GROUP SPIRITUAL DIRECITON PROGRAM FOR DEPMSSED PERSONS by Peter John. Barnes B.Sc., Memorial University of Newfioundland, 197 1 M.Div., Trinity College, 1974 Submitted to the Faculty of Theology, Acadia Divinity CoUege, in partial fulfillment of the requirements for the Degree of Doctor of Ministry Acadia DiWiity College, Acadia University Fall Convocation 1998 O by Peter John Bames 1998 I, Peter John Barnes, grant permission to the University Librarian at Acadia University to reproduce, loan, or distrubute copies of my thesis in microform, paper or electronic formats on a non-profit basis. I, however, retain the copyright in my thesis. Signature of Author Date TABLE OF CONTENTS ABSTRACT ....................................................................... vii ..- ACKNOWLEDGEMENTS ............................................... vui LIST OF ILLUSTRATIONS ................................O............. ix LIST OF TABLES ............................. ... .......................... x Chapter 1. INTRODUCTION: SUEWEYING THE HORIZONS .............................................................. 1 2. SURVEYING THE LANDSCAPE: DEFINITIONS AND LITERATURE REVIEW ................................ 9 Ministry and Theological Perspective Depression Group Process Conclusion 3. THE FOUNDATION: THE BUILDING BLOCKS ................................................................. 3 1 Fust Building Block: The Treatment of Depression Second Building Block: Group Spiritual Direction Thkd Building Block: Transfomative Learning 4, SPIRITUAL MORTAR: THEOLOGICAL PERSPECTTVES.. .................................................... 47 A Theological Perspective on Depression Theologies Address Depression 5. THE BRIDGE TO NEW LEE: THE GROUP SPIRITUAL DIRECTION PROGRAM-................... 63 Bridge Fondation Under Construction: Historicd Background and Preliminary Preparation Bridge Con~t~ction:The Group Spirituai Direction Program Planning The Group Spiritual Direction Program Bridge Construction: Outhe of Methodology 6. TESTING THE STRUCTURE ................................. 83 Qualitative Analysis by Clients and Sessions Qualitative Analysis by Themes Quantitative Analysis 7. THE BRIDGE STRONG AND SOLID: CONCLUSIONS, SUMMARY AND RECOMMENDATIONS ........................................... 187 Conclusions Recommendations for Further Research in the Area of Spintual Direction and Depression SPIRITUAL DIRECTION PROGRAM ........ SAMPLE LETTER. ...................................... CLIENT SELECTION CRITERTk PROGRAM AGENDA ................................ BECK DEPRESSION INVENTORY.......... THE SPIRITUAL EXPEUENCE INDEX .REVISED ....................*.....~...*......~ GROUP SPIRITUAL DIRECTION EV ALUATION........................................... GROUP SPIRITUAL DIRECTION PROGWGOAL AND OBJECTIVES ..... CLIENTS THEMES AM> PROGRAM THEMES ...................................................... GROUP SPIIUTUAL DIRECTION PROGWEVALUATION: SUMMARY... CLIENT CHECKLIST:SUMMARY ............ BIBLIOGRAPHY ........................................................................... 23 7 vii Spiritual direction is a very old tem used to describe the practice of spintual guidance given to a directee by a spintual director. The purpose of spiritual direction is to enable a directee to explore and enhance their understanding and relationship with their God. In group spirituai direction the group leader facilitates the participants to provide spiritual guidance. The group is empowered to aire for one another. In each session one group member claims the session and becomes the directee, while the others provide the spiritual guidance. The group spiritual direction program endeavors to meet the spiritual needs of the specifïc group members. Group spintual direction is reIatively new and there is nothhg written on its use with people with mental health problems. This thesis is prophetic in that it is the sharing of research that proves the value of group spiritual direction in helping the heaiing process of people diagnosed with mild to moderate depression. The preferred treatrnent of depressed persons is cognitive therapy and change is accomplished through addt leaming. In this thesis project the group members were coached in the use of cognitive therapy to address the spintual needs of the member who chose to be the directee in any given session. The mode1 of learning is an adult mode1 and leaniing was facilitated through the practice of reflection, and is known as Transfomative Leaming. This research, through qualitative and quantitative methodology, has show that group spiritual direction irnproves the mood of the clients who are mildly to moderately depressed. This Thesis was wmpleted with great perseverance and the fZt.hfU support of my wife, Doreen, my children, Gordon and Carolyn, and my dog Shadow. Much of the on- site supervision was done by my Ministry Supervisor, Sr. Dolores Hall, who supported and encouraged my work over the two year period of the thesis phase of the Doctor of Ministry Program. The Health Care Corporation of St. John's provided the clinical setting for this research. The staff of the Pastoral Care Department, especiaiiy Dr. Rick Singleton, Theresa Ryan, and Bernadette Murray, were especially supportive and helpftl. The staff of the Community Mental Heaith Assessrnent and Treatment Division of the Mental Hdth Program, specifidy Judy Power, Manager, who assisteci the researcher by approving the research project, by referring clients, and by providing space at LeMarchant House for the group sessions. The research project was approved by the Human Investigation Commîttee, and special thanks to Fmnkie O'Neill for assihg me in this process. Thanks also to Dr. Hassan Khalili for agreeing to be the local research advisor. The quantitative analysis of the research data was compileci by Bill Kane, M-Sc., psychologist . In the early stages of the research an advisory group consisting of Sr. Marie Ryan, Bert Fowlow, Bette Davis, Neil Quigiey, and Sr. Diane Smyth met to assist with the formulation of the goals and objectives. Also Dr. Penny Alderdice provided assistance with the literature search and facilitateci the acquisition of numerous articles, as weii as being of great encouragement in the process. The writing of the thesis was supported and encouraged by feliow Doctor of Ministry candidate, Rev. Philip Behrnan, Alberta, who acted as a mentor and guide with his regular e-mail messages. In addition Dr. Bernard O'Dwyer offered critique on the stmchire and composition of the thesis. Permission to use the Spiritual Experience Index-Revised was given by the author, Dr. Vickie Genia of Arnerican University, to whom 1offer my thanks. Rev. Peter Bames St. John's, NF., July 1998 LIST OF ILLUSTRATIONS Figure page 1. Mean Beck Depression Inventory @DI) Scores 1 7 5 2. Spirituai Expenence Index - Revised (Support) 179 3. Spirituai Experience Index - ReW(Openness) 183 4. Mean Spiritual Experience Index-Revised Ratings 185 LIST OF TABLES Table Page 1. Mean Beck Depression Inventory Scores... 173 2* T-Test Surnrnaiy for Beck Depression Inventory @DI) Scores 1 74 Mean Spirihial Experience Index-Revised (Support) Scores 177 T-Test Summary for Spiritual Experience Index - Revised (Support) Scores 178 Mean Spirituai Experience Index (Opemess) Scores 181 T-Test Summary for Spiritual Experience Index - Revised (Opemess ) Scores 182 Mean Spirituai Experience Index- Revised Scores 1 84 CB[APTER ONE INTRODUCTION: SURVEYING THE HORIZONS Pastoral Care in the mental health field presents a challenge because people with mental illnesses .often feel alienated fkom society. The challenge is also tme of the traditional instrument of pastoral care, the Church, who often hesitate to access assistance when the mentally iii have spirihial needs. People with mental ihess resist seeking extemal help including help from God, because they generdy have low self-esteem and consider themselves unwonhy of assistance. Thinking in absolutes, they see themselves negatively which affects their spintuaiity- This negativity may be evident in their lack of focus or feelings of hopelessness. Those who derfiom depression as an illness may prefer to condemn themselves and theù Go4 rather than conside~gthe possibility of being cared for by a loving God. Self confidence is impaired by their condition and consequently the lack of energy or motivation necessary to address spintual issues conf?onting them is also fnistrating. The combination of these factors regardiing the mentaiiy iii contribute to making ministry to the mentally iil a unique one requiring special skills. 1 have endeavored to prepare myseif personaliy and professionaiiy for the challenges of this special rninistry. Early in my years of rninistry in the health care field 1 realized that if1 could respond appropriately to the spiritual needs of the mentally dl, then 1 would also respond effkctively to the spiritual needs of those who are weli. The chaUenge of assessing spirituai needs of the mentaiIy il1 and endeavoring to respond with effective treatment or prograrns became my goal. 1 felt it was inappropriate to settle for the traditionai pastoral me, ministry of visitation. Much more is needed. While psychiatrie care is, in essence- the care of the psyche, and necessary for the ment* ill, invariably these people require a pater care, one that is spirituai, and gives special attention to the soul. My desire to take on the spintual care of the mentally iil inspird rny research for this project. Appropriate pastoral care dehered by capable and