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Integrating Spirituality into Counselling and Psychotherapy: Theoretical and Cl

Integrating Spirituality into Counselling and Psychotherapy: Theoretical and Clinical Perspectives Intégration de la spiritualité dans les perspectives théoriques et cliniques du counseling et de la psychothérapie Carla Daniels Marilyn Fitzpatrick McGill University abstract In recent decades, spirituality has become a prominent focus of psychological inquiry. As research begins to elucidate the role of spiritual beliefs and behaviours in mental health and the influences of spirituality in psychotherapy, developing therapist competency in this domain has increased in importance. This article will first situate spirituality as an interdependent facet of culture and then expand the tripartite model of multicultural competency—attitudes, knowledge, and skills—to consider the theoretical, empirical, and practical foundation that supports existing spiritual competencies and work with clients’ spirituality. The applicability of spirituality within mainstream theories is reviewed and highlighted with a clinical case. résumé Au cours des récentes décennies, la spiritualité est devenue un important sujet d’étude en psychologie. Tandis que la recherche commence à élucider le rôle des croyances et comportements spirituels en santé mentale et les influences de la spiritualité en psycho thérapie, on assiste à un accroissement du développement des compétences du thérapeute en ce domaine. Dans cet article, on situe d’abord la spiritualité comme étant une facette interdépendante de la culture, puis on étend le modèle tripartite de compétence multi culturelle—attitudes, connaissances, et habiletés—dans le but d’examiner le fondement théorique, empirique, et pratique qui soutient les compétences spirituelles existantes et pour permettre de travailler avec la spiritualité du client. On passe aussi en revue les possibilités d’application de la spiritualité aux grandes théories courantes, et l’on illustre le tout au moyen d’un cas clinique. Exploring cultural diversity is both a resource and a challenge in clinical prac tice (Fukuyama & Sevig, 1999); while it has rich therapeutic potential, it requires focused personal and professional development by clinicians. Cultural diversity includes the individual’s complete social identity comprising age, sexual orienta tion, disability, socioeconomic status, race/ethnicity, and religious and spiritual orientation (Loden, 1996). Although the cultural considerations for therapy have traditionally been discussed in terms of race, ethnicity, or gender (Fukuyama & Sevig, 1999), mental health professionals are increasingly being called to work holistically with all of the elements of a client’s cultural identity (American Psy Canadian Journal of Counselling and Psychotherapy / 315 Revue canadienne de counseling et de psychothérapie ISSN 0826-3893 Vol. 47 No. 3 © 2013 Pages 315–341 316 Carla Daniels & Marilyn Fitzpatrick chological Association [APA], 2003). This movement has been underlined by the APA definition of evidence-based practice in psychology that includes culture (APA Presidential Task Force on Evidence-Based Practice [APAP], 2006) and the more recent CPA initiative to develop a similar definition (Canadian Psychological Association [CPA], 2012). The spiritual competencies identified by the Association for Spiritual, Ethi cal, and Religious Values in Counseling (ASERVIC), a division of the American Counseling Association (ACA; ASERVIC, n.d.), point us in the direction of com petently integrating spirituality into counselling. However, much work remains to be done translating these competencies into a practical understanding of how to work with clients’ spirituality in counselling sessions. This article will structure the issue of competency in working with clients’ spirituality, culminating in a case vignette that illustrates principles that operate within various theories of practice. One may not fully understand spirituality without first identifying the broader meaning of culture and developing awareness of the various influences to its unique (e.g., to time and geographic location) display. Culture is defined as “the embodi ment of a worldview through learned and transmitted beliefs, values, and practices” (APA, 2003, p. 380). Like culture, spirituality is ever changing (Fukuyama & Se vig, 1999) and evolves with the values of society. The relationship between culture and spirituality is not unilateral; spirituality and culture are mutually informative. Cultural values such as moral and social responsibility support spirituality while materialism, individualism, and hedonism are antagonistic to it (Eckersley, 2007). Spiritual values or the absence thereof can also influence how we conceptualize and treat mental illness (APA, 2003); even the term “mental illness” denotes a certain kind of value system, one that seems to remove spiritual and contextual factors as a central source of inquiry. In some cultures, spiritual beliefs permeate the therapeutic encounter. Therapist and client efforts are concentrated solely on spiritual issues, internal conflict is viewed as having a spiritual origin, treatment is focused on healing the soul, and traditional medicines are prescribed to restore harmony. For example, the Abo riginal community adopts a holistic view of healing that strives to achieve balance among the mental, emotional, physical, and spiritual dimensions of self. Healing is supported by ceremonial ritual, sacred teachings, song and dance, and the use of natural herbs, all of which are designed to foster inner balance and connection with the natural and spiritual world (Canadian Institute for Health Information, 2009). Traditional healers such as elders in Aboriginal communities, curanderos among Latin Americans, folk healers in Asian cultures, and shamans in Australia have all connected spirituality with the treatment of mental health issues (Fuku yama & Sevig, 1999; Winnipeg Regional Health Authority, 2009). Undeniably, cultural variables such as spiritual, racial, and ethnic diversity and their intersec tions impact the understanding and treatment of mental illness. In North America, psychology and psychological practice are dominated by western models with western assumptions about mental illness (see Watters, 2010, for a discussion). Western ideas are partial to the medical model that privileges Integrating Spirituality into Counselling and Psychotherapy 317 the framing of problems with medical solutions and tends to overshadow more holistic assessment and treatment approaches. The rising multiculturalism of western countries means that clients are increasingly treated within a framework in which their important spiritual values are largely absent. When spirituality is peripheral or absent in our models, the discussion of the soul in treatment can be silenced; understanding the importance of individual and group beliefs in the expression and treatment of mental illness undermines this narrow view of human experience (see Arthur & Collins, 2005, for a discussion). Research supporting the connection between spirituality and well-being (see Koenig & Larson, 2001, for a review), along with increased acknowledgement of the importance of spirituality for individuals across cultures (Fukyama & Sevig, 1999), highlights the need to broaden our theories to accommodate spirituality. In the last three decades, there has been a significant increase in the literature dedicated to understanding the psychology-spirituality intersection. These works provide some guidance in the supervision and training of counsellors (Aten & Hernandez, 2004; Bartoli, 2007; Bishop, Avila-Juarbe, & Thumme, 2003), spiritual-based intervention (Eck, 2002; Miller, 2003; Sperry, 2001), and the efficacy of spiritual-based intervention (see Harris, Thoresen, McCullough, & Larson, 1999; Hook et al., 2010, for reviews). In addition to its inclusive definitions of evidence-based practice, our field considers the domain of client spirituality in its ethical codes and professional standards. The CPA (2000), the Canadian Counselling and Psychotherapy As sociation (CCPA; 2007, 2008), the APA (2010), and the American Counseling Association (ACA; 2005) support this integration by highlighting the need to respect culture (including religion and spirituality) and to engage in competent practice within the scope of received training and supervision. A prominent source of support for integration comes from the multicultural counselling movement and its multicultural competencies as well as the spiritual competencies identified by ASERVIC. The multicultural theories have led to an increased appreciation of the role of diversity in counselling. Effective multicultural counselling includes specific awareness, knowledge, and skills related to cultural competence (Sue, Arredondo, & McDavis, 1992). While multicultural compe tencies have offered us a greater appreciation for the role of culture in counselling and categorization of these competencies into a manageable framework, existing competencies have focused almost exclusively on race and ethnicity. The ASERVIC competencies have filled the gap in the neglected area of spir ituality in the multicultural literature. These competencies developed alongside existing accreditation standards mandating that curricula include spiritual and religious diversity issues as a core requirement of counsellor education (Robertson, 2008). Despite increased attention in the literature to religious and spiritual issues in counselling, including competencies and accreditation criteria, few students actually receive proper training and supervision during their graduate programs (Aten & Hernandez, 2004; Bishop et al., 2003; see Hage, Hopson, Siegel, Payton, & DeFanti, 2006, for a review). The ASERVIC guidelines have been instrumental 318 Carla Daniels & Marilyn Fitzpatrick in delineating what counsellors need to know to work with client spirituality—the what—but do not direct us to the strategies needed to achieve these competen cies. In order for our profession to move forward in this domain and step outside the dominant and unilateral medical prescriptions for health, we must develop the strategies—the how—to achieve spiritual competency (Bolletino, 2001) in the ASERVIC domains. Spiritual competency is defined as “the ability to carry out a task that has been attained by gaining the knowledge, attitudes, and skills proposed by the ASERVIC Spiritual Competencies” (Robertson, 2008, p. 21). This article will review current literature relating spirituality to counselling. Within the multicultural framework of attitudes, knowledge, and skills, we will offer uploads/Religion/ admin.pdf