a rationale for spiritually integrated psychotherapy
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A Rationale for Spiritually Integrated Psychotherapy. Kenneth I. Pargament Department of Psychology Bowling Green State University [email protected] Presented at Samaritan Annual Conference Spiritually Integrated Psychotherapy Denver, Colorado August 8, 2009. Overview of the Day. - PowerPoint PPT PresentationTRANSCRIPT
A Rationale for Spiritually Integrated Psychotherapy
Kenneth I. PargamentDepartment of Psychology
Bowling Green State [email protected]
Presented at Samaritan Annual Conference
Spiritually Integrated Psychotherapy Denver, Colorado
August 8, 2009
Overview of the Day
A Rationale for Spiritually Integrated Psychotherapy
Understanding Spirituality Assessing Spirituality Addressing Spirituality
Albert Ellis on Religion
“Obviously the sane and effective psychotherapist should not go along with the patient’s religious orientation and try to help these patients live successfully with their religions, for this is equivalent to trying to help them live successfully with their emotional illness” (p. 15; The Case against Religion).
Reasons for the Tension between Religion and
Health
Irreligiousness among Health Professionals
Reasons for the Tension between Religion and
Health Irreligiousness among Health
Professionals Competing Religions
Values of Health and Religion
Empiricism Individualism Skepticism Autonomy Pragmatism Physical and Mental
Health
• Faith• Love• Humility• Surrender• Transformation• Forbearance
Reasons for the Tension between Religion and
Health
Irreligiousness among Health Professionals
Competing Religions Lack of Knowledge
A Lack of Training
Only 15% of Ph. D. training programs in clinical psychology in the United States and Canada offer a course in religion and spirituality
Why Consider Spiritual Issues? Patients want spiritually sensitive
care
Rose et al (2001)Journal of Counseling Psychology
74 clients surveyed from 9 diverse counseling centers
Only 18% say they prefer not to discuss religious or spiritual issues in counseling
Spiritual Needs of Clients
Lindgren and Coursey (1995) 65% of people with serious mental illness would
like to talk about spiritual concerns with therapists 35% talk to their therapists about spiritual
concerns
Why Consider Spiritual Issues? Patients want spiritually sensitive care Many people turn to spirituality in
stressful times
Drawing on the Sacred as a Resource on Flight 232
“The plane was moving more erratically. I knew it wasn’t good by the increase in activity of the stewardesses. . . The guy next to me at minus four minutes said, ‘We ain’t going to make it’. . . I noticed the nun across from me had been praying on her rosary. I remembered I had a cross in my pocket. I pulled it out and held it in my hand for the rest of the ride.”
“I’d done a lot of Buddhist meditation in my life, and this trained me to become one pointed in my awareness. I was totally focused on the brace position.”
Most Frequent Method of Coping
Conway (1985-1986) Black and white elderly women with medical
problems Prayer was most frequent method of coping Prayer was more common than resting, seeking
information, prescription drugs, or going to a physician
Coping with 9/11
Schuster et al. (2001) 90% of national sample of Americans sought
solace and support from religion
Spirituality among People with Serious Mental Illness
Tepper et al. (2001) Surveyed over 400 people with serious mental illness 80% cope with their symptoms and daily problems
through religion 65% found religious coping helpful 30% say religion was most important resource More religious coping over time tied to less frustration,
less depression and hostility, and fewer hospitalizations
Why Consider Spiritual Issues? Patients want spiritually sensitive care Many people turn to spirituality in
stressful times Spirituality has been linked to
positive health outcomes
Church Attendance as a Predictor of Mortality
Hummer et al. (2000)National sample of adultsFrequent church attendance is tied to 7
year increase in life expectancyFrequent church attendance is tied to 14
year increase in life expectancy among African-Americans
Spiritual Meditation among Patients with Vascular Headaches
(Wachholtz & Pargament, 2005)
83 college students with vascular headaches according to criteria of the International Headache Society (1988)
Random assignment to four groups Spiritual Meditation (e.g., “God is peace,” “God is joy” ) Internally Focused Secular Meditation (“I am content,” “I am joyful”) Externally Focused Secular Meditation (“Grass is green,” “Sand is soft”) Progressive Muscle Relaxation
Practice technique 20 minutes per day for four weeks Assess changes in headache frequency, pain tolerance, affect,
headache control efficacy
Headache Occurrence Prior to and during the Intervention
Time
21
He
ad
ach
es
15
14
13
12
11
10
9
8
GROUP
Spiritual Meditation
Internal Secular
External Meditation
Relaxation
Diary Analyses of Headache Occurrence by Group and Time
Time Period
He
ad
ach
es
2.2
2.0
1.8
1.6
1.4
1.2
1.0
.8
.6
GROUP
Spiritual Meditation
Internal Secular
External Meditation
Relaxation
Pain Tolerance by Group and Time
TIME
21
Pa
in T
ole
ran
ce (
seco
nd
s)120
110
100
90
80
70
60
50
40
30
GROUP
Spiritual Meditation
Internal Secular
External Meditation
Relaxation
Negative Affect by Group and Time
Time
21
NP
AN
AS
28
26
24
22
20
18
16
GROUP
Spiritual Meditation
Internal Secular
External Meditation
Relaxation
Migraine Specific Quality of Life by Group and Time
Time
21
MS
QL
83
82
81
80
79
78
77
76
75
GROUP
Spiritual Meditation
Internal Secular
External Meditation
Relaxation
Headache Management Self-Efficacy by Group and
Time
Time
21
HM
SE
130
120
110
100
90
GROUP
Spiritual Meditation
Internal Secular
External Meditation
Relaxation
Why Consider Spiritual Issues? Patients want spiritually sensitive care Many people turn to spirituality in
stressful times Spirituality has been linked to positive
health outcomes Spirituality has been linked to
negative health outcomes
Spiritual Struggles
Divine struggles Interpersonal spiritual struggles Intrapsychic spiritual struggles
Ano and Vasconcelles Meta-Analysis(2004, Journal of Clinical Psychology)
Number of Studies Cumulative Confidence
Effect Size Interval
Religious Struggles
with Negative Health 22 .22* .19 to .24
Outcomes
Spirituality and Health Study Participants
1629 participantsAge: Mean = 49.1 years, SD = 17.7675.3% Christian56.2% Attend religious services “almost every day” or
“every day”55.3% Engage in private prayer “almost every day” or
“every day”59.9% “Very religious” or “fairly religious”
Spirituality and Health Study Measures
Mental Health: Symptom Assessment-45 Questionnaire (Davison, Bershadsky, Bieber, Silversmith, Maruish, & Kane, 1997)
AnxietyDepressionHostilityInterpersonal Sensitivity
Religious Struggle: Negative Religious Coping Subscale of Brief RCOPE (Pargament, Koenig, & Perez, 2000)
Social Support: Six items adapted from previous research (Zimet, Dahlem, Zimet, & Farley, 1988)
Obsessive-CompulsiveParanoid IdeationPhobic AnxietySomatization
Spirituality and Health Study Procedure
Sample recruited from sampling frame maintained by Survey Sampling International
Sampling frame reflects demographics of 2000 U.S. census
Contacted 8,500 individuals1,895 completed the survey (22% response rate)266 surveys excluded due to missing data
Spirituality and Health Study
SummaryReligious struggle positively associated with
various forms of psychopathologyRelationship between religious struggle and
psychopathology stronger for individuals with recent illness or injury
Measures (Pargament, Koenig et al. 2004)
Number of Active Diagnoses Subjective Health Severity of Illness Scale (ASA) Activities of Daily Living (ADL) Mini-Mental State Exam (MSE) Depressed Mood Quality of Life Positive Religious Coping and Religious Struggle Global Religious Measures (Church Attendance, Private
Religiousness, Religious Importance) Demographics
Consequences of Religious Struggles Study of medically ill elderly patients over two years
(Pargament, Koenig, Tarakeshwar, & Hahn, 2004) Struggles with the divine predicted increases in depressed
mood, declines in physical functional status, declines in quality of life after controls
Struggles with the divine predicted 22-33% greater risk of mortality after controls
Struggles also predict stress-related growth
Specific Religious Struggle Predictors of Mortality
“Wondered whether God had abandoned me” (RR = 1.28)
“Questioned God’s love for me” (R = 1.22) “Decided the devil made this happen” (R =
1.19)
Why Consider Spiritual Issues? Patients want spiritually sensitive care Many people turn to spirituality in
stressful times Spirituality has been linked to positive
health outcomes Spirituality has been linked to negative
health outcomes Spirituality cannot be separated from
treatment
A Forgiveness Intervention
Rye and Pargament (2002) College students hurt in romantic relationship Religious forgiveness intervention Secular forgiveness intervention Both groups facilitate forgiveness and well-being No group differences in efficacy
Strategies for Forgiveness
Two of top three strategies for secular forgiveness group“I asked God for help and/or support as I was trying to
forgive.”“I prayed for the person who wronged me as I was
trying to forgive.”
The Secular Impacts the Spiritual
Theresa Tisdale et al. (1997) Evaluation of psychiatric inpatient treatment Individual, group, milieu, and psychotropic
interventions Patients in treatment improved in adjustment Patients in treatment developed more positive
images of God
Common Measures of Religiousness and Spirituality
What is your religious denomination? How often do you attend religious services at your
congregation? How often do you pray outside of your congregation? On a 1 to 5 scale, would you say you are very religious (5)
or not at all religious (1)? On a 1 to 5 scale, would you say you are very spiritual (5)
or not at all spiritual (1)?
Research Populations Victims of 1993 Midwest floods Survivors of OK City bombing Parents of autistic children Medically ill hospitalized elderly Hospice care providers Cardiac pacemaker patients African-Americans coping with racism People coping with 9/11
Stereotypes about Spirituality
Spirituality is a defense against anxiety
Spirituality and the Search for Comfort
College student recovering from an eating disorder
“He just watches over me all the time. When something good happens, God’s there. But when something bad happens, God’s there too. . . Just knowing that there’s somebody up there . . . who is paying attention. . . makes me feel more secure.”
Spirituality and the Search for Meaning
Quadriplegic young man paralyzed by spinal cord injury:
“Well, I’m put in this situation to learn certain things, ‘cause nobody else is in this situation. It’s a learning experience; I see God’s trying to put me in situations, help me learn about Him, and myself.”
Spirituality and the Search for Intimacy
Roman Catholic priest describing mother’s funeral:
“The funeral was astounding. The whole church was there. Many, many friends were there. My blind niece played the piano and my best friend gave the homily. So there were many powerful religious expressions and family expressions. It is hard to separate one from the other.”
Spirituality and the Search for Transformation
Mormon man describing death of wife in car crash:
“I knew that she was killed. There was a big gash on her wrist, and it wasn’t bleeding and I couldn’t get any pulse. And I felt that I could lay my hands on her head and bring her back. And a voice spoke to me and said: ‘Do you want her back a vegetable? She’s fine. She’s alright. And . . . to let her go.’ That [voice] was just as clear to me as though somebody spoke to me.”
Spirituality and the Search for the Sacred
9 year old boy:
“I’d like to find God! But He wouldn’t just be there, waiting for some spaceship to land! He’s not a person, you know! He’s a spirit. He’s like the fog and the mist. . . I should remember that God is God, and we’re us. I guess I’m trying to get from me, from us, to Him with my ideas when I’m looking up at the sky!” (Coles, 1990)
Stereotypes about Spirituality Spirituality is a defense against anxiety Spirituality is a passive or avoidant way of coping
Three Styles of Spiritual Coping
Self-Directing -- “When I feel nervous or anxious, I calm myself without relying on God.”
Deferring -- “I do not think about different solutions to my problems because God provides them for me.”
Collaborative -- “When it comes to solving a problem, God and I work together.”
Who Says We’re Not a Science?
Collaborative Religious Coping
Intrinsic Religiousness
Psychosocial Competence
Deferring Religious
Coping
.2
2*
.32
*
C.P.S C.R.C.
.64**
-.57
.51*
.77
.40*
.74*
.40*
.84*
BAPC
Trust
S-E
Y
Y
Y
32
5
6
7
.65*.27*
.85 .60*
D.P.S. D.R.C.
Y1 Y2
Y3 Y4
.12*
.14*
Hoge
Feagin
X1
X2
.93
.94*
.83*
.72*.86*
y21
x11
y11
x21
11
21
.87 .61*
.62**.25*
y32
y42
y53
y63
y73
5
6
7
3
4
21
1
2
1
2
* p < .05 ** p < .10
Stereotypes about Spirituality Spirituality is a defense against anxiety Spirituality is a passive or avoidant way of coping Spirituality is a form of denial
Spirituality and Denial
“Since I got Jesus, I don’t have no memories of the past” (prisoner serving time for theft and robbery offenses)
Spirituality and Hope
“It’s all right to cry. It’s all right to hurt. It’s all right to be confused. Hope will rebuild landmarks. Hope will outlive the broken hearts” (pastor of the First Baptist Church in Oklahoma City following devastating tornadoes).
Envisioning a Spiritually Integrated Psychotherapy
Based on a theory of spiritualityEmpirically-orientedEcumenicalTransformational
Some Dangers of a Spiritually Integrated Psychotherapy
Trivializing spiritualitySpiritual reductionismValue imposition
Respect for Client’s Autonomy
“We need to be honest and open about our views, collaborate with the client in setting goals. . ., then step aside and allow the person to exercise autonomy and face consequences” (Bergin, 1995, p. 107).
Some Dangers of a Spiritually Integrated Psychotherapy
Trivializing spiritualitySpiritual reductionismValue impositionOverstating the importance of spirituality
The Law of the Instrument
“When you have a hammer in your hand, everything around you starts to look like a nail.”
The Greatest Danger “Medical and mechanistic models have made useful contributions
that should be integrated into any comprehensive theory of psychotherapy, but when these models serve as the foundation of our profession, they produce a psychology that is barren of soul. Thus, they unintentionally participate in the further desacralization of our society and in the de-souling of individual lives. Make no mistake: Soulless therapies produce soulless results. When our psychotherapies . . . become permeated with the same desacralizing assumptions that often cause our clients problems in the first place, then perhaps it is time for us to ask what we are doing as therapists and to seek other approaches that support rather than destroy the soul” (Elkins, 1995, p. 82).