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Exploring Spirituality/Religion Related Interventions Used by Mental Health Workers in Psychotherapy and Counseling

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Exploring Spirituality/Religion Related Interventions Used by Mental Health Workers in Psychotherapy and Counseling Smith ScholarWorks Theses, Dissertations, and Projects 2007 Exploring spirituality/religion related interventions used by mental health workers in psychotherapy and counseling Deanna Wilcoxson Dodd Smith College Follow this and additional works at: https://scholarworks.smith.edu/theses Part of the Social and Behavioral Sciences Commons Recommended Citation Dodd, Deanna Wilcoxson, "Exploring spirituality/religion related interventions used by mental health workers in psychotherapy and counseling" (2007). Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1273 This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized administrator of Smith ScholarWorks. For more information, please contact [email protected]. Deanna Wilcoxson Dodd Exploring Spirituality/Religion Related Interventions Used by Mental Health Workers in Psychotherapy and Counseling ABSTRACT This qualitative, exploratory and descriptive study is designed to gain understanding about the question: In what ways do mental health professionals incorporate spiritual and/or religious interventions during psychotherapy? It builds on existing research, focusing on specific interventions that have been carried out in a variety of mental health disciplines. The study is an attempt to further identify and document such interventions. It also explores factors that contribute to the successful use of the interventions within therapy sessions. Twelve highly experienced mental health workers in the eastern United States were interviewed, including clinical social workers, licensed professional counselors, pastoral counselors, clinical psychologists, and a marriage and family counselor. Analysis of their recorded responses to a structured interview with open-ended questions resulted in thick descriptions of their accounts of cases, interventions, and their perceived success factors. The most significant and dramatic finding of this research project is support for the assertion that: When appropriate, a willingness and ability to include spirituality and/or religion in the psychotherapeutic process is essential to optimal psychotherapy. EXPLORING SPIRITUALITY/RELIGION RELATED INTERVENTIONS USED BY MENTAL HEALTH WORKERS IN PSYCHOTHERAPY AND COUNSELING A project based upon an independent investigation, submitted in partial fulfillment of the requirements for the degree of Master of Social Work. Deanna Wilcoxson Dodd Smith College School for Social Work Northampton, Massachusetts 01063 2007 ACKNOWLEDGEMENTS This thesis could not have been completed without the love, inspiration, and support from my mother. Thank you, Georgie Mom. You are the best mom in the world. Thanks for encouraging me to keep going when I wanted to give up. I love you very much. A special thanks goes to her partner, my step mother Alice, who was very patient and supportive during this process. I would also like to thank all the participants of this study. Thank you for taking time out of your busy schedules to be a part of this study. And thank you for the important work you do in the world. ii TABLE OF CONTENTS ACKNOWLEDGEMENTS ……………………………………………… ii TABLE OF CONTENTS ……………………………………………….... iii CHAPTER I. INTRODUCTION ………………………………………………... 1 II. LITERATURE REVIEW ………………………………………… 5 III. METHODOLOGY ……………………………………………...... 25 IV. FINDINGS ……………………………………………………....... 36 V. DISCUSSION …………………………………………………….. 69 REFERENCES ……………………………………………………………. 94 APPENDICES Appendix A: Human Subjects Review Approval Letter ………………..... 98 Appendix B: Informed Consent Form …………………………………… 99 Appendix C: Sample Introductory Letter to Potential Participants……… 101 Appendix D: Transcriber’s Assurance of Research Confidentiality Form 102 Appendix E: Structured Interview Guide ……………………………….. 104 iii CHAPTER I INTRODUCTION The purpose of this study is to answer the following question: In what ways do mental health professionals incorporate spiritual and/or religious traditions in the interventions they use during psychotherapy? Currently there is extensive literature describing the trend toward greater acceptance of the belief that spirituality and religion have a significant role to play in strengthening psychotherapy practice. This study builds on existing research by collecting data on specific interventions that have been carried out successfully in a variety of mental health disciplines. The study is an attempt to further identify and document such interventions. It also explores factors that contribute to the successful use of spirituality/religion based interventions within psychotherapy sessions. There are numerous references in the literature about the use of religion and/or spirituality in psychotherapy (e.g., Northcut, 2000; Yarhourse, 1999), but the area of inquiry is still relatively new and existing literature calls for further research into this subject. Few resources were found that provided a listing and detailed description of common types of therapeutic interventions that incorporate the client’s spiritual or religious tradition. There is value in surveying cases where spirituality/religion based interventions were used and providing detail on how to execute each identified intervention, both for adaptation by the readers and to stimulate new ideas for practice. Specific factors found to promote the successful use of such interventions are important to document, since inappropriately used interventions have caused damage to clients (Yarhouse, 2002). In addition, some previous studies (Hodge, 2004) emphasize the need 1 to conduct an accurate assessment of the client with whom such interventions might be used. There is therefore a need for guidelines for adapting, creating, and using interventions. The sample for this study included twelve mental health professionals who agreed to participate. They met the criteria stipulated for participants: each had used spiritual/religious based interventions in their practice, were licensed, and had practiced at least three years. In fact, participants’ average number of years in practice was 24.7. In telephone or person to person interviews, participants responded to open-ended questions from a structured interview guide to describe their use of spirituality/religion related interventions. The recorded interviews were professionally transcribed and then analyzed using theme identification and coding (Anastas, 1999). The analysis resulted in eleven thematic areas that were explored and refined into six themes and five sub-themes with sub-sub themes that were then used to organize the findings and discussion. These were: participants’ approach to therapy/counseling; practitioners’ views and beliefs (definitions of spirituality and religion, the practitioner’s own spiritual and/or religious beliefs, and views regarding the use of spirituality and religion in psychotherapy, including how some moved from not using such interventions to using them); interventions as described in cases (including presenting problems, descriptions of the interventions, and non-spirituality/religion based interventions, which was coded as “techniques” to distinguish the two types during coding); success factors for interventions (therapist, client, environment, other); further training; comments on study. 2 With regard to their general approach to therapy, most participants use a holistic or systems approach and most are eclectic, some using a wide range of theories and techniques. A major theme in each participants’ approach is their commitment to understanding the client’s background and culture and responding in ways that respect and honor client individuality and uniqueness. While all the participants seriously pursue some spiritual and/or religious path of their own, they stress the importance of not imposing one’s own beliefs or practices on the client. However, most believe that it is critical to culturally sensitive therapy for all therapists, regardless of their own beliefs, to legitimate the possible consideration of the client’s spiritual or religious concerns and strengths in the therapy process. Several describe the conditions under which this can be done in a manner that is comfortable for both the therapist and the client. The findings of this study can be critiqued for use by other therapists, particularly clinical social workers. Thick descriptions are provided by participants of exactly what interventions they used and how they went about selecting and implementing these interventions. Responses to questions about success factors and lessons learned provides more detail on specific types of interventions used, and the success factors described can help in the development of guidelines for adapting, creating and using spirituality/religion based interventions. In addition, this study contributes to the field of social work by supporting more culturally competent forms of interventions in therapy (Saari, 1991), since users of the study can become more familiar with ways to incorporate the spiritual and/or religious traditions of their clients who value bringing their traditions into the therapeutic setting. 3 The findings may foster respectful treatment of spirituality and religion in therapy sessions for people of faith, or for those who have been damaged by destructive uses of religion or spiritual practices. In reading the results of this study and pursuing readings from the references, practitioners may deepen their understanding of various faith traditions and thereby become more sensitive to the
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