Spirituality and Recovery in a

Multicultural Context

Dr. Kenneth Fung, MD, FRCPC, MScTerry McCullum MSW, MA, Mdiv

May 2015

Outline

• Part I: Reflective Questions• Part II: Basic Theories & Concepts• Part III: Considerations in Practice

Reflective Questions

Do you consider yourself spiritual?

Do you consider yourself religious?

Does your spirituality /religiosity influence your practice (e.g. counselling)?

Do you feel comfortable to address “afterlife” issues with your client?

Do you feel it is ever appropriate to pray with or for you clients?

Spirituality as Evidence Based Practice• The Recovery movement recognizes spirituality as one of the five

key elements in recovery• Traditional Healers are recognized as part of the mental health

system in many non high income countries

• A 2011 study of religious faith among homeless people in supported housing found that those who “gained faith” in the first year of housing reported doing more volunteer work, feeling more engaged in community activities and having a higher quality of life than those who reported a loss of faith in the same year

• Studies show that positive religious coping was related to quality of life and positive psychological health

• A ten year study found a link between religiosity/spirituality and reduced risk of major depression

(Rush Memory and Aging Project, Strobe, 2015)

Man’s Search For Meaning

- Viktor Frankl

• “Those who have a ‘why’ to live, can bear with almost any ‘how’ “

• “Life is never made unbearable by circumstances, but only by lack of meaning and purpose”

• “I wish to stress that the true meaning of life is to be discovered in the world rather than within man or his own psyche…being human always points, and is directed, to something or someone other than oneself – be it a meaning to fulfill or another human being to encounter. The more one forgets himself – by giving himself to a cause to serve or another person to love – the more human he is and the more he actualizes himself”

Spirituality – a Definition

“Spirituality is concerned with people finding

meaning and purpose in their lives, as well as the sense of belonging,

of community…”

Royal College of Psychiatrists: Spirituality and Psychiatry Special Interest Group

Spirituality

“ A quality that goes beyond religious affiliation, that strives for inspiration, reverence, awe, meaning and purpose even in those who do not believe in God.

The spiritual dimension tries to be in harmony with the universe, strives for answers about the infinite,

and comes especially into focus at times of emotional stress, physical (and mental) illness, loss,

bereavement and death.”Murray & Zentner (1989)

Nursing Concepts for Health PromotionPrentice-Hall, London

Another Definition

“…that aspect of human existence that gives it its ‘humanness’. It concerns the structures of significance that give meaning and

direction to a person’s life and helps them to deal with the vicissitudes of existence. As such it includes such vital health

dimensions as the quest for meaning, purpose, self-transcending knowledge, meaningful relationships, love and commitment, as

well as (for some) a sense of the holy amongst us.”

Swinton, J. and Pattison, S. (2001) “Come all ye Faithful”

Health Service Journal, 111, p. 24-25.

Spirituality / Religion

Religion Spirituality

• Community-based worship• Organized set of beliefs, practices, rituals and sacred traditions

• Individualistic, personal, less formal • Self-knowledge is one of the main keys to spirituality• Represents personal values, beliefs & experiences• Inclusive and unifying

Faith and ReligionFaith must be seen as a verb. Faith is a way of behaving which involves knowing, being, willing and doing. Faith is an action. It changes and expands through our interactions with others. We expand in faith through four styles of faith, experienced faith, affiliative faith, searching faith, and owned faith. (Westerhoff)

EXPERIENCED FAITH AFFILIATIVEFAITH

SEARCHINGFAITH

OWNEDFAITH

Faith is first experienced enactively through interactions

with other “faithing selves”

Need to belong to an accepting community

Doubt and critical judgment are necessary – need to test the community’s identity and understanding of faith – in order to reach your own convictions

Owned faith is the culmination of the process which has been traditionally called “conversion”

Children imitate and respond to the actions of others

Need to act with others in a community that has a clear sense of identity – “our story”

Period of experimentation of other alternatives and other “stories”

Need to own and be owned by one’s faith

An environment of sharing experiences and interactions

is necessary for growth

Need for a strong sense of authority

Need to commit one’s life to persons and causes, even if only for short periods of time and in rapid succession

Give witness to faith by work and action

An affective experience – feelings of trust, love and

acceptance are critical

Religious affections (feelings) are still important – person needs to experience awe, wonder, and mystery: drama, art, music, dance, and storytelling, enhance growth

Inquire into the meaning and purposes of the “story” and ways by which the community of faith lives (serious study is important)

Struggle to eliminate the gap between belief and actions by committing one- self to a life style in which they really do what they believe

    Movement from a community’s understanding of faith to a personal understanding of faith

Results in a major change in a person’s feeling, thing, willing, and acting

Faith Communities and At Risk and Marginalized

PopulationsThe credibility of the church….

Rests entirely on how Christians serve those marginalized by

society….The gospel of the marginalized is where our credibility is at stake, is

found and is revealed Pope Francis

(Nat. Catholic Reporter, Feb/Mar 2015)

Spiritual Activities

•Mindfulness

•Prayer

Assessment

Importance of spirituality for the patient and spiritual development

Explanatory model of problem

Spiritual phenomenon vs mental illness

Religious / spiritual values regarding self, others, world, life, morality

Spiritual Emergencies

Spiritual / Existential issues

Psychometric Measures

e.g. Religious Commitment Inventory (RCI-10); Spiritual Transcendence Scale (STS)

18

FICA Faith and Belief

What is your faith or belief? Do you consider yourself spiritual or religious?What things do you believe in that give meaning to your life?

Importance

Is it important in your life?

What influence does it have on how you take care of yourself?

How have your beliefs influenced your behavior during this illness?

What role do your beliefs play in regaining your health?

Community

Are you part of a spiritual or religious community?

Is this of support to you and how?

Is there a person or group of people you really love or who are really important to you?

Address in Care

How would you like me, your healthcare provider to address these issues in your healthcare?

Puchalski CM et al. J Pall Med 2000;3:129-37

Negotiating Religious Issues in Care

Beliefs

Values

Medications

e.g. capsules; time of day

Counseling / Psychotherapy

e.g. meditation

Spiritual Issues in Counseling

Grief / Dying

Disability

Self-disorders

Morality

Sexuality

Spiritual experiences

Spiritual emergencies

…

Spirituality and Psychotherapy

Transpersonal Psychotherapy

e.g. Existential Psychotherapy; Gestalt

Spiritually-oriented Psychotherapy

e.g. Buddhist Perspective on Psychoanalysis

“Spiritually-inspired” Psychotherapy

e.g. ACT

Pastoral Counseling

Spiritual Direction

Spiritually-oriented Psychotherapy

Psychoanalysis

Humanistic

Interpersonal

Experiential

CBT

…

Christian Approach to SO-CBTEmphasize primacy of agape love and genuine relationship with client

Deal with the past unresolved issues; inner healing

Meaning of spiritual, experiential, mystical aspects of life and faith

Thoughts and behaviors influence feelings and use biblical truths for cognitive restructuring and behavioral change

Emphasize holy spirit’s ministry for inner healing and C/B/A change

Pay attention to contextual factors

Techniques consistent with biblical truth e.g. “blessings of mental anguish”; goal of therapy being Christ-like; open to God’s love and grace; overcome misbeliefs

“Spiritually-inspired” therapies

Mindfulness Based Cognitive Therapy

Dialectical Behavioural Therapy

Acceptance and Commitment Therapy

MH Interventions in reference to Spirituality

Reinforcing / Spiritual intervention

Congruent

Neutral

Challenging

Ethical Issues

Self-Disclosure ? Non-Judgemental stance of

therapist ? Influence client’s spiritual /

religious beliefs / values ? Adverse Effects?

Case Discussion

Discussion / Q&A

ken.fung@uhn.ca TMcCullum@loftcs.org