The Importance of Spirituality in Therapy
Studies have been reported that 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 bio-psychosocial assessment and delivery of treatment to them is considered 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. Due to these factors, Spirituality plays an integral role in the lives of many, but not all, people. Having an understanding of the role of spirituality in one’s life can help the clinician help the client.
Competency, Spirituality and Counseling
According to Geri Miller, an associate professor in the Department of Human Development and Psychological Counseling at Appalachian State University, Boone, North Carolina, in order to be considered competent to help clients address the spiritual dimension of their lives, a counselor should be able to do the following:
- Explain the relationship between religion and spirituality, including similarities and differences
- Describe religious and spiritual beliefs and practices in a cultural context
- Engage in self-exploration of his/her religious and spiritual beliefs in order to increase sensitivity, understanding and acceptance of his/her belief system
- Describe one’s religious and/or spiritual belief system and explain various models of religious/spiritual development across the lifespan
- Demonstrate sensitivity to and acceptance of a variety of religions and/or spiritual expressions in the client’s communication
- Identify the limits of one’s understanding of a client’s spiritual expression, and demonstrate appropriate referral skills and general possible referral sources
- Assess the relevance of the spiritual domains in the client’s therapeutic issues
- Be sensitive to and respectful of the spiritual themes in the counseling process as befits each client’s expressed preference, and
- Use a client’s spiritual beliefs in the pursuit of the client’s therapeutic goals as befits the client’s expressed preference.
What’s Included In A Spiritual Assessment?
When helping their patients, clinicians should consistently use a standardized assessment designed for this purpose. Included in a spiritual assessment, at a minimum, should be a determination of the patient’s denomination, beliefs, and what spiritual practices are important to them. This information will assist the counselor in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment that might be needed. Other possible questions that might be included in the assessment are as follows:
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
15) How do you think about life? I mean, do you think there’s a God; what’s the meaning
16) Why are you here?
17) What does this belief/idea/faith do for you? What role does it play in your life?
18) Is there anything you’d like to change or improve about it/you?
19) What do you want more of in your life?
20) What do you want more of in your spiritual life?
21) How would you feel if you got what you wanted spiritually?
22) What kind of person would you be if you had it?
23) What is keeping you from it?
24) Do you have the courage to ask your Higher Power to make you that kind of person?
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.
Here are some important reasons why a religious/spiritual assessment is necessary:
- 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 to other available data. (Miller, 1999).
- 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.
- 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 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).
- 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.
- 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.
To make a referral for Psychiatry or counseling please contact Daniela White, M.D. Psychiatrist in Houston at 713-426-3100.
Spirituality in Counseling –Drab, Kevin J. and Hays, P. A. (2001).
Miller, G. (1999). The Development of the Spiritual Focus in Counseling and Counselor Education. Journal of Counseling and Development, 77(4). Fall. p. 500. 2