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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 kpargam_at_bgnet.bgsu.edu – PowerPoint PPT presentation

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Title: A Rationale for Spiritually Integrated Psychotherapy


1
A Rationale for Spiritually Integrated
Psychotherapy
  • Kenneth I. Pargament
  • Department of Psychology
  • Bowling Green State University
  • kpargam_at_bgnet.bgsu.edu
  • Presented at
  • Samaritan Annual Conference
  • Spiritually Integrated Psychotherapy
  • Denver, Colorado
  • August 8, 2009

2
Overview of the Day
  • A Rationale for Spiritually Integrated
    Psychotherapy
  • Understanding Spirituality
  • Assessing Spirituality
  • Addressing Spirituality

3
Albert Ellis on Religion
  • Obviously the sane and effective psychotherapist
    should not go along with the patients 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).

4
Reasons for the Tension between Religion and
Health
  • Irreligiousness among Health Professionals

5
Reasons for the Tension between Religion and
Health
  • Irreligiousness among Health Professionals
  • Competing Religions

6
Values of Health and Religion
  • Empiricism
  • Individualism
  • Skepticism
  • Autonomy
  • Pragmatism
  • Physical and Mental Health
  • Faith
  • Love
  • Humility
  • Surrender
  • Transformation
  • Forbearance

7
Reasons for the Tension between Religion and
Health
  • Irreligiousness among Health Professionals
  • Competing Religions
  • Lack of Knowledge

8
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

9
Why Consider Spiritual Issues?
  • Patients want spiritually sensitive care

10
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

11
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

12
Why Consider Spiritual Issues?
  • Patients want spiritually sensitive care
  • Many people turn to spirituality in stressful
    times

13
Drawing on the Sacred as a Resource on Flight 232
  • The plane was moving more erratically. I knew it
    wasnt good by the increase in activity of the
    stewardesses. . . The guy next to me at minus
    four minutes said, We aint 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.
  • Id 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.

14
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

15
Coping with 9/11
  • Schuster et al. (2001)
  • 90 of national sample of Americans sought solace
    and support from religion

16
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

17
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

18
Church Attendance as a Predictor of Mortality
  • Hummer et al. (2000)
  • National sample of adults
  • Frequent church attendance is tied to 7 year
    increase in life expectancy
  • Frequent church attendance is tied to 14 year
    increase in life expectancy among
    African-Americans

19
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

20
Headache Occurrence Prior to and during the
Intervention
21
Diary Analyses of Headache Occurrence by Group
and Time
22
Pain Tolerance by Group and Time
23
Negative Affect by Group and Time
24
Migraine Specific Quality of Life by Group and
Time
25
Headache Management Self-Efficacy by Group and
Time
26
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

27
Spiritual Struggles
  • Divine struggles
  • Interpersonal spiritual struggles
  • Intrapsychic spiritual struggles

28
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

29
Spirituality and Health Study
  • Participants
  • 1629 participants
  • Age Mean 49.1 years, SD 17.76
  • 75.3 Christian
  • 56.2 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

30
Spirituality and Health Study
  • Measures
  • Mental Health Symptom Assessment-45
    Questionnaire (Davison, Bershadsky, Bieber,
    Silversmith, Maruish, Kane, 1997)
  • Anxiety
  • Depression
  • Hostility
  • Interpersonal 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-Compulsive
  • Paranoid Ideation
  • Phobic Anxiety
  • Somatization

31
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 individuals
  • 1,895 completed the survey (22 response rate)
  • 266 surveys excluded due to missing data

32
Spirituality and Health Study
  • Summary
  • Religious struggle positively associated with
    various forms of psychopathology
  • Relationship between religious struggle and
    psychopathology stronger for individuals with
    recent illness or injury

33
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

34
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

35
Specific Religious Struggle Predictors of
Mortality
  • Wondered whether God had abandoned me (RR
    1.28)
  • Questioned Gods love for me (R 1.22)
  • Decided the devil made this happen (R 1.19)

36
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

37
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

38
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.

39
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

40
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)?

41
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

42
Stereotypes about Spirituality
  • Spirituality is a defense against anxiety

43
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, Gods there. But when
    something bad happens, Gods there too. . . Just
    knowing that theres somebody up there . . . who
    is paying attention. . . makes me feel more
    secure.

44
Spirituality and the Search for Meaning
  • Quadriplegic young man paralyzed by spinal cord
    injury
  • Well, Im put in this situation to learn certain
    things, cause nobody else is in this situation.
    Its a learning experience I see Gods trying to
    put me in situations, help me learn about Him,
    and myself.

45
Spirituality and the Search for Intimacy
  • Roman Catholic priest describing mothers
    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.

46
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 wasnt bleeding and I
    couldnt 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? Shes fine. Shes alright. And
    . . . to let her go. That voice was just as
    clear to me as though somebody spoke to me.

47
Spirituality and the Search for the Sacred
  • 9 year old boy
  • Id like to find God! But He wouldnt just be
    there, waiting for some spaceship to land! Hes
    not a person, you know! Hes a spirit. Hes
    like the fog and the mist. . . I should remember
    that God is God, and were us. I guess Im
    trying to get from me, from us, to Him with my
    ideas when Im looking up at the sky! (Coles,
    1990)

48
Stereotypes about Spirituality
  • Spirituality is a defense against anxiety
  • Spirituality is a passive or avoidant way of
    coping

49
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.

50
Who Says Were Not a Science?
51
Stereotypes about Spirituality
  • Spirituality is a defense against anxiety
  • Spirituality is a passive or avoidant way of
    coping
  • Spirituality is a form of denial

52
Spirituality and Denial
  • Since I got Jesus, I dont have no memories of
    the past (prisoner serving time for theft and
    robbery offenses)

53
Spirituality and Hope
  • Its all right to cry. Its all right to hurt.
    Its 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).

54
Envisioning a Spiritually Integrated Psychotherapy
  • Based on a theory of spirituality
  • Empirically-oriented
  • Ecumenical
  • Transformational

55
Some Dangers of a Spiritually Integrated
Psychotherapy
  • Trivializing spirituality
  • Spiritual reductionism
  • Value imposition

56
Respect for Clients 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).

57
Some Dangers of a Spiritually Integrated
Psychotherapy
  • Trivializing spirituality
  • Spiritual reductionism
  • Value imposition
  • Overstating the importance of spirituality

58
The Law of the Instrument
  • When you have a hammer in your hand,
    everything around you starts to look like a nail.

59
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).
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