Exploring the Spiritual

Paths for Counselors and Psychotherapists

David R. Matteson

• Publisher: Routledge
• Year: 2011
• Print ISBN: 9780789036728
• eBook ISBN: 9781136915352
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Gain solid empirical findings to understand your own spiritual development To significantly impact clients' spirituality and use the spiritual strengths the client possesses to facilitate their move toward health, a counselor must be willing to explore his or her own spiritual development. Exploring the Spiritual: Paths for Counselors and Psychotherapists provides cognitive information grounded in the empirical findings of social science, as well as experiential material which encourages the counselors' own spiritual quest. This invaluable source clarifies the interface between the counselor's spirituality and the client's, and allows the spiritual dimension to emerge appropriately in the counseling process. Exploring the Spiritual: Paths for Counselors and Psychotherapists provides challenging questions and exercises that lead the counselor or psychotherapist through a personal exploration to attain the maturity of development needed to facilitate the client's spiritual growth. The text, written in an accessible narrative style, features helpful case studies and personal anecdotes to illustrate the concepts and processes described. Each chapter includes an overview of an issue, develops an argument or position, and presents a focused exploration of some relevant empirical research that is presented in a context that helps the reader see its personal implications. The final section leads the reader through exercises and experiments, helping them to focus on the counselor's own inner experience or encouraging the counselor to experiment with new behaviors. This insightful resource encourages the counselor to work directly with the client's spiritual experiences and conceptualizations without imposing on the client the beliefs of the counselor. Topics discussed in Exploring the Spiritual: Paths for Counselors and Psychotherapists include:

• models of spiritual development
• steps toward spiritual maturation
• the contribution of crises in belief and in values
• the physical-emotional self, and the contribution of passion and sexuality
• overcoming the divisiveness of age, race, gender, sexual orientation, and culture
• coping with suffering
• discovering one's own paths to the spiritual

Exploring the Spiritual: Paths for Counselors and Psychotherapists is a valuable resource for counselors, psychotherapists, counselor educators, and graduate students in psychology, counseling, psychotherapy, social work, and psychiatry.

PART I:
ASSESSING SPIRITUAL HEALTH AND DEVELOPMENT

Chapter 1
What is Health Spirituality? An Overview

The term mental health is a slippery one. The word healthy is commonly used in terms of physical health, and it is relatively simple to observe when a part of the body is functioning properly and making its contribution to the whole system. Psychological or spiritual health is not so simple. If we ask, for example, “What is the function of the stomach?” the answer is pretty straightforward. Conversely, it is fairly clear when the stomach is not functioning properly. When this is the case, we usually assume an illness. But how do we determine if a part of the psyche is functioning properly? How do we determine when it is ill and the system is not in synch?

If we as counselors and therapists are going to encourage our clients to bring their spiritual strengths and concerns into our sessions together, we need to take some care that the spirituality we are encouraging is promoting a more healthy life. The great spiritual leaders of the past have consistently recognized that we need to discern between genuine spiritual experiences and those that mask as spiritual but are in fact destructive. Jesus, for example, was highly critical of the religious leaders of his times, stating, “You shall know them by their fruits” (Matthew 7:16, 20, Revised Standard Version). If the desired outcome of spiritual experience is deeper connections with self, with others, and with life itself, then it is the experiences that produce these connections that are authentic spiritual experiences.

It is important to have a solid understanding of what we mean by healthy spirituality and by mental health, and to be clear discerning these. This chapter seeks such an understanding by reviewing the various models that have been used to define mental and spiritual health and by critically evaluating them. (For a more extensive historical review, see Oltmanns & Emery, 2001.)

In the second section of this chapter we will survey the vast differences in religious beliefs and in values across cultures, and see if common ground exists from which to base spiritually sensitive counseling. In the third section I will review the issue of positive thinking in order to illustrate how empirical social science can help us discriminate between healthy spirituality and a superficial or unauthentic spirituality. The focus of this research concerns principles of consonance (in social psychology), or congruity (in psychotherapy).

In the fourth section I return to some of the wisdom of traditional religion and present some integration of the material. Later, in Chap-ter 9, I more completely flesh out the process model; my view of how the counselor best relates to the client in regard to healthy spirituality will be presented.

MODELS CRITERIA FOR DETERMINING MENTAL HEALTH

In this section we will review and evaluate the medical model, and three psychological and social models: the normative or statistical model, the adaptation model, and the growth or developmental model. The purpose is to reveal the problems with some of the most used models of psychosocial health, and propose more fruitful ways to conceptualize healthy spirituality.

The Medical Model

At the beginning of the twentieth century, psychotherapy emerged primarily from the medical field of psychiatry. Since then, the medical model has had, and continues to have, an important influence on views of mental health and illness. This model is based on the metaphor of biological disease, and can be summarized as having three elements:

1. Specific symptoms are indications of dysfunction.

2. These symptoms cluster in patterns that can be diagnosed as diseases.

3. The occurrence of disease indicates that the system is out of balance, and homeostasis needs to be restored.

Symptom

An example of a symptom is a hallucination, seeing or hearing something that other people don’t hear or see. Symptoms such as hallucinations and delusions (thought disorders) are thought of as occurring in clusters, which characterize particular syndromes. The combination of hallucinations and delusions most commonly occur in the syndrome that is labeled paranoid schizophrenia.

In many areas of biological medicine, specialists can test for specific disease mechanisms and determine, for example, the presence of a viral infection or a genetic defect to confirm a diagnosis. This is not yet possible in psychiatric medicine. However, in recent decades psychiatry has learned to use psychotropic drugs for their pragmatic effects in relieving symptoms, without a necessary correlation to diagnosis. Symptoms such as hallucinations or delusions are likely to diminish strikingly when certain drugs are used, which provides some evidence for a biological root for these symptoms, at least in some patients (Oltmanns & Emery, 2001). A biochemical imbalance or a neurological dysfunction may exist. These can appropriately be treated biologically, though the mechanisms of the disease process may be unknown, and these symptoms may not necessarily be part of a full syndrome or “disease” classification. In short, the effectiveness of a biological treatment such as a psychotropic drug does not necessarily imply the correctness of the whole medical model.

The model has no clear criteria for determining whether or not a particular behavior or experience is a symptom. Some of the symptoms listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) are dysfunctional in certain contexts, but are not so in other societies or social settings. A specific behavior, such as seeing a vision, in a particular cultural context may not indicate dysfunction. In some Native American cultures, a youth who has not yet found his life direction is expected to go on a “vision quest,” and that journey often includes experiences that traditional Western psychiatry would call hallucinations. In these instances the assumption that the behavior is a symptom seems culturally inappropriate.

A further criticism of the medical model is that some behaviors have been labeled “symptoms” simply because they are statistically rare or uncommon behavior, not because they are either dysfunctional or part of a syndrome. They are abnormal in the sense of falling at one extreme on a normal curve. For decades psychiatry treated homosexual behavior as pathological, though no evidence proved it caused harm or that it was associated with other symptoms of mental disorder (Hooker, 1957, 1972). If we think of sexual orientation as a range from totally heterosexual to totally homosexual, the latter was labeled pathological solely because it was less common. Logically, bisexuality would seem to be the most flexible orientation, and either extreme (totally heterosexual, for example) might be seen as fetishistic! In short, the biological metaphor of medical diagnosis has been used in ways that, intentionally or not, masked the value judgments and the cultural ethnocentricity which led to the diagnosis. Objectively, neither homosexual acts nor visions confirming an identity are necessarily “dysfunctional.”

Diagnosis

Though the diagnosis of biological diseases in terms of clusters of symptoms has proved a fruitful approach, its application in the mental health field has not been as successful from the point of view of scientific data. Beginning with Emil Kraepelin’s (1923) Textbook of Psychiatry, followers of the medical model have assumed that a fixed set of mental disorders exists, and that their obvious manifestations cut across cultures. This assumption is called cultural universality (Sue, Sue, & Sue, 2000, p. 9). The medical concept that a series of symptoms form clusters that can be appropriately labeled “syn-dromes” or diseases has wide prevalence, and undergirds the major diagnostic categories used to provide insurance coverage (the DSM), but has little empirical validation. Studies for decades have shown little consistency in the use of diagnoses such as schizophrenia. Even the symptoms that are assumed to be defining are not the same between cultures. For example, a key symptom in defining schizophrenia in Germany, labeled Gedankenentzug, is not noted as a defining symptom in either British or American textbooks (Marsella, 1979). (Gedankenentzug refers to a patient’s experiencing the loss of thoughts but believing the thought has been taken away from him or her by someone or something outside of him or her [Ute Binder, 2001, personal communication; Marlis Pörtner, 2002, personal communication].)

Other symptoms or behaviors would be labeled disordered or dysfunctional in many cultures, both Western and Eastern. But the grouping of symptoms according to the patterns that Western psychiatrists have traditionally used … are not universally found. (Marsella, 1979, p. 247)

The pattern of symptoms thought of as depression in Western society does not have an equivalent in many non-Western cultures (Marsella, 1979, p. 247).

The primary empirical bases for the clusters that have been called “syndromes” are statistical procedures (factor analyses) based on data limited to American and British cultures. By insisting on the use of the DSM, medical insurance companies have reinforced the perception that these categories are scientific, when in fact they are culturally biased. An additional factor in the failure of researchers and practitioners to recognize the cultural bias of these concepts is the increasing specialization in practitioner training. Persons trained in psychology or medical psychiatry are likely to have little awareness of anthropology. Yet the relativity of normal behavior was emphasized as early as 1934 by anthropologist A. Hallowell. He stated that the cross-cultural investigator:

must develop a standard of normality with reference to the culture itself, as a means of controlling an uncritical application of the criteria that he brings with him from our civilization. (Hallowell, 1934, p. 2; cited in Marsella, 1979, p. 240).

As the training of practitioner counselors increasingly includes courses in multiculturalism, the recognition of the role of culture is increasing, but it has yet to fully permeate the mental health field at the level of training and research. In research, the official diagnostic systems of the medical model continue to serve as the constructs for most empirical studies in psychopathology, regardless of culture. And in clinical practice, official diagnostic systems of the medical model provide the definitions of mental illness (Oltmanns & Emery, 2001). This is “an unfortunate commentary on the ethnocentricity of [Western researchers and] practitioners.” (Marsella, 1979, p. 244).

Homeostasis

The third element of the medical model is the belief that the system is out of balance. The concept of balance within a system is one of the more useful contributions of the medical model. It was originally applied at the biological level. At the biological level, it isn’t important that two bodies have the same quantity of H₂0 or of potassium, as long as the amount of water and potassium are in balance with the other elements in a particular person’s system. Health implies that everyone should have the opportunity to achieve their individual optimal condition biologically, not that everyone fit a uniform and absolute standard of biological performance or measurement (as the World Health Organization [WHO] definition of health clarifies) (World Health Organization, 1958).

The concept of homeostasis can also be applied at the intrapsychic level, and at the social level (e.g., family systems). Intrapsychically, one person need not have the same way of treating work and play as another person, but they must achieve some balance. The whole mechanics of the id, ego, and superego in Freudian theory can be seen as a physical metaphor for the individual’s attempt to achieve homeostasis. The cognitive parallel to homeostasis is called the principle of consonance (in social psychology), or congruity (in client-centered and self-theories of psychotherapy). We will examine this in more detail in the next section of this chapter.

Homeostasis as a definition of mental health ran into trouble because it gave the false impression that successful functioning is primarily a matter of stability, of staying the same. It suggests the image of the healthy person as standing still, standing in one place. But a healthy person, biologically, is not only capable of standing, but of moving and developing. To continue with the metaphor of balance, it would seem more accurate to define health as the ability to risk a temporary imbalance, then to regain balance, risk and regain again. This is, after all, what we do in walking. Moving through life is like moving through space: it demands a dynamic balance, not a static sameness. This leads us to a model that emphasizes growth and with it an openness to new experience. Developmental or growth models have been proposed by learning and developmental theorists as well as by “third force” therapists, and contrast to the symptom and disease emphasis of traditional psychoanalytic and behavioral therapists. This type of model will be discussed more fully. But first we will look at earlier psychological models that parallel the medical model.

How do you respond to the metaphor of balance and movement as a way of thinking about mental health? Does it fit for you, or is some other metaphor or image a better fit?

Psychological and Social Models

In both the medical and the psychological models it is important to clarify the criteria for assessing a behavior as pathological or dysfunctional. The early psychological models, parallel to the medical model, tried to avoid value issues and claim objectivity. The normative or statistical model of abnormality focused on particular behaviors and whether these behaviors were common and accepted in the society.

This attempt failed once we recognized that a behavior is not dysfunctional simply because it deviates from the norm. Some “abnor-malities” are highly functional. For example, a very intelligent person who is at the extreme end of the normal curve of IQ scores is likely to be more capable of adapting than is a “normal” person (Sue, Sue & Sue, 2000). Thus the adaptation model gradually supplanted the normative model. A behavior was judged in terms of whether it was functional in adapting to the social setting; it allowed that some statistically uncommon behaviors or abilities are functional. Second, unlike the statistical model, the adaptation model recognized that behaviors that seem dysfunctional in one setting may be functional in another. For example, a Plains youth seeing flying objects in the sky during a vision-quest may be functional, whereas an urban Caucasian youth seeing UFOs would likely be viewed as having dysfunctional hallucinations.

The major problem with the adaptation model...

Table of contents

• CONTENTS
• Foreword
• Acknowledgments
• Introduction
• PART I: ASSESSING SPIRITUAL HEALTH AND DEVELOPMENT
• PART II: AREAS OF CRISIS
• PART III: HELPING AND HEALING
• PART IV: EXPERIENTIAL APPROACHES
• Appendix Appendix: Additional ResourcesAdditional Resources
• Notes
• References
• Index