Spirituality in Mental Health Practice

A Narrative Casebook

Miriam Jaffe, Widian Nicola, Jerry Floersch, Jeffrey Longhofer, Miriam Jaffe, Widian Nicola, Jerry Floersch, Jeffrey Longhofer

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000057034
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This key text presents an accessible and diverse exploration of spirituality in mental health practice, broadening the definition of spirituality to comprise a variety of transcendent experiences.

Chapters include a brief history of the tensions of spirituality in mental health practice and consider a range of emerging topics, from spirituality among the elderly and energy work (Reiki), to spirituality in addiction recovery, incarceration, and hospice work. The book offers a close examination of the limits of the medical model of care, making a case for a more spiritually sensitive practice. Rich case examples are woven throughout, and the book is paired with podcasts that can be applied across chapters, illuminating the narrative stories and building active listening and teaching skills.

Suitable for students of social work and counseling at master's level, as well as practicing clinicians, Spirituality in Mental Health Practice is an essential text for widening our understanding of how spiritual frameworks can enrich mental health practice.

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A HISTORY OF SPIRITUALITY, RELIGION, AND SOCIAL WORK

Using the “Circle of Insight” to Challenge, Question, and Create a Framework for Spiritually Sensitive Practice

Anthony Nicotera

Pre-Reading Questions

1. What do you make of the ethical requirement to extend our curiosity about our clients’ spiritualities? Is there a distinction between “spirituality” and “spiritualities”?
2. What do you believe is the minimum amount of training in “spirituality” that a mental health practitioner should acquire? What is the ideal amount of training? What is your own level of training?
3. How would you define the differences and connections between “religion” and “spirituality”?

Understanding Spirituality and Religion

A vital step in addressing the tensions, questions, and complexities inherent in spiritually sensitive social work pedagogy and practice includes more fully exploring the epistemological challenges of what we mean by spirituality and religion. Generally, spirituality is understood to be a universal and fundamental human quality consisting of the search for a sense of meaning, purpose, morality, well-being, and profundity in relationships with ourselves, others, and ultimate reality. Religion, however, involves an institutionalized, systematic pattern of values, beliefs, symbols, behaviors, and experiences oriented toward spiritual concerns, shared by a community, and transmitted over time in traditions, often relying on a set of scriptures, teachings, or moral code of conduct and rituals (Canda, Furman, & Canda, 2020; Dudley, 2016; Koenig, 2008; Oxhandler, & Pargament, 2014). Careful examination of these terms, as well as conversations among scholars and students, and practitioners and clients, about their respective theoretical and practical understanding of these concepts, provides an important foundation for spiritually sensitive social work practice and pedagogy. As Dudley (2016) asserts, “a consensus on a specific definition of spirituality may be less important to provide to others than encouragement for them to define spirituality for themselves” (p. 8). Arguably, for social workers engaging in spiritually sensitive social work practice, it is as important to understand how a person or group understands and actualizes the concepts of spirituality and religion as it is to understand more formal, scholarly definitions of these terms, if not more so.

Additionally, in light of the nuanced, complex, often ambiguous, and subjective nature of these concepts and distinctions, many researchers have asserted that a single definition of spirituality is not realistic (Belcher, & Sarmiento Mellinger, 2016; Corry, Lewis, & Mallett, 2014). For example, some argue that spirituality reduced to mere meaning-making does not distinguish it from moral or ethical inquiry. Thus, words like divine, god, higher power, and even mystery, they assert, should be used explicitly when discussing and defining spirituality. Others argue that using terms like divine and mystery, because they carry religious overtones, potentially exclude those who might consider themselves spiritual but not religious. These terms also exclude those who consider themselves to be atheist or agnostic. Senreich (2013) suggests that we use the less religiously charged word unknown, as opposed to divine, sacred, transcendent, or mystery, when speaking of the spiritual aspect of the person. He argues that using the term unknown honors all people, for “the spiritual component of a bio-psycho-social-spiritual model for social work practice needs to capture each client’s relationship to what cannot be known in a way that fully honors that person’s belief system and does not exclude any individual’s way of perceiving the nature of existence” (Senreich, 2013, p. 553). Using the term unknown avoids conflicts and concerns that people who are spiritual but not religious may have with words such as god, divine, ultimate, or higher power. Senreich’s careful contemplation of terminology reminds us too that as important as it is to take the time to examine, describe, and understand common aspects of, and distinctions between, spirituality and religion, it is equally important, maybe more so, to understand how people with a particular viewpoint might uniquely define and react to these terms.

Pew research (2015) affirms that a growing number of people, especially young people, consider themselves to be spiritual but not religious. Others are uncomfortable with spiritual language but affiliate with a particular institutionalized religious tradition. Some are less comfortable with spiritual language but acknowledge mystery and the unknown in life. Some do not pray but will meditate or practice mindfulness. There are many diverse ways in which clients define and practice spirituality and religion. This diversity raises an important creative tension that must be held and maintained. As a counterpoint to Senreich’s suggestion, it is quite possible that at least some people who consider themselves religious, or who believe in god, may feel that using the word unknown is not sacred or spiritual enough, or that it objectifies or somehow sanitizes the concept of spirituality, making it less than what it is. While some, like Senreich, may like the word unknown precisely because it does not use god language but still resonates as spiritual in relation to that which is not rationally knowable, others may believe the word unknown to be inadequate. These linguistic challenges remind us of four key considerations that provide context for the complex, multifaceted study and practice of spiritually sensitive social work: language is critically important; language will almost always fall short, be somehow inadequate, or at best incomplete; spirituality and religion are incredibly intimate and always, at some level, personal and subjective; and thus, when engaging in spiritually sensitive social work practice, we must listen first, meeting the client where they are, exploring the nuances and complexities of an individual or group’s understanding of these terms as they relate, dialectically, in creative tension, to current research and scholarship.

In addition to studying and investigating key concepts, as defined by both scholars and clients, another related, arguably central, aspect of spiritually sensitive social work practice is what Dudley (2016) refers to as affirming one’s own spirituality. He proclaims, “Let’s begin a spiritual exploration, not with our clients, but with ourselves” (p. 25). We are invited to do the work required to further examine and define our own spirituality and understanding of faith and religion as a central component of accompanying and counseling clients. Just as doing our own work, engaging in therapy ourselves, contributes to our capacity to be available to clients clinically, so too does exploring critical questions about our own beliefs and spiritual practice contribute to spiritually sensitive social work practice. There is a need to empower and ethically train social workers to effectively engage, assess, practice, and evaluate in a spirituality sensitive way, and this includes their effort to understand and explore their own beliefs about religion and spirituality (Canda et al., 2020; Crisp, 2010; Dudley, 2016; Oxhandler & Pargament, 2014; Sheridan, 2014). Thus, the symphony that is spiritually sensitive social work practice necessarily embraces at least three fundamental movements: how scholars define concepts of religion and spirituality; how these concepts are defined and understood by individuals, groups, organizations, institutions, and society; and how we as social workers seek to understand who we are as spiritual selves.

This chapter provides an overview of some of the creative tensions and critical questions at play in inviting and implementing spiritually sensitive social work pedagogy and practice in the United States, and suggests topics for further research. It also presents an overview of the historical context in which these tensions and questions exist. Finally, it invites application of the “See, Reflect, Act” Circle of Insight framework (Nicotera, 2018, 2019) to guide contemporary spiritually sensitive social work pedagogy and practice in the context of our ethical code and accreditation standards.

Integrating Spirituality and Religion into Social Work Pedagogy and Practice

While a Jesuit in Jesuit spiritual formation and also an MSW student at a faith-based institution in the mid-1990s, I found it ironic and deeply troubling that there was no course focused on spirituality and social work. In fact, discussing spirituality in social work classes was discouraged. Most often it was simply ignored. If the subjects of religion, faith, or spirituality were raised in the classroom, the most common recommendation was that we not bring them up with clients. This perspective predominated for various reasons. Some professors suggested that spirituality was not our domain, or not relevant to the therapeutic alliance and process, or not supported by research or science, not evidence-based. Well-meaning mentors and educators taught us that engaging in spiritual conversation with clients was beyond our area of expertise. They also told us that addressing spirituality and religion in social work practice could be construed as proselytizing, imposing our views on the client, which would be unethical.

Those of us interested in studying and discussing spirituality in the context of social work pedagogy and practice met in the catacombs of our social work building. There we would talk about our own spiritual lives, the role spirituality, faith, and religion played in meaning-making and identity development, and our understanding of the influence of religion and spirituality on the evolution of social work values, our profession, and the mission of our institution. We talked about what it would mean to practice in a way that respected the spiritual nature of the human person as well as our social work ethical code. As a result of our conversations and meetings, we formed a spirituality and social work student organization and openly asked why social workers were so reluctant to consider the spiritual and religious roots of the social work profession. We wondered together why we were not taught to assess and address a person’s spiritual understanding of self. We questioned the ethics of not doing so. We posited that the absence of a bio-psycho-social-spiritual approach to social work compromised our professional ethical commitment to social justice and duty to affirm the inherent human dignity of all people. We postulated that just, ethical social work practice included spiritual and religious assessment, engagement, and reflection personally, and with clients and communities. We advocated for classroom and practice opportunities to integrate spiritual and religious scholarship, and evidence-based practice tools and techniques.

However, despite professional and pedagogical movement toward greater acceptance and inclusion of spiritually sensitive social work practice since my time as a graduate student, spirituality still is not included in most social work curricula, and the majority of social workers, when surveyed, report that they have not been well educated, if at all, about spirituality sensitive social work pedagogy or practice (Canda et al., 2020; Dudley, 2016; Sheridan, 2014). My experience teaching spirituality, social justice, multifaith leadership, and social work courses, and my work as a clinical social worker, pastoral counselor, and chaplain, as well as my conversations with hundreds of students and colleagues over the past 20 years, support these research findings. In light of our profession’s commitment to a holistic person-in-environment perspective, this void is cause for concern. This case is my response to that concern.

I have come to believe that it is an ethical and professional failure to forego studying and integrating spirituality and religion as it impacts clients and social work practice. In classrooms, presentations, and at conferences, participants and students continue to ask why there is not a casebook focused on spirituality and social work. I have asked the same question. Whether at the micro, mezzo, or macro level, spirituality and questions of faith, mystery, religion, and the unknown profoundly influence people and environments. Thus, our failure to explore this confluence, in the classroom and in practice, is not only a pedagogical and professional failure but also an ethical failure. Our ethical obligation requires that we meet people as they are, where they are, as people with religious and spiritual lives and beliefs that affect their well-being.

In my current role as director of a spirituality and social work post master’s certificate program at a university continuing education program in the northeast United States, I continue to address the lack of education in spiritually sensitive social work practice. Most students affirm that spirituality and religion were not discussed in any detail, if at all, in their undergraduate or graduate social work classes. In fact, like me and my fellow students who met surreptitiously, underground, in the caverns of our social work building over 20 years ago, my students express a similar frustration, even anger at the fact social work accreditation and ethical standards are not clearer in their call for competence in spirituality and social work (Canda et al., 2020), and there have not been more substantive or significant efforts to integrate the spiritual into the bio-psycho-social person-in-environment perspective. Many students interested in discussing spirituality or religion in the classroom continue to be dismissed, or looked upon with suspicion, even labeled as overly zealous. I remain concerned that I am having the same conversations with my students today that I had with my fellow students and colleagues in the mid-1990s.

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Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Editors
• Contributors
• Preface
• Introduction: Making the Case for Podcasts
• Podcast Pairings with Chapters and Close Hearing Questions
• 1 A History of Spirituality, Religion, and Social Work: Using the “Circle of Insight” to Challenge, Question, and Create a Framework for Spiritually Sensitive Practice
• 2 The Spiritual Call to Helping Professions: Job Crafting, Meaning Making, and Field Work as Spiritual Experience
• 3 Spiritual Emergence and Spiritual Emergency
• 4 Radical Empathy, the Thin Place: Hearing Voices in Psycho-Spiritual Group Therapy
• 5 Pulling Yourself Up by Your Bootstraps: Transcending the Stories of the Ego
• 6 A Power Greater: Exploring Spirituality in Addiction Recovery
• 7 The Spirituality of Incarceration
• 8 When Life Review Is Not Enough: The Spiritual Present(ce) of Older Adults
• 9 The Asana of Being with Living and Dying: Reflections from a Day of Hospice Work
• 10 The Shared Spiritual Energy of Reiki and Early Psychoanalytic Practice
• Index