:
Unaffiliated (religious “nones”)Atheist 3.1Agnostic 4.0Nothing in Particular 15.8Don't know 0.6
ChristianEvangelical Protestant 25.4Mainline Protestant 14.7Hist. Black Protestant 6.5Catholic 20.8Mormon 1.6Orthodox Christian 0.5Jehovah’s Witness 0.8Other Christian 0.4
http://www.pewforum.org/religious-landscape-study
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BuddhistCatholic
Evangelical ProtestantHindu
Hist. Black ProtestantJehovah’s Witness
JewishMainline Protestant
MormonMuslim
Orthodox ChristianUnaffiated
Importance of religion in one’s life by religious group% of adults who say religion is . . .
Prevalence of self-identified Spirituality in
US
Pew (2017)
Integrating Spiritual Sensitivityas part of Ethical Therapeutic
Practice
• Council on Social Work Education (CSWE)
• Pew Research on Religion
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Council on Social Work Education (CSWE) Religion and Spirituality Work Group formed in 2011
Organized to promote social workers' knowledge, values, and skills for ethical and effective practice that takesinto account the diverse expressions of religion and spirituality among clients and their communities
Ethical Practice standards for professional practice in many fields of social work practice, including health, mental health recovery, hospice and palliative care, and problematic substance use
Social workers to recognize and support each person’s spiritual identity, understand role of religion and spirituality in client’s life, and refrain from discrimination and institutional oppression based on religious or nonreligious beliefs
2008 Educational Policy and Accreditation Standards (EPAS)
National Association of Social Workers' Code of Ethics and Standards for Cultural Competence
International Federation of Social Workers/International Association of Schools of Social Work's Statement of Principles
Research indicates that not all social workers include Spirituality/Religion in therapeutic practice with clients
Oxhandler, Parish, Torres & Achenbaum (2015); Limb, G., Hodge, D., Ward, P., Alboroto, R., & Larkin, Z. (2018)
SpiritualMicroaggressions
• Pathologizing spirituality
• Disparaging spirituality
• Assuming Homogeneity
• Denying spiritual prejudice
Hodge (2019)
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Benefit of Spirituality in Therapeutic Process
• Holistic view of client and clinically relevant information
• Strategies for symptom reduction
INFORMS
• Stigmatization of client’s spiritual beliefs and values
• Therapist as the expert
CHALLENGES
• Utilization of client’s strengths in recovery
• Client’s motivation and the therapeutic alliance
DEEPENS
Hodge (2018)
Clarify role of spirituality at the outset
Differences between patient and social worker’s spiritual beliefs common
Respect for clients spiritual beliefs
Social worker makes reasonable effort to become familiar with client’s spiritual beliefs
Therapeutic Modalities: Acceptance and Commitment Therapy
&Cognitive Behavioral Therapy
Strategies for integrating spiritual sensitivity into therapeutic process
DO
Do your self-work (cultural humility and self-awareness)
Initiate
• Frame engagement with treatment in terms of spiritual values/beliefs• What does client’s spiritual beliefs say in terms of self-care/healthcare
FRAME
• Frame engagement with treatment in terms of spiritual values/beliefs• What does client’s spiritual beliefs say in terms of self-care/healthcare
Utilize
• Utilize spiritual teachings/values to explore patient thinking/behaviors• How might teachings/practices enhance treatment adherence
ENCOURAGE
• Encourage use of spiritual beliefs/values as a frame for emotions/actions• How might spiritual beliefs/values provide coping strategies and improved outlook
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“There is a quiet courage that comes from an inward spring of confidence in the meaning and significance of life. Such courage is an underground river, flowing far beneath the shifting events of one's experience, keeping alive a thousand little springs of action.”
~ Howard Thurman
FICA – Spiritual Assessment ToolF - Faith and Belief
"Do you consider yourself spiritual or religious?" or "Is spirituality something important to you” or “Do you have spiritual beliefs that help you cope with stress/ difficult times?" (Contextualize to reason for visit if it is not the routine history.)
If the patient responds "No," the health care provider might ask, "What gives your life meaning?" Sometimes patients respond with answers such as family, career, or nature.
(The question of meaning should also be asked even if people answer yes to spirituality.)
I - Importance
"What importance does your spirituality have in our life? Has your spirituality influenced how you take care of yourself, your health? Does your spirituality influence you in your healthcare decision making? (e.g., advance directives, treatment)
Puchalski, C. (1996)
FICA – Spiritual Assessment Tool
C - Community
"Are you part of a spiritual community? Communities such as churches, temples, and mosques, or a group of like-minded friends, family, or yoga, can serve as strong support systems for some patients. Can explore further: Is this of support to you and how? Is there a group of people you really love or who are important to you?"
A - Address in Care
"How would you like me, your healthcare provider, to address these issues in your healthcare?" (With the newer models including diagnosis of spiritual distress, A also refers to the Assessment and Plan of patient spiritual distress or issues within a treatment or care plan.)
Puchalski, C. (1996)
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References
Bowles, D., Clayton, O., & Hopps, J. G. (2017). Spirituality and social work practice at historically black colleges and universities. Journal of Human Behavior in the Social Environment, 27(5), 424. doi:10.1080/10911359.2016.1203384
Center for Spirituality, Theology and Health, Duke University, Religious CBT Training Video -https://spiritualityandhealth.duke.edu/index.php/religious-cbt-study/training-video
CSWE (n.d.). Religion and Spirituality Clearinghouse. Retrieved from https://www.cswe.org/Centers-Initiatives/Curriculum-Resources/Religion-and-Spirituality-Clearinghouse.aspx
Fitchett, G. & Risk J. (2009). Screening for Spiritual Struggle. Journal of Pastoral Care & Counseling. 63(1-2): 1-12. http:// bishopandersonhouse.org/wp-content/uploads/2015/06/Spiritual-Screening.pdf.
Hodge, D. (2019): Spiritual microaggressions: Understanding the subtle messages that foster religious discrimination. Journal of Ethnic & Cultural Diversity in Social Work. doi:10.1080/15313204.2018.1555501
Hood, R., Hill, P., & Spilka, B. (2018). The psychology of Religion an empirical approach (5th ed.). New York, NY: The Guilford Press.
Hughes, B., Carbonell, E., Wintz, S., Hodge, D. (2018). Spiritual Care and Social Work: Integration into Practice.Retrieved from www.healthcarechaplaincy.org
Grossoehme, D., Ragsdale, J., Cotton, S., Meyers, M., Clancy, J., Seid, M. & Joseph, P. (2012). Using Spirituality After an Adult CF Diagnosis: Cognitive Reframing and Adherence Motivation. Journal of Health Care Chaplaincy. 18: 110-120. DOI: 10.1080/08854726.2012.720544
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References (cont.)
Limb, G., Hodge, D., Ward, P., Alboroto, R., & Larkin, Z. (2018). Examination of a complementary set of spiritual assessment tools for LDS clients, Mental Health, Religion & Culture, DOI: 10.1080/13674676.2018.1512089
Loue, S. (2017). Social Work Values, Ethics, and Spirituality. In Handbook of Religion and Spirituality in Social Work Practice and Research. (12th ed.). Springer Publishing http://www.springer.com/978-1-4939-7038-4
National Comprehensive Cancer Network. NCCN Guidelines® & Clinical Resources. NCCN Distress Thermometer and Problem List. Version 2.2016. 2016. https://www.nccn.org/about/permissions/thermometer.aspx.
Pew Research Center (2019, January, 31). Religion’s Relationship to Happiness, Civic Engagement and Health Around the World. Retrieved from http://www.pewforum.org/2019/01/31/religions-relationship-to-happiness-civic-engagement-and-health-around-the-world/Pew Research Center (n.d.) Religious landscape study. http://www.pewforum.org/religious-landscape-study
Plante, T. G. (2007). Integrating spirituality and psychotherapy: Ethical issues and principles to consider. Journal of Clinical Psychology, 63(9), 891-902. doi:10.1002/jclp.20383
Post, B. C., & Wade, N. G. (2009). Religion and spirituality in psychotherapy: A practice-friendly review of research. Journal of Clinical Psychology, 65(2), 131-146. doi:10.1002/jclp.20563
Pulchaski, (1996). FICA Spiritual Assessment Tool. Retrieved from https://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool
Oxhandler, H. K. (2017). Social work field instructors’ integration of religion and spirituality in clinical practice. Journal of Social Work Education, 53(3): 449-17. doi:10.1080/10437797.2016.1269706
References (cont.)
Oxhandler, H. K., Parrish, D. E., Torres, L. R., & Achenbaum, W. A. (2015). The integration of clients’ religion and spirituality in social work practice: A national survey. Social Work, 60(3), 228-237. doi:10.1093/sw/swv018
Rosmarin, D. H. (2018). Spirituality, Religion, and Cognitive-Behavioral Therapy: A Guide for Clinicians. Guilford Press. New York: NY.
Saguil, A. & Phelps, K. (2012, September 15). The Spiritual Assessment. American Family Physician 86 (6). Retrieved from https://www.aafp.org/afp/2012/0915/p546.pdf
Santiago, P., & Gall, T. (2016). Acceptance and commitment therapy as a spiritually integrated psychotherapy. Counseling and Values. 61(2): 239-254. doi:10.1002/cvj.12040
Sheridan, M. (2009). Ethical issues in the use of spiritually based interventions in social work practice: What are we doing and why. Journal of Religion and Spirituality in Social Work. 28(1-2): 99-126. doi:10.1080/15426430802643687
Shimron, Y. (2018, April) Most Americans believe in a higher power, but not always in the God of the Bible. Retrieved from https://www.washingtonpost.com/news/acts-of-faith/wp/2018/04/25/most-americans-believe-in-a-higher-power-but-not-always-in-the-god-of-the-bible/?utm_term=.ecc686f4ff3f
Stewart, C. (2013). Resolving social work value conflict: Social justice as the primary organizing value for social work. Journal of Religion and Spirituality in Social Work, 32(2): 160-176. doi:10.1080/15426432.2013.779184
Valutis, S., Rubin, D., & Bell, M. (2014). Value conflicts and value priorities: It’s not just about religion. Journal of Religion and Spirituality in Social Work, 33(2), 163-177. doi:10.1080/15426432.2014.900375
