Critical Incidents in Integrating Spirituality into Counseling

Tracy E. Robert, Virginia A. Kelly

• Publisher: American Counseling Association
• Year: 2014
• Print ISBN:
  9781556203367
• eBook ISBN:
  9781119027072
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychotherapie

This compelling casebook integrates critical incidents, spirituality, and counseling with diverse populations dealing with issues across the life development continuum. It offers counselor educators, students, and clinicians a highly useful educational tool for more effective teaching and practice that will foster lively discussion, case conceptualization, and intervention skills.

Using an applied format, the book is organized in seven sections: life span issues, spirituality and wellness, specific disorders, substance abuse, career, diverse populations, and spiritual interventions. More than 50 contributors have been selected either to present specific incidents or to react to them. After each case is described, an expert practitioner answers the questions posed and provides additional insight and alternative strategies. The editors then offer their reflections, providing a concise summary of counseling outcomes.

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Section I
Life Span Issues

Chapter 1
Children

Case

Donna Fletcher

Will, a 12-year-old White boy, came to see me with his family. He had been exhibiting oppositional defiant behavior at both home and school and had been suspended from school several times for being disruptive. Will was quick to anger and had a negative attitude toward all. He often tried to dominate his siblings.

Background

Will lived in a northeastern state with his mother, age 35, and three brothers, ages 14, 10, and 8. He attended a local Catholic school and was raised with Catholic traditions.

Will and his brothers had grown up with an alcoholic father. The family had gone through a major trauma when Will’s youngest brother died at the age of 2. Eight at the time, Will never fully processed his feelings about the loss of his brother. This tragedy also brought his father further into the throes of addiction, and his parents eventually separated.

Incident

Will’s father took his sons to visit his parents in a southern state for Thanksgiving. Before leaving to return home, he drank excessively. While on the highway, he had a horrific car accident that left Will with an injured arm and his brothers with severe wounds that required surgeries. Will was the only one in the car who was conscious after the accident, and he was able to get out of the demolished vehicle to seek help. The boys were sent home, and their father was sent to jail and later to a drug treatment program in the South.

Discussion

When my client first came to see me, he exhibited posttraumatic stress disorder symptoms, including night terrors and flashbacks as well as avoidant behaviors. Much of the initial work involved helping him process the traumas of the accident and the loss of his brother years prior.

Using a trauma-focused cognitive–behavioral model, I provided psychoeducation around “What is trauma?” as well as the possible emotional and behavioral effects. Will learned that his negative reactivity was connected to his past traumas and that his anger was rooted in sadness about the death of his brother as well as his father’s abandonment of him and his family. To cope, he learned relaxation techniques and ways to identify, talk about, and regulate his feelings.

Will had taken on the role of father for the family and was hyperfocused on earning money at odd jobs, such as mowing lawns and delivering papers, to help the family with finances. As a result, he felt empowered and domineering, yet he became very resentful.

I used structured family therapy to help put Will’s mother back in control at the head of the family, which allowed Will to be a child again. At the same time, he struggled with his feelings about his father, who had moved back to an apartment nearby. His father had supervised visits on a limited basis, and his mother was preparing to divorce him. Although Will was angry with his father, he had mixed feelings toward him, including both love and hate.

In addition to all of the above-mentioned losses, the family had to leave their home and move into a small apartment because of financial problems. Will’s mother was away from the home often because she worked and was going to school. She received a great deal of support and assistance from people at her church.

Will’s mother told me that her greatest coping mechanism was prayer and that she did this at times with the four boys. The value of prayer to the family and especially to Will became apparent to me one day while I was in a family session with all of the boys.

We had been trying to play games to build family connection, but Will, in his usual way, dominated his brothers and his behavior led to several arguments. The boys started disagreeing on their beliefs about their father and became tearful.

When Will was asked what could help him feel calmer, he began to pray the “Our Father” out loud, and the other boys joined him. I knew the prayer and also joined them. It was one of the most poignant moments in my career as a counselor, and I too was brought to tears. At the end of the prayer, the boys all appeared calmer and began chattering and playing together.

I learned from this experience the importance of helping clients feel safe in therapy and free to express their spirituality. It is also important for the counselor to feel comfortable allowing clients to take the lead. In addition, the therapist must have a clear understanding of his or her own spirituality.

My therapeutic connection with this family was strengthened because we were able to relate on a spiritual level. Although counselors are taught to disclose on a limited basis, I found that opening up and sharing some of my own spiritual beliefs, having been raised Catholic, actually helped us connect. Together, we understood prayer as a pathway to healing.

Questions

1. Will experienced many losses in his short lifetime. How should a counselor work with grief using a family’s spiritual beliefs?
2. How could the counselor help the mother be reinstated as head of this family?
3. What specific spiritual interventions could be used to deal with the trauma in this story?

Response

Kim M. Tassinari

The counselor in this case was able to connect with Will on a spiritual level through prayer, and that became a pivotal moment in the therapeutic process. Approaching counseling by incorporating spirituality, therefore, would be therapeutic and healing for Will and his family, especially in working with issues related to grief and loss. I would first approach this case by qualitatively assessing Will’s developmental and spiritual levels, gauging the family’s spiritual and cultural beliefs, and learning more about Will’s interests in order to find meaningful ways to connect with him.

Setting the Stage

Before working with Will and his family, I would reflect on and stay aware of my own spiritual and religious beliefs, especially when integrating spirituality into the therapeutic process (Cashwell & Young, 2011). In addition to these initial steps, I would, as always, provide a warm and safe environment in which Will and his family and I could develop a bond of trust and support. In this case, one with many issues to work through and resolve, the counselor should be commended for making great strides through successfully implementing effective strategies and interventions. I would continue to build levels of trust and further develop specific strategies that are effective for Will and his family.

Proceeding with this case, I would gather more information from Will’s mother and Will to explore the family’s Catholic cultural background, because Catholic traditions may vary among different ethnicities (McGoldrick, Giordano, & Pearce, 1996; O’Brien, 2010). I would further examine the family’s cultural rituals, become familiar with their religious beliefs and practices, and learn how their faith has sustained them through times of difficulty (Cashwell & Young, 2011), always approaching counseling from a cultural context and with cultural humility.

Working With Grief Using Spiritual Beliefs

After working with the family as a unit, I would work with Will individually to learn more about his own spirituality and how his faith and religion speak to him, especially during the most difficult times of his short life. Psychoeducation would be helpful because it would provide him with a level of understanding of his own grief, how the many losses have affected his life, and how grief affects persons differently. This knowledge may help normalize some of his grief and loss reactions and help him see how some of his anger and sadness have manifested in his externalizing behaviors.

From a developmental perspective, Will is crossing into early adolescence, a time of difficulty for most young teenagers and a real challenge for someone like Will, who may be seeking stability in his life (Worden, 2009). In addition, not only is Will struggling with his identity, he might also be experiencing academic issues, peer pressure, and relational issues in school. Therefore, it would be important to consult with Will’s school counselor and work collaboratively to ensure that his needs are being met in school (Sink & Devlin, 2011).

Several authors have suggested meaning-making activities that may be helpful for Will as he navigates through his adolescence and makes sense of his losses (Muselman & Wiggins, 2012; Sink & Devlin, 2011). I would try specific meaning-making exercises within the counseling session and work on different themes during each session.

For example, I might have Will write a letter to his father during a session to help Will process and express some of the anger, sadness, and resentment he feels toward him. In addressing the loss of Will’s youngest brother, I would explore with Will some of his unresolved grief over this tremendous loss and have him recall positive memories of his brother as well as what others have said about him. For an activity, I might have Will write a short epitaph honoring his deceased brother. Activities such as this are effective in helping persons make sense of and clarify the meaning of grief and loss (Edgar-Bailey & Kress, 2010).

From a faith development perspective, Will also might be experiencing a spiritual transition co-occurring with a life crisis in which his sense of a just world may be shaken because of many losses (Parker, 2011). Therefore, I would explore with Will some of the religious and spiritual texts that have nurtured and comforted him, especially during the most difficult times in his life. The use of specific prayers, particularly thos...

Table of contents

• Cover
• Title Page
• Copyright
• Foreword
• Preface
• About the Editors
• About the Contributors
• Acknowledgments
• Section I: Life Span Issues
• Section II: Spirituality and Wellness
• Section III: Spirituality and Specific Disorders
• Section IV: Substance Abuse
• Section V: Career
• Section VI: Diverse Populations
• Section VII: Spiritual Interventions
• Technical Support
• End User License Agreement