Understanding Spirituality in Spiritually Integrated Psychotherapy

Understanding Spirituality in Spiritually Integrated

Psychotherapy

Kenneth I. PargamentDepartment of Psychology

Bowling Green State Universitykpargam@bgnet.bgsu.edu

Presented atSamaritan Annual Conference

Spiritually Integrated PsychotherapyDenver, Colorado

August 8, 2009

Cindy Videoclips

Reductionism

Freud – religion as a means of anxiety reduction Durkheim – religion as a source of social solidarity Geertz – religion as a source of meaning Kirkpatrick – religion as an evolutionary by-

product

Searching for the Sacred at an Early Age

“Dear God,

How is it in heaven? How is it being the Big Cheese?”

Young Child (Heller, 1986, p. 31)

Children as Spiritual Beings

The capacity for spiritual experience and knowledge

The capacity to think about God as unique rather than humanlike

The capacity to conceive of an immaterial spirit and an afterlife

The capacity to experience spiritual emotions

A Definition of Spirituality

Spirituality is a search for the sacred.

Sacred Core

GodTranscendent

Reality

Divine

Sacred Core

Sacred Ring

GodTranscendent

Reality

Divine

Marriage

Soul

Time

Meaning

Nature

Children

Place

Sacred Qualities

Transcendence [There is an] ‘otherness’ [to religious experience. It is]

‘wholly other. . . quite beyond the sphere of the usual, the intelligible and the familiar, which therefore falls quite outside the limits of the canny” (p. 26).

Sacred Qualities Transcendence

Boundlessness “To see a World in a grain of Sand; And Heaven in a

Wild Flower; Hold Infinity in the palm of your hand; And Eternity in an Hour” (William Blake)

Sacred Qualities Transcendence Boundlessness

Ultimacy

Nature as a Sacred Resource(Ahmadi, 2006)

o “Whatever happens in the world to me or others, nature is still there, it keeps going. That is a feeling of security when everything else is chaos. The leaves fall off, new ones appear, somewhere there is a pulse that keeps going. The silence, it has become so apparent, when you want to get away from all the noise. It is a spiritual feeling, if we an use that word without connecting it to God, this is what I feel in nature and it’s like a powerful therapy” (p. 134).

Nature as a Sacred Resource(Ahmadi, 2006)

o “Whatever happens in the world to me or others, nature is still there, it keeps going. That is a feeling of security when everything else is chaos. The leaves fall off, new ones appear, somewhere there is a pulse that keeps going. The silence, it has become so apparent, when you want to get away from all the noise. It is a spiritual feeling, if we an use that word without connecting it to God, this is what I feel in nature and it’s like a powerful therapy” (p. 134).

Sacred Aspects of Life Psychological attributes (e.g., virtues, meaning)

“The things that come from God are the highest things that we look for in life; peace and joy and love and beauty and health and vitality and strength and wisdom and creativity and abundance and the whole cookie factory. . . God gives these resources to us like the sun gives light” (interviewee).

Sacred Aspects of Life

Psychological attributes (e.g., virtues, meaning) Cultural products (e.g., music, literature) “We have so much misery and suffering here.

So much difficulties and pain. But soccer is our gift from God. Our healing grace so that we Brazilians can go on” (Rev. Filiho, Washington Post)

Sacred Aspects of Life Psychological attributes (e.g., virtues, meaning) Cultural products (e.g., music, literature)

People (e.g., saints, cult leaders)

Manifestations of God in People

“God has a deep raspy voice – God is a jazz singer. She is plush, warm, and rosy – God is a grandmother. He has the patient rock of an old man in a porch rocker; He hums and laughs, he marvels at the sky. God coos at babies – she is a new mother. He is the steady, gentle hand of a nurse, the cool reassurance of a person pursuing his life’s work, and the free spirit of a young man wandering only to live and love life” (McCarthy, 2006).

Perceptions of Sacredness: Results of a National Survey

“I see evidence of God in nature and creation” (78%)

“I see God’s presence in all of life” (75%) “I sense that my spirit is part of God’s spirit”

(68%) “I experience something more sacred in life than

simply material existence” (76%) “I see my life as a sacred journey” (55%)

The Search for the Sacred

Socio-Cultural Context

Discovery

A Direct Encounter with the Divine One night, in the middle of one of my depressions, I heard

a voice I’d never heard before, and haven’t heard since. The voice said, ‘I love you, Parker.’ This was not a psychological phenomenon, because my psyche was crushed. It was ‘the numinous.’ It was ‘mysterium tremendum.’ But it came to me in the simplest and most human way: ‘I love you, Parker.’ That rare experience taught me that the sacred is everywhere, that there is nothing that is not sacred, therefore worthy of respect. (Palmer, 1998, p. 26)

Encountering the Sacred Indirectlyo “You really want to know who raised me? It was a peppertree

with a short trunk. . . It had a great nest inside that was like a womb. . . You could sit in that womblike space and look out at the world without the world seeing you. . . I felt safe and loved and protected in that tree. It was my link with God/creation – with what was stable and real. . . that tree was a sacred presence in my life, and it taught me more about God and love than I ever learned in all the years I went to Sunday school” (Anderson & Hopkins, 1991, pp. 35, 37).

The Sacred as a Product of Internal and External Forces

“One half of ‘God’s stuffing,’ comes from the primary objects the child has ‘found’ in his life. The other half of God’s stuffing comes from the child’s capacity to ‘create’ a God according to his needs” (Rizzuto, 1979,p. 179).

The Sacred and its Implications

The sacred as magnetThe sacred as reservoirThe sacred as emotional generatorThe sacred as guiding light

The Sacred as an Organizing Force

“ If the foot shall say, Because I am not the hand, I am not of the body; it is therefore not of the body? If the whole body were an eye, where were the hearing? If the whole were hearing, where were the smelling? . . . But now are they many members, yet but one body. And the eye cannot say unto the hand, I have no need of thee, nor again the head to the feet, I have no need of you. Nay, much more those members of the body, which seem to be more feeble, are necessary” (I Corinthians 12: 15, 17, 20-22).

The Search for the Sacred

Socio-Cultural Context

Discovery Conservation

Spiritual Pathways

Ways of Knowing (Bible study, science) Ways of Acting (ritual, quilting)

Nontraditional Way of Acting

“By simple definition, quilting is merely sewing pieces of fabric together into a whole. But as spiritual discipline, it is a careful attention to the details of my life. Quilting as spiritual discipline is entering the sensual richness of the universe, creating order out of chaos, beauty out of the simple, wholeness from the scraps, and in the midst, being transformed” (Bushbaum, 1999, p. 236).

Spiritual Pathways

Ways of Knowing (Bible study, science) Ways of Acting (ritual, quilting) Ways of Relating (shared worship, loving

relations)

Love as a Way of Relating

“Love releases us into the realm of divine imagination, where the soul is expanded and reminded of its unearthly cravings and needs” (Thomas Moore, 1992, p. 81).

Spiritual Pathways

Ways of Knowing (Bible study, science) Ways of Acting (ritual, quilting) Ways of Relating (shared worship, loving

relations) Ways of Experiencing (prayer, meditation)

The Search for the Sacred

Socio-Cultural Context

Discovery Conservation

Conservational

SpiritualCoping

Threat,Violation,

andLoss

9/11 as a Desecration Students in Ohio and New York City coping with 9/11 About 50% agreed that attacks were “An offense against both me

and God.” About 30% agreed that “Something sacred that came from God was

dishonored.” Perceptions of desecration are linked to:

Emotional distress Anxiety Depression PTSD Poorer physical health Extremist reactions and desire for vengeance

Ways of Spiritual Coping

Benevolent Spiritual ReappraisalSeeking Spiritual SupportSeeking Support from Clergy/Congregation MembersSpiritual HelpingSpiritual Purification

Benevolent Spiritual Reframing

Child either positively reframes a situation or God’s response to a situation by imbuing religious/spiritual meaning or significance.

“God allows me to have this illness so I can be challenged more in this life. I will be more happy because I am more fulfilled. Having to cope with Cystic Fibrosis will allow me to progress further in my next life.”

Ano and Vasconcelles Meta-Analysis(2004, Journal of Clinical Psychology)

Number of Studies Cumulative Confidence

Effect Size Interval

Positive Religious

Coping with Positive 29 .33* .30 to .35

Health Outcomes

Positive Religious

Coping with Negative 38 -.12* -.14 to -.10

Health Outcomes

The Search for the Sacred

Socio-Cultural Context

Discovery Conservation

Conservational

SpiritualCoping

SpiritualStruggle

SpiritualDisengagem

ent

Threat,Violation,

andLoss

Transformational

SpiritualCoping

Dangers of Religious and Spiritual Life

Don’t let worry kill you -- let the church help

Thursday night -- Potluck supper. Prayer and medication to follow

At the evening service tonight, the sermon topic will be “What is Hell?” Come early and listen to our choir practice.

Three Types of Spiritual Struggle

Interpersonal Intrapersonal Divine

Interpersonal Spiritual Struggles Negative interactions among congregation members:

Gossiping Cliquishness Hypocrisy Disagreements with doctrine

“They get off in a corner and talk about you and you’re the one that’s there on Saturday working with their children and washing the dishes on Sunday afternoon. They don’t have the Christian spirit” (Krause et al., 2000).

Intrapersonal Spiritual Struggles

“Is Christianity a big sham, a cult? If an organization were to evolve in society, it would have to excite people emotionally, it would have to be self-perpetuation, it would need a source of income, etc. Christianity fits all of these. How do I know that I haven’t been sucked into a giant perpetual motion machine” (Kooistra, 1990, p. 95)?

Struggles with the Divine

“Many times I wonder how there can be a God – a loving God and where he is . . . I don’t understand why He lets little children in Third World countries die of starvation and diseases. . . I believe in God and I love Him, but sometimes I just don’t see the connection between a loving God and a suffering hurting world. Why doesn’t He help us -- if He truly loves us? It seems like He just doesn’t care. Does He?” (Kooistra, 1990).

An Illustration of Spiritual Struggle

“I am told God lives in me – and yet the reality of darkness and coldness and emptiness is so great that nothing touches my soul.”

Spirituality and Health Study Participants

1629 participantsAge: Mean = 49.1 years, SD = 17.7675.3% Christian56.2% 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”

Spirituality and Health Study Measures

Mental Health: Symptom Assessment-45 Questionnaire (Davison, Bershadsky, Bieber, Silversmith, Maruish, & Kane, 1997)

AnxietyDepressionHostilityInterpersonal 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-CompulsiveParanoid IdeationPhobic AnxietySomatization

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 individuals1,895 completed the survey (22% response rate)266 surveys excluded due to missing data

Spirituality and Health Study

Statistical AnalysesRegression

Criterion measures: SA-45 subscalesModel 1: Age, gender, education, ethnicity, income, marital

status, frequency of prayer, frequency of church attendance, social support, occurrence of personal illness/injury

Model 2: Religious struggleModel 3: Interaction of religious struggle and personal

illness/injury

Spirituality and Health Study

SummaryReligious struggle positively associated with

various forms of psychopathologyRelationship between religious struggle and

psychopathology stronger for individuals with recent illness or injury

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

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

Specific Religious Struggle Predictors of Mortality

“Wondered whether God had abandoned me” (RR = 1.28)

“Questioned God’s love for me” (R = 1.22) “Decided the devil made this happen” (R =

1.19)

The Transformation of the Sacred

Rites of passageRevisioning the sacredConversion

*Admitting the limitations of the self:*Incorporating the sacred into the life of the self

Prelude to Conversion “I’m sitting there on the table, and they were

taking pictures of all the marks and bruises, and I was waiting to hear whether or not my skull was fractured. They had just told me that my eardrum was broken. . . I felt like I was going to faint, and I knew, sitting there on that table, that there had to be something different, there had to be a better way, there had to be more than this” (Pargament, 1997, p. 246).

Centering the Sacred My motivations and my whole sense of direction have

changed. My values changed. What I thought was important changed. I just completely shifted gears. It’s given me a sense of purpose and direction I never had before, and I’ve been searching different avenues but never found exactly what I was supposed to be doing. I’ve tried a lot of different things, a lot of different jobs, traveled a lot, had lots of experiences in my life. Yet always there was that kind of restless searching, searching. Now I feel like I know exactly what I’m supposed to do. (Miller & C’de Baca, p. 130)

Spiritual Disengagement

“How could you in all your greatness have abandoned me, a little girl, to the merciless hands of my father? How could you let this happen to me? I demand to know why this happened? Why didn’t you protect me? I have been faithful, and for what, to be raped and abused by my own father? I hate and despise you. I regret the first time I ever laid eyes on you; your name is like salt on my tongue. I vomit it from my being. I wish death upon you. You are no more. You are dead” (Flaherty, 1992, p. 101).

Decline

Growth

Socio-Cultural Context

Discovery ConservationConservational

SpiritualCoping

SpiritualStruggle

SpiritualDisengagement

Threat,Violation,

andLoss

TransformationalSpiritualCoping

Integration

Disintegration

Dis-integration in Sacred Destinations

Problems of small gods

Small Gods

The Grand Old Man The God of Absolute Perfection The Heavenly Bosom The Resident Policeman The Distant Star The God in Retirement

Dis-integration in Sacred Destinations

Problems of small gods False gods

Spiritual Struggle as a Predictor of Addiction

(Caprini, 2007) 90 freshmen complete measures of addiction and spiritual

struggles at three points in time over first year of college After controlling for neuroticism, social support, and

global religiousness, spiritual struggles predict greater likelihood of developing 11 of 15 types of addictive behaviors, including Gambling Food starving Prescription and recreational drugs Sex

Alcohol as a False God “As my alcoholism progressed, my thirst for God

increasingly became transmuted into a thirst for the seemingly godlike experiences that alcohol induced. Alcohol gave me a sense of well-being and connectedness – and wasn’t that an experience of God? Alcohol released me from the nagging sense that I was never good or competent enough – and wasn’t that God’s grace? Alcohol dissolved my worries about the future, allowing me to live in the present – and wasn’t that a divine gift? At my core there was a thirst, a thirst for whatever would fill the emptiness” (Nelson, 2004, p. 31).

Dis-integration in Sacred Destinations

Problems of small gods False gods Internal sacred clashes

Ambivalence toward the sacredSelf-degradationDemonization of self and others

Dis-Integration in Sacred Pathways

Problems of Breadth and Depth

Miles Wide and Inches Deep

“Spirituality in the United States may be three thousand miles wide, but it remains only three inches deep” (George Gallup, 1999, p. 45).

“ Even though nine out of ten adults have a copy of the Bible in their homes, only 35% of this largely Christian population knows who delivered the Sermon on the Mount and only 40% know what the Trinity is. “

Dis-Integration in Sacred Pathways

Problems of Breadth and Depth Problems of Fit

Spiritual Extremism Problems of Fit between Spiritual Pathways and

Situations Problems of Fit between the Individual and Social

Context

Spiritual Extremism“Several years ago, I came across a disturbing account of a man who had murdered his wife, three children, and mother for ostensibly religious reasons. With [my daughter] being so determined to get into acting I was also fearful as to what that might do to her continuing to be a Christian. . .Also, with [my wife] not going to church I knew that this would harm the children eventually . . . At least I’m certain that all have gone to heaven now. If things had gone on who knows if this would be the case. . . It may seem cowardly to have always shot them from behind, but I didn’t want any of them to know even at the last second that I had to do this. . .I’m only concerned with making my peace with God and of this I am assured because of Christ dying even for me (“Memorandum . . .” 1990, p. 25).

Dis-Integration in Sacred Pathways

Problems of Breadth and Depth Problems of Fit

Spiritual Extremism Problems of Fit between Spiritual Pathways and

Situations Problems of Fit between the Individual and Social

Context

Dis-Integration in Sacred Pathways

Problems of Breadth and Depth Problems of Fit

Spiritual Extremism Lack of Fit between Spiritual Pathways and

Situations Lack of Fit between Individual and Social Context

Problems of Continuity and Change

Spiritual Struggle at Two Times

CHRONIC (High Struggle at Baseline and High Struggle at Follow Up)

ACUTE (Low Struggle at Baseline and High Struggle at Follow Up)

ACUTE (High Struggle at Baseline and Low Struggle at Follow Up)

NONE (Low Struggle at Baseline and Low Struggle at Follow Up)

Integrated vs. Dis-Integrated SpiritualityThe effectiveness of the search for the sacred lies not in a specific belief, practice, emotion, or relationship, but in the degree to which the individual’s spiritual pathways and destinations are well-integrated, working together in synchrony with each other. At its best, spirituality is defined by pathways that are broad and deep, responsive to life’s situations, nurtured by the larger social context, capable of flexibility and continuity, and oriented toward a sacred destination that is large enough to encompass the full range of human potential and luminous enough to provide the individual with a powerful guiding vision. At its worst, spirituality is defined by pathways that lack scope and depth, fail to meet the challenges and demands of life events, clash and collide with the surrounding social system, change and shift too easily or not at all, and misdirect the individual in the pursuit of spiritual value (Pargament, in press).