UNC-CH School of Social Work Clinical Lecture Series 1...Mormon Muslim Orthodox Christian Unaffiated Importance of religion in one’s life by religious group % of adults who say religion

Spirituality and practice with Andrea Murray-Lichtman, LCSW 3/18/2019

UNC-CH School of Social Work Clinical Lecture Series 1

Integrating Spiritual Sensitivity into Therapeutic Practice

Andrea Murray-Lichtman, LCSW

UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORKMATTHEW O. HOWARD MEMORIAL LECTURE

Agenda

Defining Spirituality Defining Religion

Spirituality and your client’s wellness journey

Preparation to integrate spirituality in treatment

Integration of spirituality into treatment

Anchoring our Time Integrating Spirituality into Therapeutic Practice

Honoring our story to honor the story in others

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How do you define

Religion?

What is Spirituality?

Spirituality refers to any way of relating to that which is sacred or transcendental.

Religion refers to institutionalized or culturally bound ways of relating to that which is perceived to be sacred.

Ask an Atheist - https://the1a.org/shows/2019-01-21/atheism

https://the1a.org/shows/2019-01-21/atheism



FICA for Self-Assessment

F - Faith and Belief• Do I have a spiritual belief /practice that helps me cope with stress, with illness?

What gives life meaning? Earliest memory /experience of spiritual beliefs or practice?

I - Importance• Is my belief / practice important to me? Does it influence how I think about my

life, health and illness? Does it influence my life, self-care, healthcare decisions?C - Community• Do I belong to a spiritual community (church, temple, mosque, etc.)? Am I happy

there? Do I need to do more with the community? Do I need to search for another community? If I don't have community, would it help me if I found one?

A - Address in Care• What should be my action plan? What changes do I need to make? Are there

spiritual practices I want to develop? Would it help for me to see a chaplain, spiritual director, or pastoral counselor?

Adapted from Puchalski, C. (1996)

adapted tool can help you think about your spiritual history:

Four components of Spirituality

• Life Meaning and Purpose

• Transcendence

•Connection

•Divine (Higher Power or Unifying Force)

Christian70%

Non-Christian Faiths

6%

Other World Religions

0%

Other …

Unnafiliated (religious "nones")

23%

RELIGION IN US PEW RESEARCH CENTER (2018)

Non-Christian FaithsJewish 1.9Muslim 0.9Buddhist 0.7Hindu 0.7

Unaffiliated (religious “nones”)Atheist 3.1Agnostic 4.0Nothing in Particular 15.8Don't know 0.6

ChristianEvangelical Protestant 25.4Mainline Protestant 14.7Hist. Black Protestant 6.5Catholic 20.8Mormon 1.6Orthodox Christian 0.5Jehovah’s Witness 0.8Other Christian 0.4

http://www.pewforum.org/religious-landscape-study



BuddhistCatholic

Evangelical ProtestantHindu

Hist. Black ProtestantJehovah’s Witness

JewishMainline Protestant

MormonMuslim

Orthodox ChristianUnaffiated

Importance of religion in one’s life by religious group% of adults who say religion is . . .

Prevalence of self-identified Spirituality in

US

Pew (2017)

Integrating Spiritual Sensitivityas part of Ethical Therapeutic

Practice

• Council on Social Work Education (CSWE)

• Pew Research on Religion



Council on Social Work Education (CSWE) Religion and Spirituality Work Group formed in 2011

Organized to promote social workers' knowledge, values, and skills for ethical and effective practice that takesinto account the diverse expressions of religion and spirituality among clients and their communities

Ethical Practice standards for professional practice in many fields of social work practice, including health, mental health recovery, hospice and palliative care, and problematic substance use

Social workers to recognize and support each person’s spiritual identity, understand role of religion and spirituality in client’s life, and refrain from discrimination and institutional oppression based on religious or nonreligious beliefs

2008 Educational Policy and Accreditation Standards (EPAS)

National Association of Social Workers' Code of Ethics and Standards for Cultural Competence

International Federation of Social Workers/International Association of Schools of Social Work's Statement of Principles

Research indicates that not all social workers include Spirituality/Religion in therapeutic practice with clients

Oxhandler, Parish, Torres & Achenbaum (2015); Limb, G., Hodge, D., Ward, P., Alboroto, R., & Larkin, Z. (2018)

SpiritualMicroaggressions

• Pathologizing spirituality

• Disparaging spirituality

• Assuming Homogeneity

• Denying spiritual prejudice

Hodge (2019)



Benefit of Spirituality in Therapeutic Process

• Holistic view of client and clinically relevant information

• Strategies for symptom reduction

INFORMS

• Stigmatization of client’s spiritual beliefs and values

• Therapist as the expert

CHALLENGES

• Utilization of client’s strengths in recovery

• Client’s motivation and the therapeutic alliance

DEEPENS

Hodge (2018)

Clarify role of spirituality at the outset

Differences between patient and social worker’s spiritual beliefs common

Respect for clients spiritual beliefs

Social worker makes reasonable effort to become familiar with client’s spiritual beliefs

SENSITIVITY TO SPIRITUAL INTEGRATION

Rosmarin (2018)

Client as our Guide

Feelings

Behaviors

Experiences

https://www.youtube.com/watch?v=Y7B1lL1ouFw



Collaborationto explore role of Spirituality

Four Types of Religious and Spiritual Struggles

• Struggles with the Divine

• Intrapersonal struggles

• Interpersonal struggles

• Struggles related to supernatural evil

Hood, Hill, & Spilka (2018)

Spiritual Assessment Tools

Qualitative Assessments • Spiritual Histories

• Verbal Tools, i.e., FICA, HOPE,

Diagrammatic Assessments • Spiritual Ecomap

• Spiritual Genogram

• Spiritual Ecogram

• Spiritual Lifemap



Diagrammatic Spiritual Assessment Tools

Spiritual Lifemap Spiritual Ecomap Spiritual Ecogram Spiritual Genogram

Case Vignette

Therapeutic Modalities: Acceptance and Commitment Therapy

&Cognitive Behavioral Therapy

Strategies for integrating spiritual sensitivity into therapeutic process

DO

Do your self-work (cultural humility and self-awareness)

Initiate

• Frame engagement with treatment in terms of spiritual values/beliefs• What does client’s spiritual beliefs say in terms of self-care/healthcare

FRAME

• Frame engagement with treatment in terms of spiritual values/beliefs• What does client’s spiritual beliefs say in terms of self-care/healthcare

Utilize

• Utilize spiritual teachings/values to explore patient thinking/behaviors• How might teachings/practices enhance treatment adherence

ENCOURAGE

• Encourage use of spiritual beliefs/values as a frame for emotions/actions• How might spiritual beliefs/values provide coping strategies and improved outlook



“There is a quiet courage that comes from an inward spring of confidence in the meaning and significance of life. Such courage is an underground river, flowing far beneath the shifting events of one's experience, keeping alive a thousand little springs of action.”

~ Howard Thurman

FICA – Spiritual Assessment ToolF - Faith and Belief

"Do you consider yourself spiritual or religious?" or "Is spirituality something important to you” or “Do you have spiritual beliefs that help you cope with stress/ difficult times?" (Contextualize to reason for visit if it is not the routine history.)

If the patient responds "No," the health care provider might ask, "What gives your life meaning?" Sometimes patients respond with answers such as family, career, or nature.

(The question of meaning should also be asked even if people answer yes to spirituality.)

I - Importance

"What importance does your spirituality have in our life? Has your spirituality influenced how you take care of yourself, your health? Does your spirituality influence you in your healthcare decision making? (e.g., advance directives, treatment)

Puchalski, C. (1996)

FICA – Spiritual Assessment Tool

C - Community

"Are you part of a spiritual community? Communities such as churches, temples, and mosques, or a group of like-minded friends, family, or yoga, can serve as strong support systems for some patients. Can explore further: Is this of support to you and how? Is there a group of people you really love or who are important to you?"

A - Address in Care

"How would you like me, your healthcare provider, to address these issues in your healthcare?" (With the newer models including diagnosis of spiritual distress, A also refers to the Assessment and Plan of patient spiritual distress or issues within a treatment or care plan.)

Puchalski, C. (1996)



References

Bowles, D., Clayton, O., & Hopps, J. G. (2017). Spirituality and social work practice at historically black colleges and universities. Journal of Human Behavior in the Social Environment, 27(5), 424. doi:10.1080/10911359.2016.1203384

Center for Spirituality, Theology and Health, Duke University, Religious CBT Training Video -https://spiritualityandhealth.duke.edu/index.php/religious-cbt-study/training-video

CSWE (n.d.). Religion and Spirituality Clearinghouse. Retrieved from https://www.cswe.org/Centers-Initiatives/Curriculum-Resources/Religion-and-Spirituality-Clearinghouse.aspx

Fitchett, G. & Risk J. (2009). Screening for Spiritual Struggle. Journal of Pastoral Care & Counseling. 63(1-2): 1-12. http:// bishopandersonhouse.org/wp-content/uploads/2015/06/Spiritual-Screening.pdf.

Hodge, D. (2019): Spiritual microaggressions: Understanding the subtle messages that foster religious discrimination. Journal of Ethnic & Cultural Diversity in Social Work. doi:10.1080/15313204.2018.1555501

Hood, R., Hill, P., & Spilka, B. (2018). The psychology of Religion an empirical approach (5th ed.). New York, NY: The Guilford Press.

Hughes, B., Carbonell, E., Wintz, S., Hodge, D. (2018). Spiritual Care and Social Work: Integration into Practice.Retrieved from www.healthcarechaplaincy.org

Grossoehme, D., Ragsdale, J., Cotton, S., Meyers, M., Clancy, J., Seid, M. & Joseph, P. (2012). Using Spirituality After an Adult CF Diagnosis: Cognitive Reframing and Adherence Motivation. Journal of Health Care Chaplaincy. 18: 110-120. DOI: 10.1080/08854726.2012.720544

https://spiritualityandhealth.duke.edu/index.php/religious-cbt-study/training-videohttps://www.cswe.org/Centers-Initiatives/Curriculum-Resources/Religion-and-Spirituality-Clearinghouse.aspx



References (cont.)

Limb, G., Hodge, D., Ward, P., Alboroto, R., & Larkin, Z. (2018). Examination of a complementary set of spiritual assessment tools for LDS clients, Mental Health, Religion & Culture, DOI: 10.1080/13674676.2018.1512089

Loue, S. (2017). Social Work Values, Ethics, and Spirituality. In Handbook of Religion and Spirituality in Social Work Practice and Research. (12th ed.). Springer Publishing http://www.springer.com/978-1-4939-7038-4

National Comprehensive Cancer Network. NCCN Guidelines® & Clinical Resources. NCCN Distress Thermometer and Problem List. Version 2.2016. 2016. https://www.nccn.org/about/permissions/thermometer.aspx.

Pew Research Center (2019, January, 31). Religion’s Relationship to Happiness, Civic Engagement and Health Around the World. Retrieved from http://www.pewforum.org/2019/01/31/religions-relationship-to-happiness-civic-engagement-and-health-around-the-world/Pew Research Center (n.d.) Religious landscape study. http://www.pewforum.org/religious-landscape-study

Plante, T. G. (2007). Integrating spirituality and psychotherapy: Ethical issues and principles to consider. Journal of Clinical Psychology, 63(9), 891-902. doi:10.1002/jclp.20383

Post, B. C., & Wade, N. G. (2009). Religion and spirituality in psychotherapy: A practice-friendly review of research. Journal of Clinical Psychology, 65(2), 131-146. doi:10.1002/jclp.20563

Pulchaski, (1996). FICA Spiritual Assessment Tool. Retrieved from https://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool

Oxhandler, H. K. (2017). Social work field instructors’ integration of religion and spirituality in clinical practice. Journal of Social Work Education, 53(3): 449-17. doi:10.1080/10437797.2016.1269706

References (cont.)

Oxhandler, H. K., Parrish, D. E., Torres, L. R., & Achenbaum, W. A. (2015). The integration of clients’ religion and spirituality in social work practice: A national survey. Social Work, 60(3), 228-237. doi:10.1093/sw/swv018

Rosmarin, D. H. (2018). Spirituality, Religion, and Cognitive-Behavioral Therapy: A Guide for Clinicians. Guilford Press. New York: NY.

Saguil, A. & Phelps, K. (2012, September 15). The Spiritual Assessment. American Family Physician 86 (6). Retrieved from https://www.aafp.org/afp/2012/0915/p546.pdf

Santiago, P., & Gall, T. (2016). Acceptance and commitment therapy as a spiritually integrated psychotherapy. Counseling and Values. 61(2): 239-254. doi:10.1002/cvj.12040

Sheridan, M. (2009). Ethical issues in the use of spiritually based interventions in social work practice: What are we doing and why. Journal of Religion and Spirituality in Social Work. 28(1-2): 99-126. doi:10.1080/15426430802643687

Shimron, Y. (2018, April) Most Americans believe in a higher power, but not always in the God of the Bible. Retrieved from https://www.washingtonpost.com/news/acts-of-faith/wp/2018/04/25/most-americans-believe-in-a-higher-power-but-not-always-in-the-god-of-the-bible/?utm_term=.ecc686f4ff3f

Stewart, C. (2013). Resolving social work value conflict: Social justice as the primary organizing value for social work. Journal of Religion and Spirituality in Social Work, 32(2): 160-176. doi:10.1080/15426432.2013.779184

Valutis, S., Rubin, D., & Bell, M. (2014). Value conflicts and value priorities: It’s not just about religion. Journal of Religion and Spirituality in Social Work, 33(2), 163-177. doi:10.1080/15426432.2014.900375
http://www.springer.com/978-1-4939-7038-4https://www.nccn.org/about/permissions/thermometer.aspxhttp://www.pewforum.org/2019/01/31/religions-relationship-to-happiness-civic-engagement-and-health-around-the-world/http://www.pewforum.org/religious-landscape-studyhttps://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-toolhttps://www.aafp.org/afp/2012/0915/p546.pdfhttps://www.washingtonpost.com/news/acts-of-faith/wp/2018/04/25/most-americans-believe-in-a-higher-power-but-not-always-in-the-god-of-the-bible/?utm_term=.ecc686f4ff3f

Documents

UNC-CH School of Social Work Clinical Lecture Series 1...Mormon Muslim Orthodox Christian Unaffiated Importance of religion in one’s life by religious group % of adults who say religion