Incorporating Spirituality in Counseling and Psychotherapy: Theory and Technique / Edition 1

by Geri Miller

Overview

"This book, through its well-referenced and critically thoughtful approach, has made an invaluable contribution to the counseling literature. The extensive use of case studies and other applied materials makes it a valuable . . . reference."
–Dr. Thomas J. Russo, Department of Counseling and School Psychology, University of Wisconsin, River Falls

Incorporating Spirituality in Counseling and Psychotherapy presents an applied, insightful, and well-researched overview of the theory, practice, and ethics of integrating spiritual and religious themes and rituals into traditional therapy models. This well-conceived and immensely readable text examines common barriers and bridges between spirituality and mental health and documents the effectiveness of using spiritual practices and concepts in treatment. Most important, it encourages readers, through group activities and individual reflection, to consider their own spiritual belief systems and biases before engaging clients in therapy with a spiritual base.

Key features of this book include:

• A synopsis of the major Eastern and Western religions and spiritual movements
• Theoretical, cultural, and ethical implications of incorporating spirituality in counseling
• Practical methods for helping clients develop a spiritual identity
• Proven techniques for incorporating spiritual practices in treatment
• Case studies providing complex, real-life scenarios, as well as questions and activities for individual and group discussion

A practical book for students and a valuable resource for counselors, psychologists, social workers, addiction specialists, and other mental health professionals, Incorporating Spirituality in Counseling and Psychotherapy offers expert guidance on how to handle issues of spirituality in furthering the therapeutic process.

Product Details

ISBN-13:	9780471415459
Publisher:	Wiley
Publication date:	11/01/2002
Edition description:	New Edition
Pages:	336
Product dimensions:	7.80(w) x 9.60(h) x 0.95(d)

About the Author

GERI MILLER, PHD, is a licensed psychologist and professor in the Department of Human Development and Psychological Counseling at Appalachian State University in Boone, North Carolina. She is also the author of Learning the Language of Addiction Counseling.

Read an Excerpt

Incorporating Spirituality in Counseling and Psychotherapy

Theory and Technique

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By Geri Miller

John Wiley & Sons

ISBN: 0-471-41545-6

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Chapter One

Chapter Objectives

1. What are three questions that need to be addressed before a counselor incorporates the spiritual dimension in counseling?

2. What is a working definition of spirituality?

3. What are some of the elements of creating a sacred place in counseling?

4. What can a counselor do to encourage a spiritual practice?

Spirituality in the Context of Counseling

It is legitimate for you to ask a question such as, "Why is it important or even necessary to include the spiritual or religious dimension in counseling?" In this chapter overview, some specific areas are explored in answer to this "why" question: the widespread interest in this area nationally and internationally, the impact of this dimension on the health of our clients, and the focus on this arena by professional organizations.

American culture has become increasingly interested in spirituality and religion. Baker (1997) found that 95% of Americans believe in God and 85% believe in personal prayer having healing powers (Wallis, 1996). Also, the majority of Americans belong to religious organizations (62%), believe religion is "very important" as a part of their lives (60%), and a large percentage worship weekly or close to weekly (The Harvard Mental Health Letter, 2001). These statisticsindicate that Americans tend to think about the spiritual and religious aspects of their lives. Although this book primarily discusses spirituality and religion within the context of American culture, it is important to note here that the concern about spiritual and religious beliefs is not limited to America. Organizations such as Amnesty International Interfaith Network for Human Rights indicate that concerns about spiritual and religious beliefs are international.

Given this widespread interest in the spiritual and religious realm, counselors need to prepare for clients who come for counseling who have spiritual or religious concerns that impact the mental health struggle that has brought them to counseling. Also, counselors need to be prepared to assist clients in applying comforting spiritual or religious perspectives as a healing resource in their lives.

The importance of examining spiritual issues in counseling is supported by Propst (1980) who reported that ignoring clients' religious beliefs can reduce counseling efficacy and increase premature termination. Recent research underscores the importance of an examination of the impact of spirituality on client health. While there are various definitions of health, W. R. Miller and Thoresen (1999) define health as consisting of suffering, functional ability, and coherence (inner peace, a sense of predictability, and optimism) which operate on a continuum. The National Institute for Health Care Research conducted an examination of research involving spirituality and religion (Larson, Swyers, & McCullough, 1997). Three of the expert panels that looked at spirituality and health (physical, mental, alcohol, and drug) found a positive relationship between spirituality and religion with health and a negative relationship between spirituality and religion with disorders. One example of research that supports the positive relationship is Simmons' (2001) summary of a two-year study by Pargament and Koenig of hospitalized elderly patients. The researchers found that patients who reported spiritual struggles, such as not feeling connected with God, showed a higher risk of dying (up to 28%). There are two thorough reviews of the literature on the relationship between spirituality and religion and health: Gartner's (1996) review on the relationship between religious commitment, mental health, and prosocial behavior, and Richards and Bergin's (1997) review of the influence of spiritual and religious factors on mental and physical health.

W. R. Miller and Thoresen (1999) state that clients are frequently involved in the spiritual and religious realms in a manner that is important to the clients and related to their health. They argue that understanding clients' spiritual and religious views may assist the counselor in understanding the client's problem(s) and positively impact treatment. Therefore, to positively impact the mental and physical health of clients, counselors need to be prepared to address these spiritual and religious concerns in counseling.

Professional organizations such as the American Psychological Association (APA) and the American Counseling Association (ACA) have increasingly focused on the importance of the spiritual dimension in counseling. Both organizations feature professional divisions related to spirituality and religion. According to their 2000 membership directory, the APA's Division 36, the Psychology of Religion, has approximately 1,197 members, and as of December 2000, the ACA's Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC), has approximately 2,705 members. The ACA's educational training body also has specific training requirements in spirituality. In 2001, the ACA expanded its multicultural training requirements to include spirituality in the revised Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards. Programs that have CACREP accreditation or are seeking accreditation need to have this component included in their curriculum. This spirituality requirement speaks to both the importance of the spiritual dimension in counseling and the commitment professional counseling organizations are making to its inclusion in the curriculum. Mental health counselors need to learn to work effectively with this dimension of clients' lives and professional organizations are beginning to encourage such involvement.

The widespread interest in spirituality, the impact of this arena on clients' health, and the increasing professional focus on this area highlight the need for the inclusion of the spiritual and religious dimension in counseling. This book is biased toward the benefits of the inclusion of this dimension in counseling. If counseling is meant to assist clients in healing from their difficult life experiences, then all possible healing resources need to be explored, including the spiritual and religious dimension. Possible pathology related to spiritual or religious beliefs is explored in Chapters 5 and 6.

Although the inclusion of spirituality in counseling is important, there is a history of conflict between the spiritual and the counseling realms that inhibits such an inclusion. Although this history is explored more in depth in Chapter 2, a brief overview places the development of this integration into context. Historically, the discipline of psychology broke away from the spiritual dimension to establish itself as a field separate from philosophy. Likewise, the mental health counseling field in America has supported a more secular approach to people's problems until treatment programs for wellness and for problems such as addiction began to include the spiritual dimension as a component of counseling.

Even with a shift toward the inclusion of the spiritual dimension in counseling, spirituality and religion are not always included in counselor training. Kelly (1995) surveyed 341 counselor education programs and found that only 25% had the spiritual/religious dimension as a course component. In another survey (Pate & High, 1995), 60% of the 60 CACREP accredited programs considered the impact of client's religious beliefs and practices on counseling. Now that CACREP requires accredited programs to include the spiritual dimension in training, counselor education programs are in need of textbooks that encourage the inclusion of spirituality within their curriculum. Educators need to work at creating places to discuss the spiritual dimension within their training programs. These places need to be ones in which: (a) both educators and students feel comfortable exploring their spiritual views without judgment, (b) spirituality is included as a part of culturally diverse discussions, and (c) counselor bias about spiritual beliefs and their relationship to mental health is discussed (G. Miller, Fleming, et al., 1998). Educators entering into this arena need to dialogue with other educators regarding their difficulties and successes in incorporating this perspective into the classroom, as well as share resources and classroom exercises with one another (G. Miller, Arena, et al., 1999). Educators who choose to incorporate this dimension in their training need to be aware that they run the risk of being stereotyped or ostracized for their spiritual perspective by students, colleagues, or both. To work effectively with spiritual issues, counselors need knowledge of all aspects of spirituality. In addition, they need guidelines and suggestions on how to include this dimension in their counseling practice in an ethical and skilled manner. G. Miller (1999a) identified three questions that need to be addressed as a counselor moves toward the incorporation of this dimension in counseling:

1. How do we help people develop a spiritual identity?

2. Do we have a right and/or an obligation to help people develop a spiritual identity?

3. How does context impact application? (p. 501)

G. Miller (1999a) introduced some answers to these questions. Although Chapter 8 provides techniques counselors can use to incorporate spirituality in counseling, these techniques need to be shaped to the client's needs. In addition, the mental health field needs to continue to work to develop techniques that can effectively assist clients in developing a spiritual identity. When determining when to incorporate a spiritual dimension in counseling, counselors need to examine their own motivation and possible bias to avoid attempting to convert their clients to their own spiritual views or ignoring a client's spirituality altogether. With regard to context, counselors need to look at the setting in which they work as well as their own spiritual development and views because both can influence the inclusion of spirituality in counseling.

Finally, counselors need to be sensitive to how spiritual and religious beliefs are imbedded within a cultural context. While this area is explored in depth in Chapter 5, a few notations need to be made here. Even when a client self-identifies as being of a particular spiritual or religious group, the counselor needs to explore that identification for that particular client. Where a client lives in a country, in combination with his or her religious community's culture, can have a great impact on that client's beliefs, values, and the application of those beliefs and values. The counselor needs to be very careful about making assumptions regarding the spiritual or religious dimension of a client's life. Understanding the many facets of a client's culture (gender, age, ethnicity, locale, and so on) can assist the counselor in understanding this dimension of a client's life and thereby increase the chances for effective counseling.

Definition

West (2000) stated that spirituality is an important concept that is difficult to define. Cornett (1998) said that it is difficult to define spirituality in part, due to its being equated with religion. Kelly (1995) pointed out that although spirituality and religion can be difficult to define, both share a sense of transcendence, of other. They differ in that spirituality is a personal connection with the universe and religion involves a creed, institution, and rituals connected with a world religion. Richards and Bergin considered religion to be a "subset of the spiritual" (1997, p. 13), yet, it is possible to be one without the other. W. R. Miller and Thoresen (1999) define spirituality as an attribute that does not necessarily incorporate religion. It consists of three areas: practice (prayer, meditation, etc.), belief (morals, values, deity, transcendence), and experience (of the individual). They define religion as organized and societal in nature. The word spirituality comes from the Latin word spiritus that means breath of life. The definition of spirituality used in this text is one that evolved from the 1996 Summit on Spirituality sponsored by ASERVIC:

Spirit may be defined as the animating life force, represented by such images as breath, wind, vigor, and courage. Spirituality is the drawing out and infusion of spirit in one's life. It is experienced as an active and passive process. Spirituality is also defined as a capacity and tendency that is innate and unique to all persons. This spiritual tendency moves the individual toward knowledge, love, meaning, peace, hope, transcendence, connectedness, compassion, wellness, and wholeness. Spirituality includes one's capacity for creativity, growth, and the development of a value system. Spirituality encompasses a variety of phenomena, including experiences, beliefs, and practices. Spirituality is approached from a variety of perspectives, including psychospiritual, religious, and transpersonal. While spirituality is usually expressed through culture, it both precedes and transcends culture. (Position Paper, n.d., para. 3)

Although this definition is not absolute, it can be used as a common thread in counselor and client dialogue when examining spiritual views that may involve religious views for either the counselor or the client. The remainder of this chapter examines how the counselor can assist clients in developing the spiritual dimension of their lives.

Creation of a Sacred Place

When one listens to a barking dog, one might imagine emotion, pain, reaction, anxiety, and self-identification, but actually there is nothing there-just sound from a long and deep corridor, channeled out of nothingness and fading into nothingness again. Like that dog, we may all strive, but there is truly nothing to be done. If we look deeply into our lives, there is only a thin veneer of self-generated meaning over an immense ocean of nothingness. What we do only has meaning in the here and now. It will not remain in the next instant. Just do what you can for the present, and leave everything else to happen naturally. Work. Wash. Meditate. Eat. Study. Urinate. Sleep. Exercise. Talk. Listen. Touch. Die each night. Be born again each morning. (Ming-Dao, 1992, p. 151)

This quote captures the issues that many clients bring with them to counseling when the thin veneer of meaning has been stripped from their lives. The resulting anxiety, fear, anger, and other intense, uncomfortable emotions in combination with negative, self-defeating thoughts cause them to seek therapy. When a client's life perspective, the illusions about who he or she is, who others are, and how the world operates, is pierced or shattered, this sense of meaninglessness can be overwhelming and, to varying degrees, devastating.

Continues...

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Table of Contents

Chapter 1 Introduction 1

Chapter Objectives 1

Spirituality in the Context of Counseling 1

Creation of a Sacred Place 6

Encouragement of Self-Care 9

Encouragement of Spiritual Practice 11

Case Studies 17

Exercises 18

Suggested Readings 19

Chapter 2 Historical Development 21

Chapter Objectives 21

Separateness and Integration 21

Barriers between Spirituality/Religion and Therapy 23

Bridges between Spirituality/Religion and Therapy 30

Case Studies 39

Exercises 41

Suggested Readings 43

Chapter 3 Western or Monotheistic Religions 45

Chapter Objectives 45

Overview 45

Working across Differences 55

Judaism 58

Christianity 62

Islam 74

Zoroastrianism 77

Sikhism 81

Native American Religions 83

Case Studies 86

Exercises 87

Suggested Readings and Web Sites 89

Chapter 4 Eastern Religions 93

Chapter Objectives 93

Overview 93

Hinduism 94

Shintoism 99

Jainism 102

Buddhism 105

Confucianism 108

Taoism 111

Case Studies 114

Exercises 116

Suggested Readings and Web Sites 117

Chapter 5 Theoretical Integration with Cultural Implications 121

Chapter Objectives 121

Therapy Integration 121

Transference Issues 126

Countertransference Issues 128

Types of Integration 131

Cultural Implications 133

Case Studies 136

Exercises 138

Suggested Readings 140

Chapter 6 Counseling Focus Integration 141

Chapter Objectives 141

Helping Clients Develop a Spiritual Identity 141

Case Application 151

Counseling Avenues 153

Case Studies 158

Exercises 160

Suggested Readings 162

Chapter 7 Ethical Issues 163

Chapter Objectives 163

Overview 163

Informed Consent 164

Determination of Secular or Religious Counseling 171

Development of a Spiritual Identity 172

Avoidance or Minimization of Dual or Multiple Relationships with Clients 175

Collaboration with Clients' Religious Leaders 177

Respect for Clients' Religious or Spiritual Values 178

Boundaries of the Counselor's Work Settings 181

Counselor's Area of Competence 182

Case Studies 184

Exercises 186

Suggested Readings 188

Chapter 8 Specific Treatment Techniques 189

Chapter Objectives 189

Overview 189

Religious Practices 191

General Practices 199

Religious and General Practices 204

Case Studies 211

Exercises 212

Suggested Readings 214

Appendix A American Association for Marriage and Family Therapy (AAMFT) Code of Ethics 215

Appendix B American Counseling Association (ACA) Code of Ethics and Standards of Practice 225

Appendix C American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct 251

Appendix D National Association of Social Workers (NASW) Code of Ethics 275

References 297

Author Index 309

Subject Index 313

Editorial Reviews

"Written in articulate, succinct, and well-organized prose." (Choice, April 2003)

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