This document provides an overview of spirituality and its applications in therapy. It discusses how spirituality plays an important role in many people's lives and how failing to consider a client's spiritual beliefs can be detrimental in treatment. Some key points made include that up to 90% of patients rely on religion or spirituality during illness, spiritual interventions can help those struggling to find meaning, and competently addressing spirituality requires counselors to understand different beliefs and practices without imposing their own views. The document aims to help therapists appropriately incorporate spirituality when relevant to a client's goals and wellbeing.

1. APPLICATIONS OF SPIRITUALITY
IN THERAPY
Kevin J. Drab, M.A., M.Ed., LPC, CAC Diplomate
Assistant Professor, Addictions Counseling Sciences
Drexel University, Philadelphia, PA
(215) 762-6922 e-mail: Kevin.Drab@drexel.edu
web sites: http://psychonotes.com/
http://BCTPRO.com

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Two Important Points
• This training is not concerned with what is true or not true with regard to beliefs.
• Our function is to assist clients to develop or discover beliefs and behaviors which work for them. No matter how antithetical or unsophisticated they may seem to our own belief systems.
Observations
• In some areas of the United States, up to 90 percent of patients rely on religion for comfort or strength during times of serious illness.
• A recent review of more than 1,200 studies of religion and health reported that at least two thirds of the studies evaluated had shown significant associations between religious activity and better mental health, better physical health or lower use of health services.
• Failure to not consider a client’s spiritual/religious beliefs in one’s biopsychosocial assessment and delivery of treatment to them is a very serious oversight.
• Spirituality or religion may be a collection of adequate, simple, unquestioned beliefs about the world and oneself, or it may involve an active search for meaning and purpose greater than oneself.
• Spirituality plays an integral role in the lives of many – but not all - people. Some (and maybe many) people go through life, and change unhealthy behaviors, with little or no dependence on spiritual beliefs.
• Many troubled people have been helped by spiritual interventions when they have moved from preoccupation with their limited, problem-saturated worlds to a larger search for meaning.
• Spirituality and related constructs are difficult to objectify and measure. These constructs are so culturally embedded and tacit that it requires considerable critical exploration to clarify what we are exactly studying. The dimensions and measures of spirituality most pertinent for treatment are yet to be defined.
• Besides being complex and multifactorial there are profound differences in how people experience and report their “spirituality.” A particularly confounding aspect lies in the tendency of people to report
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they hold a strong belief or do a certain thing, only to find out their actual behavior does not reflect their report.
• Many clinicians, including counselors, psychologists, social workers, etc., are interested in facilitating others’ search for meaning during the “recovery” process. Some are sufficiently skilled, qualified and competent to do so, but many are not.
• An attentive openness to spiritual and religious issues in secular counseling settings depends on counselors' knowledgeable sensitivity to the potential pertinence of the spiritual/religious dimension for clients, despite the inattention typically given to this dimension in secular settings. Proficient counselors, irrespective of their personal spiritual/religious orientation, can and should incorporate clients' spirituality or religiousness when appropriate.
• Clinicians who choose to employ spiritual techniques should be familiar with associated risks and ethical issues involved in doing so, especially relating to the development of dual relationships (where the clinician attempts to be both clinician and spiritual guide to a client).
Competencies: Spirituality and Counseling
In order to be competent to help clients address the spiritual dimension of their lives, a counselor should be able to:
1. Explain the relationship between religion and spirituality, including similarities and differences,
2. Describe religious and spiritual beliefs and practices in a cultural context,
3. Engage in self-exploration of his/her religious and spiritual beliefs in order to increase sensitivity, understanding and acceptance of his/her belief system,
4. Describe one's religious and/or spiritual belief system and explain various models of religious/spiritual development across the lifespan,
5. Demonstrate sensitivity to and acceptance of a variety of religions and/or spiritual expressions in the client's communication,
6. Identify the limits of one's understanding of a client's spiritual expression, and demonstrate appropriate referral skills and general possible referral sources,
7. Assess the relevance of the spiritual domains in the client's therapeutic issues,
8. Be sensitive to and respectful of the spiritual themes in the counseling process as befits each client's expressed preference, and
9. Use a client's spiritual beliefs in the pursuit of the client's therapeutic goals as befits the client's expressed preference.
From: Miller, G. (1999). The Development of the Spiritual Focus in Counseling and Counselor Education. Journal of Counseling and Development, 77(4). Fall. p. 500.
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Spiritual Assessment Q: Does the Joint Commission specify what needs to be included in a spiritual assessment?
A: Spiritual assessment should, at a minimum, determine the patient's denomination, beliefs, and what spiritual practices are important to the patient. This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed. The standards require organization's to define the content and scope of spiritual and other assessments and the qualifications of the individual(s) performing the assessment. Examples of elements that could be but are not required in a spiritual assessment include the following questions directed to the patient or his/her family:
1) Who or what provides the patient with strength and hope?
2) Does the patient use prayer in their life?
3) How does the patient express their spirituality?
4) How would the patient describe their philosophy of life?
5) What type of spiritual/religious support does the patient desire?
6) What is the name of the patient's clergy, ministers, chaplains, pastor, rabbi?
7) What does suffering mean to the patient?
8) What does dying mean to the patient?
9) What are the patient's spiritual goals?
10) Is there a role of church/synagogue in the patient's life?
11) How does your faith help the patient cope with illness?
12) How does the patient keep going day after day?
13) What helps the patient get through this health care experience?
14) How has illness affected the patient and his/her family?
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Why do I exist? What’s my purpose?
WHAT?
What/Who am I?
What’s my relationship to the world, to others, etc.?
Where does it all come from?
Why does it exist? What’s it’s purpose?
How should I behave with regard to the world and myself?
How should I think and feel about the world and myself?
HOW?

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Some descriptions of spirituality
" ...the feelings, acts, and experiences of individual men in their solitude, so far as they apprehend themselves to stand in relation to whatever they may consider the divine [which is not necessarily God, but any force in the universe]". "Like love, like wrath, like hope, ambition, jealousy, like every other instinctive eagerness and impulse, it adds to life an enchantment which is not rationally or logically deducible from anything else.... Religious feeling is thus an absolute addition to the Subject's range of life. It gives him a new sphere of power. When the outward battle is lost, and the outer world disowns him, it redeems and vivifies an interior world which otherwise would be an empty waste." "Religion thus makes easy and felicitous what in any case is necessary [for our survival in the universe]."
--William James, The Varieties of Religious Experience
"In its broadest sense, spirituality is an aspect of any attempt to approach or attend to the invisible factors in life and to transcend the personal, concrete, finite particulars of this world.... Spirituality is not always specifically religious. Mathematics is spiritual in a broad sense, abstracting from the concrete details of life. A walk through the woods on a sunny fall day can be a spiritual activity, if only because it's a way of getting away from home and routine and being inspired by tall, old trees and the processes of nature, which are far beyond human scale. Spirit, the Platonists said, lifts us out of the confines of human dimensions, and in doing so nourishes the soul."
--Thomas Moore, Care of the Soul
“There is within us a fundamental dis-ease, an unquenchable fire that renders us incapable, in this life, of ever coming to full peace. This desire lies as the center of our lives, in the marrow of our bones, and in the deep recesses of the soul. At the heart of all great literature, poetry, art, philosophy, psychology, and religion lies the naming and analyzing of this desire. Spirituality is, ultimately, about what we do with that desire. What we do with our longings, both in terms of handling the pain and the hope they bring us, that is our spirituality... Augustine says: ‘You have made us for yourself, Lord, and our hearts are restless until they rest in you.’ Spirituality is about what we do with our unrest.”
-- Ronald Rolheiser, The Holy Longing: The Search for a Christian Spirituality.
A personal affirmation of a transcendent connectedness in the Universe.
-- Kelly, E. W. (1995), p. 4.
The courage to look within and to trust. What is seen and trusted appears to be a deep sense of belonging, of wholeness, of connectedness, and of openness to the infinite.
-- Shafranske & Gorsuch, et al. (1984), p.233.
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"When we say 'this horse has spirit', or 'the spirit of the nation was rekindled', we mean that a positive and creative energy is realized, witnessed or perceived. The power to live, work, create is actualized. In a similar way, a spiritual person is a positive and creative human being. They know, deep inside of themselves that they make the difference. They have located their 'yes' to life."
-- Father Leo Booth, Breaking the Chains
"The very distinction between spiritual and material or sacred and secular, is ultimately invalid, for the spiritual mode finds its place in all actions, whether physical or psychical, that lead us to a fuller knowledge of God. Whatever leads us to a knowledge of God is spiritually based; it also leads us away from preoccupation with ourselves to a fuller participation in the world's affairs and the concerns of others."
--Martin Israel, Precious Living
The animating force in life, represented by such images as breath, wind, vigor, and courage. Spirituality is the infusion and drawing out of spirit in one’s life. It is experienced as an active and passive process. Spirituality also is described as a capacity and tendency that is innate and unique to all persons. This spiritual tendency moves the individual towards knowledge, love, meaning, hope, transcendence, connectedness, and compassion. Spirituality includes one’s capacity for creativity, growth, and the development of values system. Spirituality encompasses the religious, spiritual, and transpersonal.
-- Consensus definition from the Summit on Spirituality (Oct 1995), and
quoted in Miller, G. (1999), p. 499.
A way of being and experiencing that comes about through awareness of a transcendent dimension and that is characterized by certain identifiable values in regard to self, others, nature, life, and whatever one considers to be the ultimate.
-- Elkins, et al. (1988), p. 10.
The feelings, thoughts, experiences, and behaviors that arise from a search for the sacred. The term ‘search’ refers to attempts to identify, articulate, maintain, or transform. The term ‘sacred’ refers to a divine being or Ultimate Reality or Ultimate Truth as perceived by the individual.
--Larson, D. B., et al. 1998.
Some Etymology:
Religion – from Latin religio, meaning “obligation” or “a binding together”. Religio was commonly used in the sense of “bond between human beings and the gods”.
Spirit – from Latin spiritus, literally meaning “breath”, and usually used to refer to the “source of life”, “the animating force”, or “the essence” of a being.
Relationship – quality or state of being connected or related, as in thought, meaning, etc.
Connection – from Latin connectere, meaning “to tie or bind together”.
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SPIRITUALITY can be defined as how you perceive and live out your relationship with the world and yourself.
a. It is based on the assumption that there is more than what is immediately, physically apparent.
b. In some way deals with a unifying, integrating or vitalizing dimension of experience.
c. It involves the concept of a relationship or connection with something outside oneself (or outside one’s consciousness), which entails interaction and interdependency, in contrast to how one would relate to a fact (like the function of a gene) or mechanical process (like electricity or the law of gravity).
d. It’s personally meaningful in that it provides beliefs about the nature and purpose of the world and ourselves, typically including guides on how to think and behave.
RELIGION is an the expression of spiritual or religious belief/experience in a set of symbols, beliefs or doctrines, and practices by which groups and individuals relate to themselves and the world. Religion, for many people, is the concrete, culturally oriented definition and expression of their spirituality.
1. Religion and spirituality clearly share many common characteristics, such as a search for what is sacred or holy in life, coupled with some kind of transcendent (beyond the self) relationship with God or a higher power or universal energy.
2. They differ in important ways, such as religious factors being focused more on prescribed beliefs, rituals, and practices as well as social institutional features; were as, spiritual factors are concerned with individual subjective experiences, sometimes shared with others.
3. Religion is defined by its boundaries; spirituality by a difficulty in defining its boundaries.
4. Religion and religiosity can, in fact, interfere with a person’s spiritual growth. The spiritual purpose of religious practice can be lost in obsessional piety or in political and economic agendas that focus on power and prestige.
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THREE DOMAINS OF SPIRITUALITY
These broad domains (derived in large part from Miller, 1999) are consistent with a psychosocial perspective that is sensitive to cultural, ethnic, socioeconomic, and religious differences. Each domain can encompass a wide range of constructs and variables. And each is amenable to a variety of qualitative and quantitative assessment approaches (e.g., biographical and autobiographical material, narrative interviews, physiological measurement, self-report questionnaires, etc.)
1. Spiritual Practices – generally focuses on observable behavior which give expression to the person’s sense of meaning and purpose, such as meditation, prayer, chanting, fasting, reading spiritual material, style of dress, wearing or possessing spiritually-meaningful objects, participation in specific religious activities such as rituals, pilgrimages, public prayer.
2. Spiritual Beliefs – How the person makes sense of her/his life experience through a variety of concepts, ideas and models. This covers a very broad and loosely delineated range of subjects such as ideas about the origin and nature of the world and reality, beliefs about transcendence (a higher being or force, souls, afterlife, other realms), as well as personal morality and endorsed values. Stories, symbols, other key representations of the person’s beliefs often play a strong role in this dimension. Many of the ideas and images found in spiritual beliefs are tacit or intuitive for many people, and do not lend themselves easily to examination or change.
3. Spiritual Experience – the experiential dimension which many regard as the fundamental and defining nature of spirituality. Such experiences can be roughly divided into routine, everyday encounters of the transcendent or sacred, versus exceptional, spiritual and mystical experiences. A serious obstacle to talking about these experiences lies in the variability with which individuals interpret what has happened to them: some will talk about and integrate the experience as a spiritual one, while others do not. On the more mundane level, we would also consider the overall emotional tone of the person’s spiritual life (does the person feel grateful or resentful, joyful or despairing, timid or courageous, guilty or accepted, worthless or valuable?).
MULTIPLE FORCES IMPACTING ONE’S SPRITUALITY
• CULTURE
• ENVIRONMENTAL DEMANDS
• PERSONALITY (Biopsychosocial Factors)
• STAGE OF LIFE
• SOCIAL CIRCLES
• EXISTENTIAL CONCERNS
• EXPERIENCES
• EDUCATION
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Some Spiritual/Religious Sources
♦ Islam
♦ Hinduism
♦ Buddhism
♦ Taoism
♦ Christianity
♦ Judaism
♦ Bahai
♦ Native American religions
♦ Shamanism
♦ Santeria
♦ Voodou
♦ Channeling, e.g., Seth Speaks, A Course in Miracles
♦ Fiction
♦ Spiritualism
♦ Inspirational books, e.g., The Celestine Prophecy
♦ Mysticism
♦ UFOs
♦ Theosophy
♦ Wicca/Pagan Movement
♦ Reincarnation/Past life memories
♦ Scientology
♦ Satanism
♦ Psychedelics
♦ Near-Death Experiences
♦ Dreams
Examining our tacit assumptions -- Does a spiritual belief need to:
♦ Benefit the individual? Produce positive feelings?
♦ Be realistic?
♦ Refer to a transcendent (not physical) reality?
♦ Have a social component, or be asocial, or even antisocial?
♦ Involve a morality—the valuation of behaviors?
♦ Provide an explanation for the universe and the individual?
♦ Be teleological: provide a purpose for the world and the individual?
♦ Be a consistent set of concepts and assumptions which guide the individual’s behavior?
♦ Have ancient origins, or be developed outside of the individual’s experience?
♦ Involve a personal relationship with a transcendent force or realm?
♦ Be explicable or applicable to another individual?
Some Possible Therapeutic Factors of Spirituality
• Relief, acceptance, peace, gratitude.
• Optimism and hope
• Belonging: both as being-in-the-world and social connectedness
• Meaningful world-view: "the purpose of it all; sense of direction; of how all events are related.
• Decreased fear, anxiety, depression, frustration, anger, etc.
• Redefinition of self: usually more positive and accepting of self; new, more enhanced identity.
• Improved relationships; less focus on self; more altruistic.
• Surrender of infantile-like control; increased trust in processes of world and self.
• Increased motivation and energy.
• Feelings of more courage and strength in face of hardships, threats, death.
• Deeper involvement with and connectedness to life.
• Humility in face of accepted limits and awe of meaning of life and universe. 9

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“Healthy” and “Unhealthy” Religious Values and Lifestyles
Derived from: Richards, P. S. & Bergin, A. E. (1997). A spiritual strategy for counseling and psychotherapy. Washington, D.C.: American Psychological Association.
• Intrinsic: sincere, congruent, lives religion, personal faith.
• Extrinsic: Role playing, incongruent, uses religion, normative faith.
• Actualizing: growth-oriented, self-regulating agency, experiential/creative, self- renewing/repentant, integrates ambiguity and paradox.
• Perfectionistic: righteous performances, overcontrolled inefficacy, compulsively ritualistic/stagnant, self-punitive, depressed, anxious about the unanticipated.
• Reforming/renewing: change-oriented, benevolent/reforming power, tolerant, egalitarian.
• Authoritarian: rigid, dogmatic/absolutistic, intolerant/prejudiced, controlling/dominating.
• Reconciling: forgiving, humble, appropriately direct, problem solving.
• Dependent: pleasing/submissive, compliant/masochistic, passive-aggressive, conflict avoidant.
• Inspiring: attunement to spirit of truth, prophetic, mystical – good reality testing.
• Hyperspiritual: God controlled/externalized, occult/evil inspired, mystical – poor reality testing.
Some of my thoughts on a “healthy” spirituality
1. Regardless of content belief(s) need to be robust (hardy, capable of weathering crises).
2. Contributes positively to enhancing the individual’s life and how they feel about themselves and others.
3. Helps individual to function better (cope, survive), especially in demanding situations.
4. Is a good fit with their “ecology”--personality, culture, schemas, etc.
Personal misuses of spirituality
• Avoiding responsibility for one's life. Total absorption into belief system and abandonment of relationships, activities and interests not related to it. No balance, no flexibility, no self-care, no thinking, no life!
• Unrealistic sense of certitude and absoluteness.
• Manipulating others.
• Denying and rationalizing inhumanity and ignoble actions.
• Ignoring and repressing the shadow side. Projecting one's "dark side" onto others.
• Laziness: intellectual, social, emotional, and spiritual.
• Suppressing emotional disturbances and ignoring real life problems.
• Avoiding existential issues of aloneness, meaning and mortality.
• Claims to superiority, specialness, elitism.
• Repressing real self to attain "perfection". Neglecting or denying one's needs.
• Intolerance, judgementalness, paranoia.
• Acting impulsively on impulses, delusions or hallucinations, e.g., voice of God, visions of spirits, commands to cleanse the earth, exuberant energy to convert everybody. Boundaries between fantasy and reality become blurred.
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• Settling for simplistic solutions to complex life problems, e.g., apocalyptic forecasts, faith cures all, destroy all evil, etc.
Some possible impediments to developing healthy spirituality
• Unresolved parental/authority issues
• Co-Dependency impairments
• Trauma or serious abuse history
• Considerable repressed anger and hurt
• Negative experiences with religion
• Control focused
• Needs are repressed or nonconscious
• Misperception of what spirituality is
• Intellectual rejection of concept
• Cynicism, disillusionment or arrogance
• Fear of implications
• Cognitive impairments or mental illness
Note: most problems involve difficulties in areas of trust and self-awareness.
Assessment
Traditional neglect of the issue of spiritually has led to five broad areas of failure: occasional devastating misdiagnosis; not in frequent mistreatment; an increasingly poor reputation; inadequate research and theory; and a limitation of psychiatrists own personal development. -- Scott Peck, The Road Less Traveled.
Why Assess a Client’s Spirituality?
Spiritual assessment is the process by which health care providers can identify a patient's spiritual needs pertaining to their mental health care. The determination of spiritual needs and resources, evaluation of the impact of beliefs on healthcare outcomes and decisions, and discovery of barriers to using spiritual resources are all outcomes of a thorough spiritual assessment.
1. Prognosis – Religious involvement is predictive of positive physical and mental health outcomes, possibly even serving a protective factor. When religious involvement did not appear to provide benefit, the inquiry should look into where it may have been protective, but then was overwhelmed by other influences, or may have even been detrimental to the client. Clearly, the person’s religious history and present sense of spirituality must be considered in sufficient detail and in relation tom other available data. (Miller, 1999).
2. Context -- The clinician can expect that for many clients their spirituality and religion are an important or even central elements in their larger worldviews and life context within which presenting concerns will be addressed. Understanding clients’ spirituality can promote clearer communication, offering contextual information that is important to the process of treatment. As the clinician explores the cognitive, affective, and unconscious elements of mental health issues, they can help clients by an alert openness to how spiritual and religious threads may be woven into such concerns and used in their resolution.
3. Outcome – As treatment progresses the individual’s spiritual and religious beliefs will provide not only resources to draw upon, but may also change in some respects themselves. As much
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as religious beliefs may have positive value for health, there is also a possibility that some aspects of the individual’s beliefs may increase risk or exacerbate problems (e.g., a rigid, unforgiving divinity).
4. Intervention – Utilizing the client’s own specific spiritual perspectives to enhance and integrate treatment strategies can produce good results. Building on certain assumptions, practices, or following the logic of a certain belief are all examples of how the individual’s beliefs can become important resources for change.
5. Comfort and Acceptance -- Discussing the client’s spiritual and religious beliefs and experiences with them in a sensitive and appropriate manner can often constitute an intervention in itself. Frequently, all that is necessary is to listen to the patient's responses, providing presence and support, rather than demonstrating expertise in religious matters. When religion/spirituality is what gives meaning, purpose and hope, the client often feels supported and comforted by sharing these beliefs with the concerned clinician. Likewise, if there are religious doubts or anxieties present, sharing these feelings with a caring, accepting professional may help with resolution. "Cure sometimes; relieve often; comfort always."
Possible Assessment Results
In arriving at a conclusion regarding the client’s spiritual/religious status, it is important to realize that this is only a functional analysis, and that among other limitations, it is important to realize that more than one of these categories may be at play in the individual’s experience.
Category I: Psychopathological Problem. Spiritual/Religious thoughts/behavior are problems and are attributable to Mental Disorder. Psychiatric Disorder is primary and religious/spiritual concerns are secondary or even epiphenomenal. Examples: psychotic processes involving religious delusions (e.g., belief that one is Jesus Christ; experience of the world as evil and oneself as the source of all evil), or hallucinations (e.g., hearing or seeing the devil).
Category II: Psychological Problem. This reflects the DSM-IV-TR’s V62.89 Religious or spiritual Problem diagnosis, and assumes that the difficulty is not attributable to a mental disorder. The DSM states: “This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values which may not necessarily be related to an organized church or religious institution.” (American Psychiatric Association, 2000, p. 741). Upon determining that the origin of the spiritual/religious problem is not pathological, the clinician must decide whether or not the particular concern warrants attention in the mental health setting, i.e., they are “psychoreligious” or “psychospiritual” in nature, which can be addressed in the course of therapy, or are more appropriate for a religious professional or specialist in spiritual/religious matters such as a transpersonal therapist. The decision to treat or refer is guided by several considerations including the client’s presenting problems, their goals for treatment, the training and qualifications of the therapist, the seriousness and acuteness of the religious or spiritual problem, and the amenability of such a problem to more standard therapeutic interventions (i.e., cognitive, gestalt, etc.). In simple terms, one must ask if this problem can find its way onto a treatment plan, or whether it can wait until the completion of treatment, or whether there must be conjoint work with a religious professional or specialized therapist. 12

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♦ Psychoreligious problems are experiences that a person finds troubling or distressing and that involve the beliefs and practices of an organized church or religious institution. Examples include loss or questioning of a firmly held faith, change in denominational membership, conversion to a new faith, and intensification of adherence to religious practices and orthodoxy.
♦ Psychospiritual problems are experiences that a person finds troubling or distressing and that involve that person's relationship with a transcendent being or force. These problems are not necessarily related to the beliefs and practices of an organized church or religious institution. Examples include near-death experience and mystical experience. This category can be used when the focus of treatment or diagnosis is a psychoreligious or psychospiritual problem that is not attributable to a mental disorder.
Category III: Absence of Difficulties in Religious/Spiritual Area. There are no apparent difficulties in this area, although the spiritual/religious domain of the individual’s life may still bear exploration as treatment progresses.
How do we know the Religious Experience isn’t psychosis? Below are diagnostic criteria proposed by two Israeli psychiatrists working with orthodox Jewish patients:
Psychotic episodes: 1) are more intense than normative religious experiences in their religious community; 2) are often terrifying; 3) are often preoccupying; 4) are associated with deterioration of social skills and personal hygiene; 5) often involve special messages from religious figures.
Greenberg, D., & Witztum, E. (1991). Problems in the treatment of religious patients. American Journal of Psychotherapy, 45(4), 554-565.
SPIRITUAL ASSESSMENT TOOLS
The Spiritual Assessment Interview
Developed by David Lukoff, Ph.D.
A. RELIGIOUS BACKGROUND AND BELIEFS
1. What religion did your family practice when you were growing up?
2. How religious were your parents?
3. Do you practice a religion currently?
4. Do you believe in God or a higher power?
5. What have been important experiences and thoughts about God/Higher Power?
6. How would you describe God/Higher Power? personal or impersonal? loving or stern?
B. SPIRITUAL MEANING AND VALUES
1. Do you follow any spiritual path or practice (e.g., meditation, yoga, chanting)?
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2. What significant spiritual experiences have you had (e.g., mystical experience, near-death experience, 12-step spirituality, drug-induced, dreams)?
C. PRAYER EXPERIENCES
1. Do you pray? When? In what way(s)?
2. How has prayer worked in your life?
3. Have your prayers been answered?
The FICA Spiritual Assessment
From: Puchalski, C.M., Romer, A.L. (2000). Taking a Spiritual History Allows Clinicians to Understand Patients More Fully. Journal of Palliative Medicine 3(1), 129-137.
F: FAITH AND BELIEFS 1) What are your spiritual or religious beliefs?
2) Do you consider yourself spiritual or religious?
3) What things do you believe in that give meaning to your life?
I: IMPORTANCE AND INFLUENCE 1) Is it important in your life?
2) How does it affect how you view your problems?
3) How have your religion/spirituality influenced your behavior and mood during this illness?
4) What role might your religion/spirituality play in resolving your problems?
C: COMMUNITY 1) Are you part of a spiritual or religious community?
2) Is this supportive to you and how?
3) Is there a person or group of people you really love or who are really important to you?
A: ADDRESS 1) How would you like me to address these issues in your treatment?
Examples of Cases assessed in FICA format:
Case 3 -52-year-old female scientist comes in for yearly physical.
F: Naturalist I: Feels at one with nature. Each morning she sits on her patio looking out over the trees in the woods and feels "centered and with purpose." C: Close friends who share her values. A: After the discussion about belief, she will try to meditate, focusing on nature, on a daily basis to increase her peacefulness.
Case 4 - 45-year-old male comes in for a physical. He previously drank heavily but has not had a drink for 10 months. He finds abstinence from alcohol to be very difficult.
F: Jewish (reform) I: His religion is more a cultural affiliation than it is a religious one. He does believe there is a God, but has no personal relationship with that God. C: Finds support and friendship at his temple, which he goes to at the high holidays.
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A: He will try Alcoholic Anonymous as a way of maintaining his sobriety. He is not sure what the concept of "turning it over to God" means, but he will try to work on it.
The HOPE Assessment
H -- sources of hope, strength, comfort, meaning, peace, love and connection O -- the role of organized religion for the patient P -- personal spirituality and practices E -- effects on medical care and end-of-life decisions
From: Anandarajah, G., & Hight, E. (2001). Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. American Family Physician, 63(1), 81-89.
Therapist Problems With Spirituality
1. Ignorance or unwillingness to acknowledge that therapy and spirituality are often dealing with the same issues of meaning and identity; and not understanding how they work together in some areas and are applied separately in others.
2. Lack of knowledge or training in dealing with spiritually-related matters.
3. “Psychologizing” by dismissing client’s spiritual concerns as symptoms of regressive tendencies, neuroticism, immaturity, or defense mechanisms.
4. “Spiritualizing” by believing that spiritual forces will solve/absolve/heal/correct all client’s problems if only their faith is strengthened.
5. Intentional or unconscious proselytizing of one’s own belief system, e.g., AA, New Age, Christianity, Humanism, Rationalism, Me-ism, etc.
6. Mistakenly channeling all client’s spiritual concerns into 12 step program, rather than recognizing its limits, doing a — evaluation of the needs, and endeavoring to provide guidance, resources and referrals.
7. Fear of client’s spiritual insights and experiences, particularly when they are emotional. Failing to take the Dr. Silkworth approach.
8. Problems with own spirituality, particularly unfinished business with some spiritual system or with parental/authority figures, which results in destructive counter-transference.
9. Intimidated by fervor, knowledge, or authority of client and/or their belief system and experiences.
10. Own intolerance, prejudice, rigidity, or ignorance. Including unwillingness to be exposed to and learn about others’ beliefs and religious symbols/rituals.
11. Failing to challenge client’s beliefs, practices or experiences, which are clearly more harmful than helpful.
12. Relying on spiritual guidance in doing therapy to the exclusion of clinical supervision, peer consultation, reading professional literature, and continual openness to new concepts and methods of treatment.
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What a therapist could do regarding a client’s spirituality
1. Be alert for indications of problems in this area.
2. Call attention to the subject and provide an explanation for your questioning.
3. Assist client to identify and articulate beliefs and needs.
4. Help in identifying what is working and what is not:
a. in the client’s life spheres
b. in the therapy process
5. Facilitate client making desired changes in beliefs.
6. Provide information and materials, e.g. books and articles, to assist client.
7. Provide referrals to appropriate experts, e.g., pastoral counselors and spiritual mentors, and to groups with germane spiritual orientations.
Some useful books for the searching client
Came to Believe, Alcoholics Anonymous
Care of the Soul, T. Moore
Chop Wood, Carry Water, Fields, et al.
How to Keep a Spiritual Journal, R. Klug
Man’s Search For Meaning, V. Frankl
My Spiritual Progress Guide, L. Hyde (Hazelden)
The Alternative 12 Steps: A secular guide to recovery, M. Cleveland
The Road Less Traveled, S. Peck
What is Spirituality?, P. Bjorkland (Hazelden)
When Bad Things Happen to Good People, K Kushner
Women and Spirituality, J. Englemann (Hazelden)
WHY DIDN’T THEY TELL ME?
1. Clients are generally not comfortable revealing their religious/spiritual beliefs in the first few sessions of secular therapy unless they are invited to.
2. They may feel they’ll be thought less of by the therapist, as irrational, not in control of their lives, etc.
3. Many don’t consider their beliefs relevant to their problem.
4. Clients may avoid discussing their beliefs as they see a conflict between their problem and the expectations of their faith.
SOME THINGS TO DO
™ Notice any clues from documents, what person may be wearing, the terms they use, references to affiliations or significant people in their lives, what they seem to avoid talking about, etc., which you might then inquire about.
™ In a well-timed manner, you may inquire as to their beliefs, such as:
1. How do you think about life? I mean, do you think there’s a God; what’s the meaning
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of life; why are you here? That sort of thing.
2. Could you tell me more about that?
3. What does this belief/idea/faith do for you? What role does it play in your life?
4. Is there anything you’d like to change or improve about it/you?
5. What do you want more of in your life?
6. What do you want more of in your spiritual life?
7. How would you feel if you got what you wanted spiritually?
8. What kind of person would you be if you had it? e.g., strong, peaceful, forgiving, detached.
9. What is keeping you from it?
10. Do you have the courage to ask your Higher Power to make you that kind of person?
™ Assume a non-expert, curious and caring approach when questioning and discussing the individual’s beliefs.
™ Be alert for the possibility that a person’s stated beliefs may not be reflected in actual internal/external behaviors.
™ There are three principle themes you are looking for in exploring their beliefs and problems:
1. Incongruencies and congruencies between beliefs and behavior
2. What resources/solutions do they have in their beliefs – what’s already working and what could be drawn on to help them even more?
3. Specific areas of their religious/spiritual beliefs/practices they may want to change.
™ Let them teach you, and also consult books, web sites, experts, etc. to help you better understand the client’s beliefs.
™ Never assume you need to “fix” their beliefs/practices, or give them new ones, unless they specifically ask for assistance.
OTHER EXAMPLES OF QUESTIONS AND IDEAS YOU MIGHT PURSUE
♦ How does that fit with your beliefs?
♦ How has this belief/idea/practice helped you?
♦ How might your belief help you with that?
♦ How strongly do you believe that?
♦ If I just looked at your behavior, what kinds of beliefs would I probably assume you had?
♦ WWDJ? – “What Would Jesus Do?” You may have the client pick any model whether deity or spiritual person to identify belief congruent behaviors, which may help them to change their own behavior.
♦ What might be the reason you’ve been given this problem?
♦ How might this experience change you?
♦ When you are on your deathbed, reflecting on what you’ve achieved in your life, what do you want to remember and feel about this time?
♦ What can you change today that will help you get closer to your goal?
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Behavioral Approaches to Enhance Spirituality
from: Martin, J., & Booth, J. (1999). Behavioral approaches to enhance spirituality. In W. Miller (Ed.). Integrating spirituality into treatment. Wash., DC: APA. pp. 161-175.
Doing More: Increasing and maintaining spiritual and religious behavior, e.g., prayer, meditation, good works, sacrifice, retreats, etc.
Being More: Enhancing one’s spiritual identity through reflecting on personality traits, areas requiring improvement, and doing more value-congruent behaviors and thoughts.
Doing Less: reducing value-incongruent thoughts and behaviors, e.g., overindulgence, bitterness, resentment, unawareness, and other spiritually inconsistent behavior.
Specific Issues Which May Arise in Treatment
(much of this is derived from chapters in Miller (1999))
Note: Each one of these issues requires a set of individualized skills which must be learned, practiced and built upon. Often the client already has parts of these skills in place, but has not understood how to apply them (re. to approaches such as Solution-Focused Therapy).
SPIRITUAL SURRENDER
1. Realization that one’s life and/or specific problem exceeds one’s resources to control or solve; and that all approaches thus far have often compounded the emotional distress and aggravated the problem.
2. Recognition of a higher value or greater good in the seemingly negative situation.
3. Connecting with higher value or good – focusing and trusting in external force to handle problem and decrease or cease strategies to control the situation.
4. Surrender is followed by an enhanced state of being (total acceptance, feelings of completeness, gratitude and compassion) and not a sense of defeat or loss.
Approaches: List of things can and cannot control; inventory of positive and negative consequences of trying to control the uncontrollable; examining incongruencies in one’s spiritual view of the world; addressing feelings of vulnerability and fear; resolving ambivalence; imagery/prayer/ceremony of handling over situation to higher power; specific tools such as God Box, leaving written problem in sacred place; “acting as if;” changing automatic thoughts and habits of behavior; etc.
ACCEPTANCE
1. Developing capacity to fully embrace whatever is in the present moment. Resignation, agreement, servitude or passivity may be involved, but are not the most desirable course for an individual to take.
2. Integrally linked with surrender the individual learns to use a new frame of reference to enable them to live with limitations, problems or losses in a calm, nonresisting manner.
Approaches: Developing or enhancing one’s life philosophy with emphasis on big picture and purpose of one’s overall life; changing expectations; evoking hope; trusting in the care and direction of Higher Power; developing strategies to change thinking to develop tolerance to (detachment from) difficulties; reframing experiences;
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writing story/theme of one’s life and examining assumptions; praying for guidance and faith; using contemplation to determine priorities; work on forgiveness; etc.
FORGIVENESS
1. Literally to give up or give away anger and resentment which is predominantly self-destructive. Letting go of desire for revenge reflects a freedom from the circumstance and strength to absorb injury. Includes, most importantly, forgiving self for limitations and mistakes.
2. “Resentire,” meaning to relive, is the origin of the word resentment. In essence continually reacting to an event in one’s memory as if it was actually happening in the here-and-now and may be thought of as a form of insanity (i.e., like a psychosis - not reality-based).
3. Requires persistence and patience as these patterns of responding are deeply ingrained by instinct, experience, culture and even some religious views.
Approaches: Pros and cons of living with the feelings/thoughts; addressing beliefs about how to react to injury; looking at own behavior for similar behaviors and making appropriate apologies to those we have harmed; empathy exercises about offender to include their humanness, foibles, and goodness; turning it over to Higher Power; writing and reciting a prayer for person for their well-being and happiness; expressing feelings and working through interlinked injuries from others; forgiving but not forgetting; self-monitoring for old reactions; helping others who have been hurt; etc.
HOPE
1. Trust and confidence in self, others and/or Higher Power that things will work out for the best and one will succeed. Often based more on faith than certainty (which is unattainable).
2. One Spanish word for hope is “espera” which also means to wait – emphasizing that hope is often a way to relax one’s desperation to achieve something, and be more patient and persistent over the long term.
Approaches: Developing belief in higher force guiding events and working for one’s benefit; conveyed by therapist by conveying empathy, and belief in client’s ability to survive and change; providing accurate information to the client and reframing their problem and/or life (e.g., this is a gift!); modeling of those who have successfully reached goals similar to the one(s) the client desires; eliciting self-motivational statements; emphasizing past incidents and patterns which indicate purpose in how client’s life is unfolding, as well as their own successes in the past.
SERENITY
1. Can be thought of as a peace of mind or inner composure and calm, often in the face of external or difficult circumstances. After considerable study Roberts and Cunningham’s (1990) concept analysis arrived at the definition: a spiritual experience of inner peace, trust, and connectedness that exists independently of external events” (p.582). Kurtz and Ketcham (1992) described the term as being at home meaning “the place where we find peace and harmony that comes from learning to live with the knowledge of our imperfections and from learning to accept the imperfections of others” (p.232).
2. The most tangible expression of the importance of serenity can be found expressed in the Serenity Prayer, which many people recite whenever they are beginning to feel upset: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
Approaches: developing intrapersonal skills fostering inner peace, such as surrender, self-forgiveness, humility, relaxation, acceptance, forgiveness, hope, and the sense of connectedness; addressing expectations and beliefs incongruent with one’s spiritual beliefs; meditation and centering prayer; creating an inner safe space through imagery, music, and building on selected memories; living in the present; etc.
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Spirituality and the Mentally Ill
Due to the complexity and idiosyncrasy of mental illness there are no clear guidelines for working with patients regarding their spirituality. Some practical considerations would include the degree and duration of stabilization, current and former spiritual beliefs, as well as the content of delusions and cognitive distortions and the extent of their current influence. It is tempting to think that the concept of an all-loving, all- encompassing spiritual force may be a desirable antidote to the self-loathing, hopelessness, and isolation suffered by many mentally-ill individuals, while failing to realize that the individual may experience such a prospect as intrusive, overwhelming, and entirely unwelcome. We try to help the patient identify what they may need in the spirituality domain.
Particularly for the chronically mentally ill, it would be more beneficial to arrive at a circumspect understanding of the individual and their needs, followed by an indirect exploration with them regarding their beliefs. Reading material or conversations with fellow-patients may prove more productive then the inquiries of a clinician or chaplain. The following suggestions are offered with some reticence in recognition of how difficult it is to generalize on such matters—on occasion I have successfully done the opposite of what I suggest here. The most important use of spirituality in the early stages of recovery from mental or physical illness is as a positive motivator to get through the daily travails.
SCHIZOPHRENIA
♦ Stay concrete, simple and here-and-now.
♦ Focus on hope in current life and immediate future.
♦ Avoid supernatural or abstract concepts.
♦ Suggest a spiritual force represented by structure of patient’s life (GOD = Good Orderly Direction).
♦ Assist in identifying helpful relationships and plans, e.g., symptom-coping resources.
♦ Avoid philosophical discussions or cryptic, bizarre tangents.
♦ Allow patient to determine how “close” the spiritual relationship can be—typically I encourage keeping the force outside and at some distance from the patient, unless their boundaries are very strong.
BIPOLAR DISORDER
♦ Avoid intellectualizing and lengthy discussions.
♦ Focus on the patient’s immediate needs.
♦ Review personal limitations and interdependency on others and the world.
♦ Challenge thinking errors.
♦ Emphasize hope and trust for future based on progress thus far.
♦ Encourage an I-Thou relationship based on simplicity and humility.
♦ Also, invoke the Good Orderly Direction concept.
DEPRESSION
♦ Critically examine self-denigrating beliefs that use a religious rationale.
♦ Emphasize spiritual force as source of courage and energy for client to actively tackle their illness—rather than an panacea.
♦ Unconditionally accepting and constant spiritual force which holds patient responsible for caring for her/himself.
♦ Encourage regular gratitude and forgiveness review periods.
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♦ Ensure involvement with a community, or at a minimum a single relationship, which supports the patient’s spiritual beliefs.
COUNSELING & SPIRITUALITY: A SELECTED BIBLIOGRAPHY
-- Kevin J. Drab, M.A., M.Ed.
Note: The instructor highly recommends those titles that are bolded and italicized!
For Clinicians
• Brothers, B. J. (Ed.). (1992). Spirituality and couples: Heart and soul in the therapy process. New York: The Haworth Press, Inc. Given that spirit is part of the mind/body/spirit system that constitutes a human being, the editor suggests that there also exists a higher self, or at least the possibility of a higher self, in therapists and patients alike. The authors of this book, representing a wide spectrum of spiritual traditions, explore the nature of the meeting of higher selves in the course of relationship. They present the painful experiences of couples in crisis as opportunities for spiritual transformation.
• Burke, M. T. & Miranti, J. G. (Eds.). (1992). Ethical and spiritual values in counseling. Alexandria, Va.: American Association for Counseling and Development. This volume is a selection of sixteen excellent articles which were published in Counseling and Values. The articles address a number of specific issues and populations including family therapy, individual counseling and psychotherapy, career counseling, and philosophical issues regarding values and ethics. The text would serve as a useful resource for counselors and counselor educators interested in the role that ethics, spirituality, and values play in the counseling process.
• Burke, M. T. & Miranti, J. G. (Eds.). (1995). Counseling: The spiritual dimension. Alexandria, VA.: American Counseling Association. This is a collection of articles designed to encourage mental health professionals to consider the spiritual dimension of the counseling process, reflect on their own spirituality, and facilitate the enhancement of spiritual wellness in their clients. It covers a variety of topics related to spirituality including information on spirituality as an integral component of the counseling process, multicultural awareness, the spiritual journey of gay men and lesbians, and exploring the religious needs of the dying. Burke is a professor and department chairperson of the Department of Human Services at the University of North Carolina, and Miranti is a professor of counselor education and graduate dean at Our Lady of Holy Cross College in New Orleans, Louisiana.
• Burke, M. T., Hackney, H., Hudson, P., Miranti, J., Watts, G. A., & Epp, L. (1999). Spirituality, religion, and CACREP curriculum standards. Journal of Counseling & Development, 77, 251- 257.
• Cardena, E., Lynn, S. J., & Krippner, S. (Eds.). (2000). Varieties of anomalous experience: Examining the scientific evidence. Washington, D. C.: American Psychological Association.
• Carson, V. B. (Ed.). (1989). Spiritual dimensions of nursing practice. Philadelphia, PA: W. B. Saunders.
• Comas-Dia, L., & Griffith, E. E. (1988). Clinical guidelines in cross-cultural mental health. NY: Wiley.
• Doka, K. J. & Morgan, J. D. (Eds.). (1993). Death and spirituality. Amityville, New York: Baywood Publishing Company, Inc. This twenty-seven chapter text is one in a group entitled Death, Value and Meaning Series with series editor John D. Morgan. The authors suggest that counselors should both incorporate spiritual assessment in the counseling process and also educate themselves to the varied religions of their clients. Various chapters of the book in part attempt to facilitate this process, outlining perspectives of major American religious traditions, as well as reminding that history, custom, and religion serve to shape spirituality, which is still always an individual perspective.
• Elkins, D. N., Hedstrom, L. J., Hughes, L. L., Leaf, J. A., & Saunders, C. (1988). Toward a humanistic- phenomenological spirituality. Journal of Humanistic Psychology, 28, 5-18.
• Evans, K., & Sullivan, M., (1990). Step study counseling with the dual disordered client. Center City, MN: Hazelden.
• Fowler, J. W. (1982). Stages of faith: The psychology of human development and the quest for meaning. San Francisco, CA: Harper & Row.
• Frankl, V. E. (1984). Man's search for meaning: An introduction to logotherapy (3rd edition). NY: Simon & Schuster.
• Fukuyama, M. A. & Sevig, T. D. (1999). Integrating spirituality into multicultural counseling. Thousand Oaks, CA: Sage.
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• Hays, P. A. (2001). Addressing cultural complexities in practice: A framework for clinicians and counselors. Washington, D. C.: American Psychological Association.
• Hinterkopf, E. (1998). Integrating spirituality into counseling: A manual for using the experiential focusing method. Alexandria, Va.: American Counseling Association. This book describes a model called Experiential Focusing Method, used to help clients work through religious and spiritual problems, deepen spiritual experiences, and bring about new connections to spirituality. Through focusing, the client learns to examine subtle but concrete bodily feelings that are part of spiritual discovery and growth. This method can be utilized in conjunction with any psychotherapeutic model. The author is a licensed professional counselor in private practice in Austin, Texas, and has taught Focusing in a variety of global settings over the past 25 years.
• Hood, R. W., Spilka, B., Hunsberger, B., & Gorsuch, R. (1996). The psychology of religion: An empirical approach (2nd ed.). NY: Guilford Press.
• Kelly, E. W., Jr. (1995). Spirituality and religion in counseling and psychotherapy: Diversity in theory and practice. Alexandria, VA.: American Counseling Association. This text provides systematic approaches for evaluating the appropriateness of including spiritual and religious discussions in counseling sessions. The author provides an overview of the world’s major religions, discusses leading psychological theories concerning spirituality and religion, and defines the role and influence of spirituality and religion in human development. A variety of treatment techniques and assessment methods are presented which are respectful of diverse religious and spiritual traditions. Also included in this book is information for working with ethically diverse clients, older clients, and dying or grieving clients. The author is a professor of counseling at The George Washington University, a licensed professional counselor and a psychologist in Virginia.
• Kus, R. J. (Ed.). (1995). Spirituality and chemical dependency. Binghamton, NY: Haworth Press, Inc. This book is excellent reading for all who provide services to people in recovery from any addictive condition. It contains thoughtful essays that reinforce the crucial links between spirituality and recovery, and that open to the reader new and different ways to experience God or a Higher Power. The author, RN, PhD, is a nurse-sociologist, specializing in gay men’s studies and alcohol studies, and has been conducting cross-cultural gay men’s studies in Europe, where he has presented over 25 workshops and papers. Dr. Kus is also the editor of Keys to caring: Assisting your gay and lesbian clients (Alyson, 1990), Gay men of alcoholics anonymous: First-hand accounts (WinterStar Press, 1990), and Addiction and recovery in gay and lesbian persons (Haworth, 1995). He is now studying to become a Roman Catholic priest for the diocese of Raleigh, North Carolina.
• Larson, D. P., Swyers, J. P., & McCullough, M. E. (1998). Scientific research on spirituality and health: A consensus report. Rockville, MD: National Institute for Healthcare Research.
• Miller, W. R. (Ed.). (1999). Integrating spirituality into treatment: Resources for practitioners. Washington, D. C.: American Psychological Association. This edited volume provides clinicians with practical advice on including clients’ spiritual perspectives in the therapeutic relationship. It addresses broad, transtheoretical aspects of spirituality, including acceptance, forgiveness, hope, prayer, and meditation. It also introduces reliable and valid measures that can be used for assessing spirituality and provides examples of spiritually based interventions and collaborations that can enhance successful treatment.
• Page, R. C., & Berkow, D. N. (1998). Group work as facilitation of spiritual development for dug and alcohol abusers. Journal for Specialists in Group Work, 23(3), 285-297.
• Pardini, D. A., Plante, T. G., Sherman, A., & Stump, J. E. (2000). Religious faith and spirituality in substance abuse recovery: Determining the mental health benefits. Journal of Substance Abuse Treatment, 19, 347-354.
• Propst, L. R. (1988). Psychotherapy in a religious framework: Spirituality in the emotional healing process. New York: Human Sciences Press, Inc. This volume provides a counseling guide for clergy, pastoral counselors and psychotherapists, and promotes the serious inclusion of clients’ spirituality in the core and fiber of the therapeutic process. A step-by-step sequencing of counseling is presented, utilizing psychotherapy techniques (particularly cognitive-behavioral approach) that research literature suggests are effective treatments. The author emphasizes Christian theology and psychology, making this a possible choice for seminary courses in pastoral counseling.
• Puchalski, C.M., Romer, A.L. (2000). Taking a Spiritual History Allows Clinicians to Understand Patients More Fully. Journal of Palliative Medicine 3(1): 129-137.
• Rainer, T. (1987). The new diary: How to use a journal for self-guidance and expanded creativity. Los Angeles: Jeremy P. Tarcher, Inc. This is a creative and comprehensive work that offers numerous possibilities for using a diary to achieve one’s own purposes. Well acquainted with the large and growing literature on journaling, Rainer includes an index and 10 pages of bibliography of interest, which may serve both counselor and client as they write for self-reflection and inner growth.
• Richards, P. S. & Bergin, A. E. (1997). A spiritual strategy: For counseling and psychotherapy. Washington, D. C.: American Psychological Association. The authors declare that the book celebrates and symbolizes that the human spirit, under God, is vital to understanding personality and therapeutic change. They suggest that
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spirituality is the most fundamental aspect of human nature, and with its inclusion, the ability to advance psychological science, professional practice and human welfare can truly soar. While their personal experience is theistic, they are committed to an ecumenical arena of respect and appreciation for the varied world cultures of belief, including Oriental, African, and Native American traditions, spiritual humanism, and individualized religiosity.
• Richards, P. S. & Bergin, A. E. (2000). Handbook of psychotherapy and religious diversity. Washington, DC: American Psychological Association.
• Richards, P. S. & Bergin, A. E. (Eds.). (2000). Handbook of Psychotherapy and Religious Diversity. Washington, D.C.: American Psychological Association. This book represents the new consciousness among therapists, that spirituality, faith, religion, morals, and ethics are an integral part of every culture, and that therapeutic counseling is almost always cross cultural. This is an essential handbook for all mental health professionals without a theological education, and those who have theological background will also find it informative. It provides a thorough overview of tenets of the major religious traditions as well as sound treatment guidelines for integrating the religious dimension of clients’ lives into the therapeutic process.
• Richards, P. S., Rector, J. M., & Tjeltveit, A. C. (1999). Values, spirituality, and psychotherapy. In W. Miller (ed.), Integrating spirituality into treatment: Resources for practitioners. pp. 133-160. Washington, D.C.: American Psychological Association.
• Robert, K, & Cunningham, G. (1990). Serenity: Concept analysis and measurement. Educational Gerontology, 16, 577-589.
• Santa-Maria, M. L. (1983). Growth through meditation and journal writing: A Jungian perspective on Christian spirituality. New York: Paulist Press. The author, a psychotherapist in private practice in St. Petersburg, Florida, holds to the Jungian thesis that many psychological problems of adulthood are symptomatic of a deeper spiritual concern, such as search for life meaning and purpose, and ultimately, a search for God. Our Western society, with its focus upon technology and its excessive use of reason, has brought about an impoverishment of the spiritual life of individuals. This work presents seven dimensions of mature Christian spirituality complete with scriptural references, exercises in guided meditation and journal writing, and brief bibliographic notes for further reading.
• Scotton, B.W., Chinen, A. B., & Battista, J. R. (1996). Textbook of transpersonal psychiatry and psychology. New York: Basic Books.
• Shafranske, E. P. (1996). Religion and the clinical practice of psychology. Washington, DC: American Psychological Association.
• Shafranske, E. P., & Gorsuch, R. L. (1984). Factors associated with the perception of spirituality in psychotherapy. Journal of Transpersonal Psychology, 16, 231-241.
• Simon, D. (1996). Crafting consciousness through form: Solution-focused therapy as a spiritual path. In S. D. Miller, M. A. Hubble, & B. L. Duncan (Eds.), Handbook of solution-focused brief therapy. San Francisco, CA: Jossey-Bass.
• Spector, R. E. Cultural diversity in health and illness (5th edition). Upper Saddle River, NJ: Prentice Hall Health.
• Stanard, R. P., Sandhu, D. S., & Painter, L. C. (2000). Assessment of spirituality in counseling. Journal of Counseling and Development, 78, 204-210.
• Sternberg, R. J. (ed). (1993). Wisdom: Its nature, origins, and development. Cambridge, England: Cambridge University Press.
• Taylor, S. E. (1986). Positive illusions. NY: Basic Books.
General
• Alcoholics Anonymous World Services (1953). Twelve steps and twelve traditions. NY: Author.
• Alcoholics Anonymous World Services (1976). Alcoholics Anonymous (3rd ed.). NY: Author. (originally published in 1939).
• Alcoholics Anonymous World Services. (1983). Came to believe. New York.
• Bernan, P. L. (1990). The search for meaning: Americans talk about what they believe and why. NY: Ballantine Books.
• Boring, C. E. (2000). The spirituality of man. Sarasota, FL: Van Gogh Publications.
• Brown, J. E. (Recorded & Edited). (1953). The sacred pipe: Black elk’s account of the seven rites of the Oglalia Sioux. Norman, OK: University of Oklahoma Press.
• Claxton, G. (1992). The heart of Buddhism. Hammersmith, London; The Aquarian Press.
• Cleary, T. (1993). The essential Koran: The heart of Islam. Edison, NJ: Castle Books.
• Cleveland, M. (1992). The alternative 12 steps: A secular guide to recovery. Deerfield Beach, FL: Health
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Communications.
• DelBene, R. (1981). The breath of life: A simple way to pray. Minneapolis: Winston Press. This may be of assistance to counselors or clients seeking ways to incorporate spirituality in daily life. The author, an Episcopal priest who gives much attention to spiritual direction and teaching others the breath prayer, shares here his counsel for how “to have on the lips what is always in the heart.” The breath prayer is a short, ancient prayer of praise and petition that usually arises out of our present concern. When practiced with discipline, it can bring one closer to an awareness of living in the presence of God.
• Fields, R., Taylor, P., Weyler, R., & Ingrasci, R. (1984). Chop wood, carry water: A guide to finding spiritual fulfillment in everyday life. NY: Tarcher.
• Foster, S. 1992). The book of the vision quest: Personal transformation in the wilderness. NY: Simon & Schuster.
• Fulgham, R. (1995). From beginning to end: The rituals in our lives. New York: Villard.
• Garvey, J. (Ed.). Modern spirituality: An anthology. Springfield, Ill.: Templegate Publishers. The great spiritual traditions would all agree that many of the problems that the modern industrial nations tend to categorize as political and economic have roots in the heart – a truth that can be seen clearly with attention and discipline. That discipline is what spirituality is all about, declares the author, who was inspired to collect this sampling of some of the best modern spiritual writers. Of the fifteen writers, most are Catholic, Orthodox, or Anglican, and one is Buddhist. This resource puts both counselor and client in touch with a selection of some great spiritual writings of this era.
• Gonzalez-Wippler, M. (1994). Santeria: The religion. St. Paul, MN: Llewellyn Publications.
• Groeschel, B. J. (1983). Spiritual passages: The psychology of spiritual development. New York: Crossroad. To strive for originality in the field of spiritual development strikes Father Groeschel as impertinent. Instead, he seeks to fashion “a useful synthesis” between the doctrines of Christian spiritual tradition and “the more tested and realistic insights of that potpourri called modern psychology.” Part II of this informational book provides a psychological understanding of the three ways.: “The Purgation,” “The Illuminative Way,” and “The Unitive Way”.
• Hamilton, T., & Samples, P. (1994). The twelve steps and dual disorders. Center City, MN: Hazelden. There is also a workbook of the same name for clients.
• Hart, K. E. (1999). A spiritual interpretation of the 12-steps of AA: From resentment to forgiveness to love. The Addictions Newsletter, 6, 1, pp. 15, and 42-43.
• Hassan, S. (1990). Combating cult control. Rochester, VT: Park Street Press.
• Hazelden. (1997). Practice these principles and what is the Oxford Group? Center City, MN: Hazelden-Pittman Archives Press.
• Huxley, A. (1970). The perennial philosophy. NY: Harper & Row.
• Hyde, L. (1992). My spiritual progress guide. Center City, MN: Hazelden. This is an excellent little workbook which assists individuals to develop their spirituality within the context of the Twelve Steps of Alcoholics Anonymous, but could be useful to anyone looking for a gentle way to structure their own personal spirituality.
• James, W. (1929). The varieties of religious experience. NY: Modern Library.
• Janis, S. (2000). Spirituality for dummies. Foster City, CA: IDG Books Worldwide.
• Kaplan, A. (1985). Jewish meditation: A practical guide. NY: Schocken Books.
• Klug, R. How to keep a spiritual journal. Nashville: Thomas Nelson. The author, a teacher, editor, and missionary, has kept a journal for more than 25 years, describing it as “a tool for self-discovery, an aid to concentration, a mirror for the soul, a place to generate and capture ideas, a safety valve for the emotions, a training ground for the writer, and a good friend and confidant.” It contains a helpful bibliography on journaling as a spiritual discipline.
• Kurtz, E. (1979). Not-god: A history of Alcoholics Anonymous. Center City, MN: Hazelden.
• Kurtz, E., & Ketcham, K. (1992). The spirituality of imperfection: Storytelling and the journey to wholeness. NY: Bantam Books.
• Kushner, H. (1981). When bad things happen to good people. NY: Schocken Books.
• LaVey, Anton S. (1969). The satanic bible. NY: Avon Books.
• Mel B. (1991). The new wine: The spiritual roots of the twelve step miracle. Center City, MN: Hazelden.
• Miles, J. (1996). God: A biography. NY: Vintage Books.
• Moore, T. (1992). Care of the soul. NY: Harper Collins.
• Nisker, W. S. (1990). Crazy Wisdom. Berkeley, CA: Ten Speed Press.
• Panati, C. (1996). The sacred origins of profound things: The stories behind the rites and rituals of the world’s religions. NY: Penguin Books.
• Peck, M. S. (1978). The road less traveled. NY: Simon & Schuster.
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• Peck, M.S. (1987). The different drum. NY: Simon & Schuster.
• Pittman, B., & B., D. (1994). Courage to change: The Christian roots of the twelve-step movement. Center City:MN: Hazelden-Pittman Archives Press.
• Progroff, I. (translator). (1957). The cloud of unknowing.
• Progoff, I. (1977). At a journal workshop: The basic text and guide for using the intensive journal. New York: Dialogue House Library. Along with Carl Jung, Marion Milner, and Anais Nin, Ira Progoff is one of four 20th- century pioneers of psychology and literature who played a major role in conceptualizing the principles of modern journal writing. His system, called the Intensive Journal, is somewhat complex and is best learned by attending one of his journal workshops, after which this text has demonstrable usefulness. More than anyone else, Progoff has brought journal writing as a form of growth work to public attention.
• Rolheiser, Ronald (1999). The holy longing: The search for a Christian spirituality. NY: Doubleday.
• Smith, H. (1994). The illustrated world’s religions: A guide to our wisdom traditions. Newy York: Harper Collins.
• Spirituality and Health magazine. A sort of Psychology Today for spirituality. This is a nice mix of inspirational and research info. For more info visit: http://www.spiritualityhealth.com
• Storr, A. (1996). Feet of clay: Saints, sinners and madmen: A study of gurus. NY: Free Press.
• Wuthnow, R. (1994). Sharing the journey: Support groups and America's new quest for community. NY: The Free Press.
• Yoder, B. (1990). The recovery resource book. NY: Simon & Schuster.
Some Internet Resources on Spirituality
These days, the best way to access a broad range of resources quickly and easily is through the Internet. The following are just several of hundreds of worthwhile sites dealing with spirituality and religion.
• About.com Guide to Alternative Religions http://altreligion.about.com/culture/religion/altreligion/mbody.htm
• BeliefNet Guide to Online Sacred Texts http://www.beliefnet.com/help/link_directory.asp In addition to links to texts from a wide variety of faiths including Hinduism, Buddhism, Islam, Christian Science, Christianity, Judaism, Baha’i, Confucianism, Taoism, and Earth-Based. This site also includes articles, columns, and news on religion and spirituality.
• First Nations Spirituality is a "directory of Internet resources relating to the aboriginal spiritual traditions of North America." http://www.aetheric.com/firstnations/
• Harvard Pluralism Project Guide to Religions http://www.fas.harvard.edu/~pluralsm/html/links.html
• Islamic Studies page, created by Professor Alan Godlas in the Department of Religion at the University of Georgia, covers Islam and Islamic studies. http://www.arches.uga.edu/~godlas
• John Templeton Foundation http://www.templeton.org/
• Nielsen's Psychology of Religion Pages http://www.psychwww.com/psyrelig/psyrelig.htm This is currently the most comprehensive web site on the psychology of religion. It includes: methods of research, notable people, graduate study programs, publication resources, links to related sites, and the full text of William James's Varieties of Religious Experience.
• Rowan Fairgrove's Multifaith and Religion Sites http://www.conjure.com/religion.html A comprehensive guide to religious resources, especially related to multifaith issues.
• Sacred Transformations: Spiritual Crisis http://www.mindspring.com/~bobby2/sacred/SC/SC.html
• Science and Spirit http://www.science-spirit.org/
• Silver Threads offers an extensive annotated list of links to other Pagan, Wiccan and related websites. http://members.aol.com/JehanaS/w_sites.html
• Spirituality and Health (magazine and extensive web site) http://www.spiritualityhealth.com/
• Spirit Web http://www.spiritweb.org/ -- this is one of the best sites for connecting with a wide range of sites all over the world which have something to do with spirituality: from astrology to mysticism. This web site set out to promote spiritual awakening with a special focus on: meditation, yoga, theosophy, the western esoteric tradition, astrology, channelings, out of body experiences, light technology and other healing methods.
• The American Religious Experience Project, West Virginia University http://are.as.wvu.edu/
• The Witches' Voice is a news and education network with articles on current issues and events, files on the basics of witchcraft and on holidays, and many links to other Pagan sites. http://www.witchvox.com/wvoxhome.html
• Transpersonal Internet Guide to Mega-sites on Religion and Spirituality http://www.internetguides.com/tpi.html#spiritpt
• Vodoun (or Voodoo) Information Pages provide an introduction to Vodoun, descriptions and photographs of basic rituals, as well as a detailed bibliography. http://www.arcana.com/voodoo/