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The Role of Spirituality in Mental Health Interventions a Developmental Perspective

The Role of Spirituality in Mental Health Interventions a Developmental Perspective

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International Journal of Transpersonal Studies 
Te Role of Spirituality in Mental Health Interventions: A Developmental Perspective
Liora Birnbaum Aiton Birnbaum
Kar Yona, Israel Kar Yona, Israel
Ofra Mayseless 
Haia University Haia, IsraelTis article presents a our-level developmental description o the extent to which cliniciansapply spirituality in therapy. At the rst level, clinicians begin to sense dissonance regarding their traditional, positivist worldview while conducting conventional psychotherapy, espe-cially in cases involving lie-threatening situations or loss. At the second level, cliniciansopen up to the possibility o the existence o a metaphysical reality and to spiritual/transper-sonal belies expressed by clients. At the third level, clinicians may cautiously contact thistranscendental reality and seek ways to utilize this dimension to access inormation relevantto therapy. At the ourth level, clinicians actively engage in implementing transpersonalinterventions aimed at acilitating change and healing. Tese levels o integration are delin-eated along with inherent changes in therapist worldview, perceived proessional role, andrelevant dilemmas.
here is a large body o empirical evidencesuggesting links between spiritual and religiousexperiences and health (Miller, 1999; Koening & Larson, 2001; Koening, McCullough, & Larson,2001; Pargament, 1997), thus underscoring theimportant role o patients’ spirituality in their mentalhealth. In clinical practice, too, greater attention is being placed on the role o religious aith and spirituality inan eort to humanize psychotherapy (Beck, 2003) andto bring a more comprehensive and holistic approach tointervention (Frame, 2003; Miller, 1999, 2003; Richards& Bergin, 1997, 2004; Sharanske, 1996; Sperry, 2001).Internationally, mental health proessional associationshave highlighted the need or developing sensitivity tothis lie dimension (Culliord, 2002) because: “in every human being there seems to be a spiritual dimension, a quality that goes beyond religious aliation that strivesor inspiration, reverence, awe, meaning and purpose,even in those who do not believe in God” (Murray &Zentner, 1989, p. 259).For example, in a longitudinal study by theHigher Education Research Institute (HERI, 2004)at the University o Caliornia, Los Angeles (UCLA),112,000 undergraduate students at 236 colleges aroundthe United States (US) were surveyed in order tounderstand their perceptions o spirituality and its rolein their lives. Most students demonstrated a remarkably high level o interest and participation in the spiritualdomain, with many involved in a spiritual search and/ora search or meaning and goals in lie, and reporting a sense o commitment to relevant belies. Moreover, they arrived at the university with the expectation that theiracademic pursuits would urther not only accumulationo theoretical or proessional knowledge but also enhancetheir spiritual development.Similarly in a smaller, clinical sample o “seriously ill” patients with diagnoses including schizophrenia,bipolar disorder, unipolar depression, schizoaectivedisorder, and personality disorder (Koening & Larson,2001), 60% reported that religion/spirituality, including transpersonal belies, had a signicant positive impacton their illness.Tus, there is growing recognition that spirit-uality represents a central actor in individuals’ lives ando the need to take it into consideration in mental healthinterventions. It is, however, as yet unclear how this
International Journal of Transpersonal Studies 
sensitivity to the spiritual domain might be implementedand what might constitute a ull acknowledgement o thisdimension in individual psychotherapy (see discussionsby Corbett & Stein, 2005; Elkins, 2005; Epstein, 1995;Germer, Siegal, & Fulton, 2005; Luko & Lu, 2005;Miller, 1999; Sharanske & Sperry, 2005; Welwood,1985, 2002).In this paper we present a conceptual discussion o the possible ways by which spirituality might be (and hasbeen) incorporated in mental health interventions. Wesuggest a developmental approach involving various levelso integrating spirituality into mental health practice.Successive levels denote a more comprehensive and perhapsadvanced stage in the introduction o spirituality into thesphere o mental health. Te various levels’ representationo increased spiritual understanding and use o relevantconcepts and techniques in therapy may also be seen torefect parallel shits in attitude and practice evident inthe world o psychology. Tey also mirror gradual shitsin the way clinicians perceive themselves as helpers andthe nature o the service they provide their clients.We have identied our such levels o spirituality integration, which can be briefy described as ollows:(a) Dissonance: Te clinician maintains their traditionalmaterialist position but senses dissonance between itsimplications and the needs o clients in certain extremesituations; (b) Opening up: Te clinician acknowledgesthe validity o diverse world views, including theexistence o a transcendent or transpersonal reality,and passively accepts and responds to clients’ spiritualmaterial; (c) Contact with caution: Te clinician actively acquires knowledge about the “sel in treatment”through various spiritual channels, or example, accessing altered states o consciousness; (d) Engaged: Te clinicianis able to ully integrate and implement transpersonalinterventions to promote health and empower clients.Each o these levels is related to ontological andepistemological shits and also involves various ethicaldilemmas as to the nature and purpose o interventionand the techniques used, as well as the nature o therelationship between clinician and client change.
ne reason or the neglect o the spiritual dimensionby mental health proessionals has to do with the19
century positivist worldview regarding the material world as the only existing world. Within this paradigmthere was no room or the metaphysical. Te soul wasbasically seen as derived rom the physical body or, withina dualistic approach, as separate but dependent on thebody; when the body dies, everything (mental world,soul) ceases to exist. Spiritual experiences and belies were mostly seen as refecting anomalous activity o the mind or brain, or as a sort o delusional belie. Inthe rst case (anomalous mind or brain activity), theseexperiences or belies (e.g., talking to someone whodoes not exist in material reality) might have been seenas refecting disease or drug abuse. In the second case(delusional thinking), well unctioning individuals whobelieve in the existence o a metaphysical, transcendental world were oten seen as deranged, irrational, or as lying to themselves in this specic domain. Such illogicalbelies were attributed to a ear o death and diculty to accept the “truth” that we completely cease to existonce we die. Alternatively, when such ideas were part o a recognized religious belie system, their validity wasneither contested nor accepted; they were conceived tobe outside the domain o valid scientic knowledge:“Tere are things you know and there are things youbelieve in” (Mayseless, 2006). (Yet we note that clinicalinterventions within a religious ramework by priests,ministers, rabbis, or pastors did openly acknowledge anduse the spiritual and transpersonal dimensions all along,[Koening, McCullough, & Larson, 2001].)Interestingly, there were certain situationsin clinical practice that seemed to “allow” the use o patients’ spiritual belies in the existence o a higherpower and /or “another reality” without raising unduecriticism. Tese were conditions o existential crisisand lie threatening situations such as terminal illness,loss or grie, or contemplation o suicide. In such cases,issues related to meaning, higher purpose in lie, theexistence o a higher being, lie ater physical death, andother spiritual concerns are quite common. In the caseo suicide contemplation, or example, Birnbaum andBirnbaum (2005) identied central concerns regarding relationship with God (perceived as orgiving, punishing,guiding, or containing), belie in reincarnation, and lieater death.Such situations were open to diverse interven-tions based on patients’ spiritual belies or those oeredby therapists. Perception o a continuing relationship with a deceased person, a search or a higher purpose ormission in lie, and the concept o God or a higher powerand its relationship with the individual have long beenperceived as intuitive and integral parts o the therapeuticdiscourse in these particular situations. Te same goes orthe amous 12-step approach to addictions, which was
International Journal of Transpersonal Studies 
built upon acceptance o, and reliance on, a higher power(Miller, 1999).Te question is: Why? What is it in thesecircumstances that shields them rom practitionerresistance and condemnation o “irrational” spiritualbelies? Tere seem to be three relevant themes in suchlie threatening situations that allow clinicians to gobeyond their dominant materialist belies: (1) Tese casesare usually perceived as crises that demand individuals’ultimate inner resources o strength, including theirspiritual belies, which receive legitimacy in light o thecrisis; (2) Te human quest or hope in such situationscalls or solutions beyond human control and rationalperception; i practitioners adhered to their usual reality perception, no hope, solace or consolation would beorthcoming; (3) Compassion towards seriously ill ordying people relaxes practitioners’ judgmental criteria;individuals are given the privilege o observing their livesrom a transcendental-holistic perspective without having to worry about being seen as irrational.In sum, at this rst level, spiritual belies andconcerns are usually not evoked by the clinician butare acknowledged and allowed without criticism due toextreme situations. O course this delineation is highly prototypical and, hence, may not do justice to thefexibility with which many clinicians actually exhibit when spiritual issues are raised in therapy. Te point we are making is that at this level proessionals’ typicalontological assumptions (only the material exists; themental world dies when the body dies) and epistemologicalbelies (we cannot get inormation rom deceased people,higher beings, or a cosmic, universal wisdom) signicantly limit the therapeutic process. Teir infuence may be allthe more powerul and insidious since they are otennot openly acknowledged or stated, yet they are likely to aect both style and content o therapy (e.g., what isconsidered relevant and solicited in the evaluation and what is not, what receives attention or emphasis and whatis downplayed or ignored, what is merely “allowed” and what is reinorced), thus coloring interpretations given,interventions oered, and the entire encounter.Some relevant questions and dilemmas relating to this level might include: Should clinicians accept “non-scientic phenomena” as legitimate? Should they honorsuch concerns and worldviews even i they clearly do notshare them and actually think that they are antasticcreations o the imagination? For example, i a widow tellsa therapist about her conversations with her late husband whom she believes contacts her rom the “other side,should clinicians (as many do) interpret this as an internalconversation with her representation o her husband,or should they accept the possibility that the deceasedactually exists in another dimension and continue romthere to explore her possible relations with him in otherincarnations?
Opening Up
he second phase in the inclusion o spiritual acetsin mental health interventions involves a personalparadigm shit on the part o the clinician. In this stage,therapists can place spirituality and psychology side-by-side. Tis requires that they relinquish the positivismand empiricism characteristic o the previous stage inavor o a post-modern or existential-humanistic position(Capra, 1983; Lorimer, 1998; Ravindra, 2000). Fromsuch a post-positivist view, the clinician can questionthe validity o 19
century empirical science, realizing that there is no objective reality, only interpretations o realities. Hence, a client’s view o reality–his or her liestory or narrative–is what matters, and clinicians cannotand should not disqualiy it, just as they cannot andshould not convince a client who believes in God or in a certain religious tradition that this is simply a subjective,non-valid belie. According to this view, a spiritual ortranscendental reality can be accepted as a legitimate worldview to be explored in therapy i and when theclient raises such issues.I an existential-humanistic view is adopted,and especially i the assumptions o transpersonalpsychology are considered (Wilber, 1977), the paradigmshit involves entertaining the possibility that a spiritualsphere actually exists and may be explored. A clinicianat this level would assert that i spiritual phenomena orbelies have any infuence on the mental and physical world, there should be no obstacles in the way o assessing this infuence via accepted research methodologies(Mayseless, 2006). In line with this view is the largebody o research examining associations betweenspiritual activities such as meditation and varied physicaland mental states. Studies have described the impact o meditation on the nervous system, including changeso brain waves, changes o perception, improvemento emotional regulation, and more (Anand, China, &Singh, 1961; Brown & Engler, 1986; Davidson, Kabat-Zinn, & Schumacher, 2003; Kasamatsu & Harari, 1966;Lutz, Greschar, Rawlings, Ricard, & Davidson, 2004).Scientic inquiry into the relationship betweenspiritual, mental, and physical aspects o reality hastaken many other orms. For example, Sabom (1982) and

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